Highlights
- •What is currently known about this topic?
Congenital anomalies that require surgery are highly lethal in low-resource settings.
- 2.What new information is contained in this article?
Survival improved for gastroschisis and esophageal atresia since previous reports.
Measuring weight and electrolytes regularly allows quantification of the malnutrition
and frequent electrolyte derangements in these children, which should prompt more
frequent testing and treatment of abnormalities in similar settings.
Summary
Introduction
Congenital anomalies necessitating prolonged fasting have a high mortality in low-income
settings, partially due to malnutrition and electrolyte disturbances in the absence
of parenteral nutrition (PN). Interventions to address these problems require an accurate
baseline quantification of the morbidity and mortality of this population. This prospective
study aimed to determine peri-operative morbidity, fluid and electrolyte disturbance,
growth, and mortality in neonates with gastroschisis (GS), intestinal atresia (IA),
and esophageal atresia (EA) in Uganda.
Methods
Standardized patient care of 45 neonates treated in Uganda from Oct 2021 to March
2022 with protocolized fluid and nutrition, vital signs, and routine laboratory measurements.
Patient demographics, admission and hospital characteristics are described with mean
+/-SD. Characteristics of survivors and non-survivors were compared with Fischer’s
exact tests, logrank tests, and CoX Ph model.
Results
Twenty-eight (62.2%) patients had GS, 4 (8.9%) EA, and 13 (28.9%) IA. Thirty-six percent
(16/44) of patients survived to discharge (26% GS, 50% EA, 54% IA) with an average
length of stay of 17.3 days (+/- 2.2) (survivors) and 9 days (+/- 1.7) (non-survivors).
Average weight was 2.21 kg (+/- 0.62) at presentation, with no significant weight
change during the study. Abnormal serum sodium in 64%, phosphate 36.5%, and magnesium
20.8% of measurements. Mortality did not correlate with diagnosis (p=0.47), electrolyte
derangement, or weight change.
Conclusion
Mortality of neonates born with GS, EA, and IA is high in Uganda. Malnutrition and
fluid/electrolyte derangements are common and may affect mortality. This study provides
a comparison group for studying interventions to improve outcomes for these populations.
Keywords
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Article info
Publication history
Accepted:
January 3,
2023
Received:
January 2,
2023
Publication stage
In Press Accepted ManuscriptIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
