Mortality rate of infants with gastroschisis and healthcare-associated infections admitted in the neonatal and paediatric intensive care units in a tertiary hospital in Tshwane district, South Africa
Article Sidebar
Main Article Content
Abstract
Background. Gastroschisis is associated with significant morbidity and mortality in neonates. Healthcare-associated infections (HAIs) worsen outcomes, with a high mortality, and timely management is crucial for survival. In South Africa, data regarding mortality and HAI management in neonates with gastroschisis are limited.
Objectives. To evaluate the incidence of mortality and factors associated with mortality in neonates with gastroschisis admitted in the intensive care unit (ICU) and treated for HAI.
Methods. A retrospective study was conducted from July 2017 to October 2023. Eligible infants were identified using intensive care admission registers and the neonatal database. Patient demographics, treatment modalities, and outcomes, including mortality, were analysed. The Score for Neonatal Acute Physiology II (SNAP-II) severity was calculated retrospectively.
Results. A total of 66 neonates with gastroschisis and HAI that were admitted in the intensive care units were included in this study. Three neonates were managed for HAI twice, resulting in 69 HAI episodes. The incidence of culture-positive HAI was 77.9%, with a mortality of 84.8% per included neonate. Approximately half of the positive bacterial cultures with sensitivity testing were resistant to at least three classes of antimicrobial drugs. A SNAP-II score ≥30 was associated with higher mortality (p=0.038). Inotropic support was required in 76.8% of cases, correlating with higher mortality (p<0.001).
Conclusion. HAI remains a major cause of mortality in neonates with gastroschisis. Higher SNAP-II scores and inotropic support were associated with poor outcome. The high incidence of multidrug-resistant pathogens highlights the need for tailored antimicrobial strategies. Further research is needed to improve survival rates in this high-risk populations.
Article Details
Issue
Section
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The SAJCH is published under an Attribution-Non Commercial International Creative Commons Attribution (CC-BY-NC 4.0) License. Under this license, authors agree to make articles available to users, without permission or fees, for any lawful, non-commercial purpose. Users may read, copy, or re-use published content as long as the author and original place of publication are properly cited.
Exceptions to this license model is allowed for UKRI and research funded by organisations requiring that research be published open-access without embargo, under a CC-BY licence. As per the journals archiving policy, authors are permitted to self-archive the author-accepted manuscript (AAM) in a repository.
How to Cite
References
1. Vilela PC, Ramos De Amorim MM, Falbo GH, Santos LC. Risk factors for adverse outcome of newborns with gastroschisis in a Brazilian hospital. J Pediatr Surg 2001;36(4):559-564. https://doi.org/10.1053/jpsu.2001.22282
2. Williams SL, Leonard M, Hall ES, Perez J, Wessel J, Kingma PS. Evaluation of early onset sepsis, complete blood count and antibiotic use in gastroschisis. Am J Perinatol 2018;35(4):385-398. https://doi.org/10.1055/s-0037-1607420
3. Ramadan G, Rex D, Okoye B, Kennea NL. Early high C-reactive protein in infants with open abdominal wall defects does not predict sepsis or adverse outcome. Acta Paediatrica 2010;99:126-130. https://doi.org/10.1111/j.1651- 2227.2009.01501.x
4. Khalil B, Baath M, Baillie C, et al. Infections in gastroschisis: organisms and factors. Pediatric Surg Int 2008;24(9):1031-1035. https://doi.org/10.1007/s00383- 008-2210-0
5. Bigio JZD, Tannuri ACA, Falcão MC, Carvalho WBd, Matsushita FY. Gastroschisis and late-onset neonatal sepsis in a tertiary referral center in Southeastern Brazil. J de Pediatria 2022;98:168-174. https://doi.org/10.1016/j. jped.2021.05.003
6. Mills J, Lin Y, Macnab Y, Skarsgard E. Perinatal predictors of outcome in gastroschisis. J Perinatol 2010;30(12):809-813. https://doi.org/10.1038/jp.2010.43 7. Sundaram V, Dutta S, Ahluwalia J, Narang A. Score for neonatal acute physiology II predicts mortality and persistent organ dysfunction in neonates
with severe septicemia. Indian Pediatrics 2009;46(9):775-780.
8. Morse S, Groer M, Shelton MM, Maguire D, Ashmeade T. A systematic review: The utility of the revised version of the Score for Neonatal Acute Physiology among critically ill neonates. J Perinat Neonatal Nurs 2015;29(4):315-344.
https://doi.org/10.1097/JPN.0000000000000135
9. Gom S, Grieve A, Velaphi S. Characteristics and outcomes of neonates with gastroschisis managed in a public tertiary hospital in a developing country. S Afr J Child Health 2019;13(4):168-173. https://doi.org/10.7196/SAJCH.2019. v13i4.1588
10. Stevens P, Muller E, Becker P. Gastroschisis in a developing country: Poor resuscitation is a more significant predictor of mortality than postnatal transfer time. S Afr J Surg 2016;54(1):4-9.
11. Van Eck A. A retrospective review of the outcomes of gastroschisis at a tertiary hospital in Cape Town. Masters dissertation. Stellenbosch University; 2017. https://scholar.sun.ac.za/server/api/core/bitstreams/9ff31247-719a-4122- b1dd-26d9c0624880/content (accessed 19 October 2024).
12. Anyanwu LC, Ade-Ajayi N, Rolle U. Major abdominal wall defects in the low- and middle-income setting: current status and priorities. Pediatr Surg Int 2020;36(5):579-590. https://doi.org/10.1007/s00383-020-04638-8
13. Wright NJ, Langer M, Norman ICF, et al. Improving outcomes for neonates with gastroschisis in low-income and middle-income countries: A systematic review protocol. BMJ Pediatrics Open 2018;2:e000392. https://doi.org/10.1136/ bmjpo-2018-000392
14. Wesonga A, Situma M, Lakhoo K. Reducing gastroschisis mortality: A quality improvement initiative at a Ugandan pediatric surgery unit. World J Surg. 2020;44(5):1395-1399. https://doi.org/10.1007/s00268-020-05373-w
15. Oyinloye AO, Abubakar AM, Wabada S, Oyebanji LO. Challenges and outcome of management of gastroschisis at a tertiary institution in North- Eastern Nigeria. Front Surg 2020;7(8):1-5. https://doi.org/10.3389/ fsurg.2020.00008
16. Buthelezi PF, Naby F, Kannigan Y. Retrospective review of bacteriological profiles and antibiogram in a tertiary neonatal unit. Southern Afr J Infect Dis 2023;38(1). https://doi.org/10.4102/sajid.v38i1.537
17. Schmatz M, Srinivasan L, Grundmeier RW, et al. Surviving sepsis in a referral neonatal intensive care unit: Association between time to antibiotic administration and in-hospital outcomes. J Pediatr 2020;217:59-65e1. https:// doi.org/10.1016/j.jpeds.2019.08.023