Predicting mortality in neonates with gastroschisis in a Southeastern state of Brazil

Muniz, Virginia Maria; Lima Netto, Antônio; Carvalho, Katia Souza; Valle, Claudia Saleme do; Martins, Cleodice Alves; Salaroli, Luciane Bresciani; Zandonade, Eliana

doi:10.1590/1806-9282.20221116

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Revista da Associação Médica Brasileira

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Original Article • Rev. Assoc. Med. Bras. 69 (2) • 2023 • https://doi.org/10.1590/1806-9282.20221116 copy

Predicting mortality in neonates with gastroschisis in a Southeastern state of Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

This study aimed to verify risk factors associated with gastroschisis mortality in three neonatal intensive care units located in the state of Espírito Santo, Brazil.

METHODS:

A retrospective cohort study of neonates with gastroschisis was performed between 2000 and 2018. Prenatal, perinatal, and postsurgical variables of survival or nonsurvival groups were compared using chi-square statistical test, t-test, Mann-Whitney U test, and logistic regression. Tests with p<0.05 were considered statistically determined.

RESULTS:

A total of 142 newborns were investigated. Mean maternal age, gestational age, and birth weight were lower in the group of nonsurvival (p<0.05). Poor clinical conditions during admission, complex gastroschisis, closure with silo placement, the use of blood products, surgical complications, and short bowel syndrome were more frequent in the nonsurvival group (p<0.05). Complex gastroschisis [adjusted odds ratio (OR) 3.74, 95% confidence interval (95%CI) 1.274–11.019] and short bowel syndrome (adjusted OR 7.55, 95%CI 2.177–26.225) increased the risk of death. Higher birth weight inversely reduced the risk for mortality (adjusted OR 0.99, 95%CI 0.997–1.000).

CONCLUSION:

Complex gastroschisis and short bowel syndrome increased the risk of death, with greater birth weight being inversely correlated with the risk of mortality. The findings of this research can contribute to the formulation of protocols to improve the quality and safety of care in order to reduce neonatal mortality associated with gastroschisis.

KEYWORDS:
Infant, newborn; Gastroschisis; Infant mortality; Congenital abnormalities; Risk factors

Variables	Category	Survival N=94	Nonsurvival N=48	Total N=142	P-value
Variables	Category	N (%)	N (%)	Total	P-value
Admission hospital	NICU A	53 (56.4)	21 (43.8)	74 (52.1)	0.266^† † Chi-square test;
	NICU B	19 (20.2)	10 (20.8)	29 (20.4)
	NICU C	22 (23.4)	17 (35.4)	39 (27.5)
Maternal age (years) mean/SD		20 (±3.7)	18.5 (±4.0)	19.5 (±3.8)	0.040^‡ ‡ Student's t-test; ^* * P-value <0.05;
Antenatal consultations	≥6	45 (47.9)	22 (45.8)	67 (47.2)	0.818^† † Chi-square test;
Antenatal diagnosis	Yes	50 (53.2)	32 (66.7)	82 (57.7)	0.124^† † Chi-square test;
Route of birth	Cesarean section	57 (60.6)	33 (68.7)	90 (63.4)	0.343^† † Chi-square test;
Gender	Male	47 (50)	31 (64.6)	78 (54.9)	0.099^† † Chi-square test;
Gestational age (weeks) mean±SD		37.2 (±1.8)	35.8 (±2.4)	36.7 (±2.1)	0.001 ^‡ ‡ Student's t-test; ^ P-value <0.01; SD: standard deviation;
Birth weight (g) mean±SD		2.504 (±457)	2.188 (±467)	2.397 (±483)	0.000^‡ ‡ Student's t-test; ^ P-value <0.01; SD: standard deviation;
Apgar 1 mean±SD		7.4 (±1.4)	6.9 (±1.8)	7.2 (±1.5)	0.057^‡ ‡ Student's t-test;
Apgar 2 mean±SD		8.5 (±0.9)	8.5 (±1.1)	8.5 (±0.9)	0.833^‡ ‡ Student's t-test;
Birth-surgery time (h) median (IQR		3.0 (1–7)	2 (1–7)	3 (1–7)	0.455^§ § Mann-Whitney nonparametric test;
Birthplace	Inborn	39 (41.5)	24 (50)	63 (44.4)	0.334 †
Clinical conditions	Poor	20 (21.3)	21 (43.8)	41 (28.8)	0.005 ^† † Chi-square test; ^ P-value <0.01; SD: standard deviation;
Gastroschisis	Complex	28 (29.8)	35 (72.9)	63 (44.3)	0.001^† † Chi-square test; ^ P-value <0.01; SD: standard deviation;
Wall closure	Silo	17 (18.1)	23 (47.8)	40 (28.1)	0.001^† † Chi-square test; ^ P-value <0.01; SD: standard deviation;
Venous access	PICC	48 (51)	19 (39.6)	67 (47.2)	0.378^† † Chi-square test;
Vasoactive substances	Yes	60 (63.8)	38 (79.2)	98 (69)	0.062^† † Chi-square test;
Antibiotics	≥2 courses	71 (75.5)	36 (75)	107 (75.4)	0.945^† † Chi-square test;
Time on MV median (IQR)		6 (4–11)	8 (3–15)	6 (4–13)	0.456^§ § Mann-Whitney nonparametric test;
Time on TPN median (IQR)		22 (16–30)	16 (0.5–35.5)	21 (13–32)	0.007^§ § Mann-Whitney nonparametric test; ^ P-value <0.01; SD: standard deviation;
Sepsis	Yes	61 (64.9)	37 (77.1)	98 (69)	0.137^† † Chi-square test;
Blood products	Yes	66 (70.2)	42 (87.5)	108 (76.1)	0.022^† † Chi-square test; ^* * P-value <0.05;
Surgical complications	Yes	18 (19.1)	25 (52.1)	43 (30.2)	0.001^† † Chi-square test; ^ P-value <0.01; SD: standard deviation;
Short bowel syndrome	Yes	7 (7.4)	24 (50)	31 (21.8)	0.001^† † Chi-square test; ^ P-value <0.01; SD: standard deviation;
LOS median (IQR)		28.5 (19–44)	24 (2–52)	28 (18–44)	0.002^§ § Mann-Whitney nonparametric test; ^ P-value <0.01; SD: standard deviation;

Variable	Category	Crude OR (95%CI)	P-value	Adjusted odds ratio (aOR)^† (95%CI)	P-value
Maternal age (years)		0.901 (0.815–0.997)	0.043 ^* * P<0.05;	0.924 (0.811–1.054)	0.240
Antenatal diagnosis	Yes No	1.760 (0.853–3.631) 1	0.126	1.197 (0.423–3.387)	0.734
Birth weight (g)		0.998 (0.998–0.999)	0.001 ^ P<0.01.	0.998 (0.997–1.000)	0.027 ^ P<0.01.
Gestational age (weeks)		0.746 (0.624–0.891)	0.001 ^ P<0.01.	1.023 (0.745–1.330)	0.993
Gastroschisis	Complex Simple	6.346 (2.924–13.775) 1	0.001 ^ P<0.01.	3.747 (1.274–11.019)	0.016 ^* * P<0.05;
Wall closure	Silo Primary	4.341 (1.997–9.436) 1	0.001 ^ P<0.01.	2.656 (0.888–7.945)	0.080
Surgical complications	Yes No	4.589 (2.136–9.859) 1	0.001 ^ P<0.01.	2.489 (0.822–7.536)	0.107
Vasoactive substances	Yes No	2.153 (0.954–4.859) 1	0.065	0.990 (0.299–3.281)	0.987
Sepsis	Yes No	1.820 (0.822–4.031) 1	0.140	0.421 (0.111–1.604)	0.205
Blood products	Yes No	2.970 (1.134–7.778) 1	0.027 ^ P<0.01.	3.031 (0.578–15.875)	0.189
Short bowel syndrome	Yes No	12.429 (4.780–32.315) 1	0.001 ^ P<0.01.	7.556 (2.177–26.225)	0.001 ^ P<0.01.
Clinical conditions	Poor Good	2.878 (1.353–6.119) 1	0.006 ^ P<0.01.	2.052 (0.727–5.791)	0.174

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[1] *Corresponding author: lucianebresciani@gmail.com