Section of Pediatric Surgery, Riley Hospital for Children, 705 Riley Hospital Drive RI2500, Indianapolis, IN 46202, USA.
Moi Teaching and Referral Hospital, P.O. Box 3-30100, Nandi Road, Uasin Gishu County, Eldoret, Kenya; Central and Southern Africa (COSECSA), College of Surgeons of East, 157 Olorien, Nijro Road ECSA HC, P.O. Box 1009, Arusha, Tanzania.
J Pediatr Surg. 2022 Aug;57(8):1664-1670. doi: 10.1016/j.jpedsurg.2021.09.041. Epub 2021 Oct 10.
Gastroschisis is a common birth defect with < 5% mortality in high income countries, but mortality in sub Saharan Africa remains high. We sought to compare gastroschisis management strategies and patient outcomes at tertiary pediatric referral centers in the United States and Kenya.
This retrospective chart review examined uncomplicated gastroschisis patients treated at Riley Hospital for Children in Indianapolis, USA (n = 110), and Shoe4Africa Children's Hospital in Eldoret, Kenya (n = 75), from 2010 to 2018. Analyzed were completed using Chi square, Fisher's exact, and independent samples t tests and medians tests at the 95% significance level.
Survival in the American cohort was double that of the Kenyan cohort (99.1% vs 45.3%, p< 0.001). Sterile bag use for bowel containment was lower in Kenya (81.3% vs 98.1%, p< 0.001), but silo use was comparable at both institutions (p = 0.811). Kenyan patients had earlier median enteral feeding initiation (4vs 10 days, p< 0.001) and accelerated achievement of full enteral feeding (10vs 23 days, p< 0.001), but none received TPN. Despite earlier feeding, Kenyan patients displayed a higher prevalence of wound infections (70.8% vs 17.1%, p< 0.001) and sepsis (43.9% vs 4.8%, p< 0.001). In Kenya, survivors and non survivors displayed no difference in sterile bag use, hemodynamic stability, all cause infection rates, or antibiotic free hospital days. Defect closure (p< 0.001) and enteral feeding initiation (p< 0.001) were most predictive of survival.
Improving immediate response strategies for gastroschisis in Kenya could improve survival and decrease infection rates. Care strategies in the US can center on earlier enteral feeding initiation to reduce time to full feeding.
Level III.
先天性腹裂是一种常见的出生缺陷，在高收入国家的死亡率<5%，但在撒哈拉以南非洲，死亡率仍然很高。我们旨在比较美国和肯尼亚的三级儿科转诊中心在治疗先天性腹裂的管理策略和患者结局方面的差异。
这项回顾性图表研究纳入了 2010 年至 2018 年期间，在美国印第安纳波利斯 Riley 儿童医院（美国）（n=110）和肯尼亚埃尔多雷特的 Shoe4Africa 儿童医院（肯尼亚）（n=75）接受治疗的单纯性先天性腹裂患者。分析采用卡方检验、Fisher 确切检验和独立样本 t 检验，以 95%置信水平进行中位数检验。
美国组的存活率是肯尼亚组的两倍（99.1% vs 45.3%，p<0.001）。肯尼亚组使用无菌袋进行肠道封闭的比例较低（81.3% vs 98.1%，p<0.001），但在两个机构使用肠造口术的比例相似（p=0.811）。肯尼亚患者开始肠内喂养的中位时间更早（4 天 vs 10 天，p<0.001），达到全肠内喂养的时间更快（10 天 vs 23 天，p<0.001），但均未接受 TPN。尽管喂养时间更早，但肯尼亚患者的伤口感染发生率更高（70.8% vs 17.1%，p<0.001）和败血症发生率更高（43.9% vs 4.8%，p<0.001）。在肯尼亚，存活者和非存活者在无菌袋使用、血流动力学稳定性、总感染率或无抗生素住院天数方面没有差异。缺陷闭合（p<0.001）和肠内喂养开始（p<0.001）是预测存活率的最主要因素。
改善肯尼亚先天性腹裂的即时应对策略可能会提高存活率并降低感染率。美国的护理策略可以侧重于更早地开始肠内喂养，以减少达到全喂养的时间。
III 级。
