Name: Virginia Maria Muniz
Type: PhD thesis
Publication date: 06/08/2021
Advisor:

Name Rolesort descending
Eliana Zandonade Advisor *
Luciane Bresciani Salaroli Co-advisor *

Examining board:

Name Rolesort descending
Eliana Zandonade Advisor *
Luciane Bresciani Salaroli Co advisor *
Gustavo Enrico Cabral Ruschi External Examiner *
Ana Daniela Izoton de Sadovsky External Examiner *
Luiz Carlos de Abreu Internal Examiner *
Edson Theodoro dos Santos Neto Internal Examiner *

Summary: Introduction: Gastroschisis is subject matter to several health care workers, due to controversies regarding its pathogenesis, temporal increase in prevalence, risk factors not yet fully understood and progress in treatment techniques. Objectives: To verify the health care profile and risk factors to mortality of newborns with gastroschisis admitid in three public hospitals in Vitória, Espírito Santo, Brazil. Methodology: Retrospective multicenter cohort study with gastroschisis patients admitted to neonatal intensive care unit of Hospital Estadual Infantil Nossa Senhora da Glória (HEINSG), Hospital Estadual Infantil e Maternidade Alzir Bernardino Alves (HEIMABA) and Hospital Estadual Dr. Jayme Santos Neves (HEJSN) in period between January 2000 and December 2018. Patients were compared by groups of born in a referral center or outside, and groups of deaths or survivors. Statistical tests were carried out and statistical significance was considered when p-value < 0.05. Results: A total of 144 newborns were investigated. The group of patients born outside reference centers had higher rates of absence of antenatal diagnosis (p = 0.001), vaginal delivery ( p = 0.001), longer time between delivery and abdominal wall closure surgery (p = 0.001), until silo removal (p = 0.001), until first enteral feeding (p = 0.008), to weaning from mechanical ventilation (p = 0.034), used less peripherally inserted central catheter (PICC) and had a lower mean of serum sodium (p = 0.015) when compared with group of neonates born in reference centers. The mean maternal age (p = 0.040), gestational age (p = 0.001) and birth weight (p = 0.000) were lower in group of deaths. Unfavorable clinical conditions during hospitalization (p = 0.005), complex gastroschisis (p = 0.001), abdominal wall closure with silo placement (p = 0.001), use of blood products (p = 0.022), surgical complications (p = 0.001) and short bowel syndrome were more frequent in group of deaths (p = 0.001). Complex gastroschisis (OR = 3.74; 95%CI = 1.274 -11.019) and short bowel syndrome adjusted (OR = 7.55; 95%CI = 2.177 – 26.225) increased risk of death. The increase of birth weight inversely reduced the risk for mortality adjusted (OR = 0.99; 95%CI = 0.997-1000). Conclusion: Although this result may suggest that not all neonates with gastroschisis should be born in a tertiary referral center, it should be noted that faster and more specialized transport is needed for patients born outside the referral centers, and beds are guaranteed in neonatal care reference units, with aim of reducing time between delivery and first surgical intervention. These findings can contribute to formulation of protocols to improve quality and safety of care to gastroschisis patients. In another sphere, it presents elements for management of public policies to reduce neonatal mortality by congenital anomalies that can be avoided by surgical treatment, such as gastroschisis.

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