Gastroschisis is a full thickness abdominal wall defect, usually to the right of the umbilicus, through which a variable amount of viscera herniates, without a covering membrane. Newborns with gastroschisis present challenging problems to paediatric surgeons. The incidence of gastroschisis is rising worldwide. In developed countries, advances in neonatal intensive care have improved survival of patients with gastroschisis. In the few reported studies from Africa, mortality rates of patients with gastroschisis are high. The aim of this study was to evaluate outcome of gastroschisis from a centre in Africa with modern neonatal intensive care facilities. Methods: A retrospective analysis of all neonates admitted with the diagnosis of gastroschisis at Inkosi Albert Luthuli Central Hospital (IALCH) over a 6-year period (2002-2007). Proportions in percentages were used for categorical variables. For continuous variables the mean with standard deviation (SD) were derived. Two sampled t-test was used to show the pvalue for the time to reduction between the non-survivors and survivors with a 95% confidence interval. Results: There was a significant increase in the prevalence of gastroschisis among neonatal surgical admissions from 6.2% in 2003 to 15.2% in 2007. There were more females 53.4%, the majority (71.7% had low birth weight and 64.2% were born prematurely. Although 75% (n=79) of the mothers attended antenatal clinic, antenatal diagnosis by ultrasound was made in only 13 (n=12%)). Most of the babies 90.6% were out-born, with 70.8% delivered by normal vaginal delivery (NVD), and 57.4% of the mothers were primiparous. Primary closure was achieved in 73.5% of the patients. The overall mean (SD) time from birth to primary surgical intervention was 16 (13.04) hours and was higher 17(9.1) hours in those who died compared to survivors 15 (16.0), but the difference was not statistically significant, p=0.4465 and mortality was 43% with sepsis as the leading cause. Staged closure with a plastic silo bag was associated with more than double the mortality as compared to primary closure. Conclusion: The prevalence of gastroschisis among neonatal surgical admissions has increased in accordance with international trends. Due to lack of antenatal diagnosis, most of the babies were out-born resulting into delay in offering surgical treatment. Mortality is still high despite the presence of modern intensive care. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2008.

Objetivos: Examinar a associação das relações entre o tamanho da onfalocele e parâmetros biométricos fetais, como a circunferência cefálica e abdominal, com mortalidade e morbidade pós natais. Métodos: Estudo retrospectivo envolvendo 48 gestações únicas com onfalocele fetal que apresentavam cariótipo normal e sem malformações graves. O diâmetro médio da onfalocele fetal obtido no primeiro exame ultrassonográfico foi estimado. A razão entre o diâmetro da onfalocele e a circunferência cefálica (DO/CC) ou circunferência abdominal (DO/CA) foi correlacionada com óbito pós-natal, necessidade de intubação no primeiro dia de vida, tempo de intubação oro-traqueal, cirurgia em dois tempos ou com uso de tela sintética, reoperação, tempo de nutrição parenteral, início da dieta oral e tempo de internação. Resultados: A razão DO/CA diminui com o decorrer da gestação e a razão DO/CC aumenta, mas ambos de forma não significativa. A razão DO/CA 0,263 é a que apresenta melhor desempenho para predição do óbito pós-natal, com sensibilidade de 72,7%, especificidade de 75,7%, valor preditivo positivo de 47,1% e valor preditivo negativo de 90,3%. Limitando-se a análise dos casos até 31 semanas observa-se melhora do desempenho da razão DO/CA 0,263, com sensibilidade de 100%, especificidade de 78,6%, valor preditivo positivo de 57,1% e valor preditivo negativo de 100%. A relação DO/CA 0,263 mostrou correlação com maior necessidade de intubação orotraqueal no primeiro dia de vida, introdução tardia da dieta oral e cirurgia em dois tempos ou com uso de tela sintética. Conclusão: Em onfalocele isolada ou associada à malformação menor, a razão DO/CA 0,263 foi o melhor parâmetro biométrico para predição de mortalidade e morbidade pós-natal / Objective: To examine the association of omphalocele size to fetal biometry parameters ratio with postnatal mortality and morbidity. Methods: Retrospective analysis of 48 singleton pregnancies with ultrasound diagnosis of fetal onfalocele with normal karyotype and no severe malformations associated. Fetal omphalocele mean diameter acquired in the first ultrasound examination was estimated. Omphalocele diameter to head circumference (OD/HC) and abdominal circumference (OD/AC) ratio was correlated to postnatal death, need for intubation in the first day of life, time of mechanical ventilation, two step surgery or use of mesh, reoperation, parenteral feeding, time to first oral feeding, first hospital discharge. Results: Although not significantly, OD/AC ratio decreases with gestational age and OD/HC ratio increases with gestational age. OD/AC ratio 0.263 presents the best performance to predict postnatal death with sensitivity (S) of 72.7%, especificity (E) of 75.7%, positive predictive value (PPV) of 47.1% and negative predictive value (NPV) of 90.3%. An improvement in the prediction of postnatal death was observed when analyzed OD/AC ratio 0.263 in gestational ages below 31 weeks with S = 100%, ES = 78.6%, PPV = 57.1% and NPV = 100%. A positive correlation between OD/AC ratio 0.263 and need for intubation in the first day of life, two step surgery or use of mesh and time to first oral feeding was observed. Conclusion: In isolated fetal omphalocele, or associated to minor malformation, OD/AC ratio 0.263 was the best biometric parameter to predict postnatal mortality and morbidity

Objetivos: Examinar a associação das relações entre o tamanho da onfalocele e parâmetros biométricos fetais, como a circunferência cefálica e abdominal, com mortalidade e morbidade pós natais. Métodos: Estudo retrospectivo envolvendo 48 gestações únicas com onfalocele fetal que apresentavam cariótipo normal e sem malformações graves. O diâmetro médio da onfalocele fetal obtido no primeiro exame ultrassonográfico foi estimado. A razão entre o diâmetro da onfalocele e a circunferência cefálica (DO/CC) ou circunferência abdominal (DO/CA) foi correlacionada com óbito pós-natal, necessidade de intubação no primeiro dia de vida, tempo de intubação oro-traqueal, cirurgia em dois tempos ou com uso de tela sintética, reoperação, tempo de nutrição parenteral, início da dieta oral e tempo de internação. Resultados: A razão DO/CA diminui com o decorrer da gestação e a razão DO/CC aumenta, mas ambos de forma não significativa. A razão DO/CA 0,263 é a que apresenta melhor desempenho para predição do óbito pós-natal, com sensibilidade de 72,7%, especificidade de 75,7%, valor preditivo positivo de 47,1% e valor preditivo negativo de 90,3%. Limitando-se a análise dos casos até 31 semanas observa-se melhora do desempenho da razão DO/CA 0,263, com sensibilidade de 100%, especificidade de 78,6%, valor preditivo positivo de 57,1% e valor preditivo negativo de 100%. A relação DO/CA 0,263 mostrou correlação com maior necessidade de intubação orotraqueal no primeiro dia de vida, introdução tardia da dieta oral e cirurgia em dois tempos ou com uso de tela sintética. Conclusão: Em onfalocele isolada ou associada à malformação menor, a razão DO/CA 0,263 foi o melhor parâmetro biométrico para predição de mortalidade e morbidade pós-natal / Objective: To examine the association of omphalocele size to fetal biometry parameters ratio with postnatal mortality and morbidity. Methods: Retrospective analysis of 48 singleton pregnancies with ultrasound diagnosis of fetal onfalocele with normal karyotype and no severe malformations associated. Fetal omphalocele mean diameter acquired in the first ultrasound examination was estimated. Omphalocele diameter to head circumference (OD/HC) and abdominal circumference (OD/AC) ratio was correlated to postnatal death, need for intubation in the first day of life, time of mechanical ventilation, two step surgery or use of mesh, reoperation, parenteral feeding, time to first oral feeding, first hospital discharge. Results: Although not significantly, OD/AC ratio decreases with gestational age and OD/HC ratio increases with gestational age. OD/AC ratio 0.263 presents the best performance to predict postnatal death with sensitivity (S) of 72.7%, especificity (E) of 75.7%, positive predictive value (PPV) of 47.1% and negative predictive value (NPV) of 90.3%. An improvement in the prediction of postnatal death was observed when analyzed OD/AC ratio 0.263 in gestational ages below 31 weeks with S = 100%, ES = 78.6%, PPV = 57.1% and NPV = 100%. A positive correlation between OD/AC ratio 0.263 and need for intubation in the first day of life, two step surgery or use of mesh and time to first oral feeding was observed. Conclusion: In isolated fetal omphalocele, or associated to minor malformation, OD/AC ratio 0.263 was the best biometric parameter to predict postnatal mortality and morbidity