Fatores associados ao óbito de bebês com gastrosquise: um estudo retrospectivo

Abstract

Gastroschisis is a congenital anomaly with an increasing incidence around the world. In addition, the mortality rate from this disease is higher in low and middle-income countries. The aim is to verify the factors associated with death in babies diagnosed with gastroschisis in a tertiary maternity hospital. This is a retrospective hospital-based cohort study carried out at the Assis Chateaubriand Maternity School (MEAC). The medical records of newborns with gastroschisis were analyzed and the inclusion criteria were: pregnancy with a live fetus with a gestational age > 24 weeks; prenatal diagnosis confirmed by the MEAC/UFC obstetrics team; diagnosis confirmed by the MEAC/UFC neonatology team and the MEAC/UFC pediatric surgery team. The variables were collected using REDCap and the statistical analyses were carried out using R software. This study was submitted to and approved by MEAC's Research Ethics Committee, under protocol number 7040683. It was observed that babies whose mothers came from the countryside were 4.2 times more likely to die, and that the babies who died had started prenatal care significantly earlier than the babies who survived. Babies with complex gastroschisis were 4.05 times more likely to die, and failure to perform primary closure in the first approach increased these chances by 7 times. In addition, the babies who died had spent significantly more days on invasive mechanical ventilation. For parenteral nutrition, admission to the Neonatal Intensive Care Unit and hospitalization, the time was significantly shorter, so that the longer the period, the lower the chances of death. The use of a peripherally inserted central catheter and the occurrence of metabolic acidosis were associated with death. Among the variables included in the multivariate logistic regression, the number of days using invasive mechanical ventilation showed a statistically significant association with the outcome of death. Thus, in view of the associations found, it can be seen that in addition to the early diagnosis of gastroschisis, it is necessary to improve the care provided to babies with gastroschisis in orderto reduce the number of deaths.