Uncomplicated gastroschisis care in the US and Kenya: Treatment at two tertiary care centers.

• Survivability of uncomplicated gastroschisis at two tertiary hospitals was 99.1% in the US and 45.3% in Kenya. • Decreased survival may be from increased bowel exposure to the environment, limited TPN access, and higher rates of infection and sepsis. • Future strategies include improving bowel coverage, patient transport, and access to TPN • Patients in the US can benefit from sutureless closure and early feeding intervention. 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 of evidence: Level III. [ABSTRACT FROM AUTHOR]