Resumo

MBUTHO, M M T  e  COETZEE, M. Mortality rate of infants with gastroschisis and healthcare-associated infections admitted in the neonatal and paediatric intensive care units in a tertiary hospital in Tshwane district, South Africa. S. Afr. j. child health [online]. 2025, vol.19, n.4, pp.144-148. ISSN 1999-7671.  https://doi.org/10.7196/SAJCH.2025.v19i4.3814.

BACKGROUND. Gastroschisis is associated with significant morbidity and mortality in neonates. Healthcare-associated infections (HAIs) worsen outcomes, with a high mortality, and timely management is crucial for survival. In South Africa, data regarding mortality and HAI management in neonates with gastroschisis are limited. OBJECTIVES. To evaluate the incidence of mortality and factors associated with mortality in neonates with gastroschisis admitted in the intensive care unit (ICU) and treated for HAI. METHODS. A retrospective study was conducted from July 2017 to October 2023. Eligible infants were identified using intensive care admission registers and the neonatal database. Patient demographics, treatment modalities, and outcomes, including mortality, were analysed. The Score for Neonatal Acute Physiology II (SNAP-II) severity was calculated retrospectively. RESULTS. A total of 66 neonates with gastroschisis and HAI that were admitted in the intensive care units were included in this study. Three neonates were managed for HAI twice, resulting in 69 HAI episodes. The incidence of culture-positive HAI was 77.9%, with a mortality of 84.8% per included neonate. Approximately half of the positive bacterial cultures with sensitivity testing were resistant to at least three classes of antimicrobial drugs. A SNAP-II score >30 was associated with higher mortality (p=0.038). Inotropic support was required in 76.8% of cases, correlating with higher mortality (p<0.001). CONCLUSION. HAI remains a major cause of mortality in neonates with gastroschisis. Higher SNAP-II scores and inotropic support were associated with poor outcome. The high incidence of multidrug-resistant pathogens highlights the need for tailored antimicrobial strategies. Further research is needed to improve survival rates in this high-risk populations.

Palavras-chave : gastroschisis; neonate; healthcare-associated infection; outcome; mortality.

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