Journal of Neonatal Biology

Gastroschisis in a Premature Infant in Papua New Guinea: Initial Treatment with a Normal Saline Bag Silo

International Conference and Expo on Neonatology & Perinatology - October 21, 2022 | Webinar

October 21, 2022 | Webinar

Jack Mulu

General Paediatric Surgeon, Papua New Guinea

Scientific Tracks Abstracts: J Neonatal Biol

Abstract:

Gastroschisis is one of the most common congenital abdominal wall defects, with an incidence of 4-5/10,000 new-borns worldwide. The management is challenging for paediatric surgeons and health care workers all over the world. There are several surgical options, from primary closure to staged closure using various kinds of silos. The prognosis has improved over the years in HICs with well set up hospitals where more than 95% survives. If surgical closure is not done within the first 6 hours post-partum impeding complications intervene. The tight 2.5 – 5 cm diameter defect near the right side of the umbilicus provides the avenue of the intra-abdominal contents to protrude into the amniotic cavity in intra-uterine life and the visceral exposure to the external environment increases the morbidity and mortality after delivery. In LMICs in resource limited settings the complications are inevitable. In the absence of NICU TPN, gastroschisis management is challenging. It adds on when prenatal diagnosis is absent as well as a manufactured silo to cover the herniated viscera. The inevitable complications such fluids and electrolyte shift, aspiration pneumonia, RIAP, NEC and infections are unavoidable. This is further confounded by the late presentation to the nearest hospital. The tedious and meticulous management of such cases in which complications were avoided and alternative routes in commencing early feedings were the hail marks in the survival of some of these challenging neonatal surgical emergency cases. Three papers have been published in such cases in 2003, 2015 and 2021. The following is a case of gastroschisis in a preterm and low birth weight infant managed by a 3-stage process, the first stage using a normal saline bag silo, and it provides lessons for surgery and for primary care. The survival of this neonate highlights some of the challenging skills that were done in which those who are in LMICs can learn from. Abbreviations: TPN (Total Parenteral Nutrition), NICU (Neonatal Intensive Care Unit), RIAP (Raised Intraabdominal Pressure), LMICs (Low and Middle Income Countries), HICs (High Income countries), NEC (Necrotising Enterocolitis), DIC (Disseminated Intravascular Coagulopathy). Keywords: Gastrochisis, silo, normal saline bag.

Biography :

Jack Mulu is General and Specialist consultant surgeon at Port Moresby General Hospital in Papua New Guinea and Senior Lecture at the School of Medicine and Health Sciences in delivering surgical services. His aim to deliver quality and delicate service to those paediatric populations who are in need and to educate our young generations to live a life worthy in this world.