Gastroschisis in Neonates

Background: Gastroschisis is a rare congenital condition that is typically diagnosed antenatally in developed countries. However, in resource-limited settings, it remains a significant therapeutic challenge. Mortality rate in sub-Saharan Africa is alarmingly high, ranging from 69.8 to 95%, compared to 2%–8% in high-income countries. Objective: This study aimed to identify disparities in the diagnosis and management of gastroschisis between low- and high-income countries to propose strategies for improving global outcomes. Material and Methods: We conducted a retrospective, observational, two-centre study at the University Hospital Centres of Cocody (Abidjan, Ivory Coast) and Limoges (France). The study included 34 neonates from Cocody and 19 from Limoges, treated between January 2012 and June 2023. Results: In Cocody, only 8.8% of cases were diagnosed prenatally, all deliveries occurred in peripheral centres, and 70.6% of neonates were transferred within 24 hours. Bowel reintegration was performed in a single stage in 38.2% of cases and in a two-stage procedure in 41.2%. In contrast, all cases in Limoges were diagnosed antenatally, deliveries took place within the hospital, and bowel reintegration occurred within 60 minutes of birth—either in one stage (78.9%) or two stages (21.1%). Mortality by day 28 was 94.1% in the Cocody cohort compared to 10.5% in Limoges. Conclusion: The key factors contributing to high mortality in resource-limited settings include a low antenatal diagnosis rate, leading to a high proportion of deliveries in peripheral centres and delays in surgical intervention. Additionally, the lack of paediatric intensive care units may have further increased mortality in complex cases.