Assessment of the Neonatal Referral and Transport System for Patients With Gastroschisis Reffered to Kenyatta National Hospital
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Date
2022Author
Hetal, Rajnikant G
Type
ThesisLanguage
enMetadata
Show full item recordAbstract
Background: Gastroschisis is a surgical condition where the bowel eviscerates through an
anterior abdominal wall defect. This is a source of major heat and fluid loss and infection
in the neonate. Patients with gastroschisis born within a tertiary level hospital with specialty
services available have better outcomes as compared to those who are born outside such a
hospital. Birth outside a tertiary level facility confers serious challenges in pretransit and
intra-transit care with resultant morbidity and mortality.
Objective: The main objective of this study was to assess the neonatal referral and transport
system for patients with gastroschisis referred to KNH.
Materials and Methods: A prospective cross-sectional study design was used. Using
consecutive sampling approach, patients received at Kenyatta Nation Hospital (KNH)
pediatrics surgery unit(PSU) after referral from peripheral facilities were recruited. Data
were collected on referring hospital factors, pre- and intra- transit factors, time and distance
covered. Assessment of the neonatal referral and transport system for patients with
gastroschisis referred to KNH was done using pre and intra transit factors as per the
standard transport protocols in literature.
Stata 16.0 was used for data analysis. Descriptive statistics such as percentages, means,
mode and medians were used to describe the characteristics of study participants. Data
were presented in pie charts, bar graphs, frequency tables and written reports.
Results: Twenty-nine patients presented with gastroschisis during the study period. Mean
age was 7.07 hours range 3 – 18 hours. There were 16 (55.2%) males and 13 (44.8%)
females. Mean birthweight was 2019.8 grams, and a mean gestational age of 36.5 weeks.
Mean duration of transit was 5 hours, median 5 hours and a range of 1 – 9 hours. Mean
distance from referring facility to tertiary facility was 153.1 km, range 19 – 348.
Out of 10 pre-transit factors assessed, 27.6% of patients scored 7, 48.3% scored 6, 17.2%
scored 5 and 6.9% of patients scored 4. Most affected factors in the pre-transit protocol
were lack of monitoring chart (0%) and comment on blood investigations (0%), gastric
decompression (3.4%), prenatal obstetric scan (44.8%). Only 2/13 cases with gastroschisis
were picked by the prenatal ultrasound.
For intratransit scores, out of 14 parameters, 9 were only in 6.9%, 8 in 17.2%, 7 in 20.7%,
6 in 24.1% and 5 in 31%. Most affected were incubator use (0), pulse oximetry (31%),
thermometer (55.2%), blood pressure monitor (44.8%), neonatal resuscitation training
(58.6%), functioning nasogastric tube (13.8%), bowel monitoring (0%), adequate bowel
cover (34.5%), parent content (48.3%).
Conclusion: This study demonstrates that pretransit and transit care of neonates with
gastroschisis is grossly inadequate. Interventions to promote care of neonates with
gastroschisis are advised to reduce mortality. Such interventions would target areas of need
as identified by this study.
Publisher
University of Nairobi
Rights
Attribution-NonCommercial-NoDerivs 3.0 United StatesUsage Rights
http://creativecommons.org/licenses/by-nc-nd/3.0/us/Collections
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