Gastroschisis Challenges North and South: Challenges in Nigeria

Emmanuel Ameh, M.D.
Chief Consultant Paediatric Surgeon, National Hospital, Abuja, Nigeria

Presented by Sherif Emil, M.D., C.M.

Summary Slides: Gastroschisis Challenges North and South: Nigeria

Challenges

  • Incidence varies across country
  • BASELINE DATA (Zaria, 2000: 14 infants) Age presenting: 7hrs – 5days (median 24hrs)
  • All delivered at home, unsupervised
  • Primary fascial /skin only closure: 10
  • Improvised (surgical silo): 3
  • Limited NICU
  • No TPN
  • Mortality: 10 /14 (71%)

Key challenges have always centered around:

  • Home delivery
  • Delayed presentation
  • Lack of appropriate silo material
  • Anaesthesia challenges
  • Lack of NICU facilities
  • Limited parenteral nutrition infection

Measures Taken to Address Challenges

  • Avoiding/minimising surgery as much as possible
  • Using various types/modifications of preformed silo
    • Kano silo
    • Alexis retractor (expensive, recent cheaper version from China: $91 vs $12)
  • Nutrition
    • Partial parenteral nutrition (Trophamine, Freamine, Astymin)
    • Early trophic enteral feeding
    • Tailored enteral feeding schedule
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