5. GS in low to middle income countries (LMICs)

LMICs have an overall high mortality rate in neonates with correctable congenital anomalies [38, 39] and suffer from a lack of medical facilities and personnel [40]. Non-governmental and governmental organizations have been criticized for not doing enough [41, 42] though new partnerships are attempting to redress this [43, 44].

Mortality from GS in low-to-middle-income countries (LMICs) can reach up to 80–100% [45–48] which is in sharp contrast to the <10% in HICs [49]. Sepsis is a major culprit in most cases of neonatal mortality in LMICs [48]. The Gastroschisis International (GiT) network has suggested that poor resuscitation combined with sepsis and abdominal compartment syndrome is directly linked to the poor outcome [50].

Antenatal care may not be well developed [51] or mothers may engage poorly with it [52] which risks births in areas far from the reach of the pediatric surgeon. A delay in transfer of the neonate with GS remains a main concern [47, 53] however a recent study from South Africa has suggested that resuscitation at the initial point of care and throughout transfer may be the key to improving the end result [51].
