Anesthesia-Related Adverse Events in Infants With Gastroschisis at a South African Tertiary Pediatric Hospital: A Retrospective Cohort Study

Abstract

Background: Infants with gastroschisis represent a high-risk surgical population, particularly in low- and middle-income countries (LMICs) where perioperative resources are constrained. While survival in high-income settings exceeds 90%, reported mortality in Sub-Saharan Africa ranges from 58.1% to 100%. Anesthesia-related adverse events (ARAEs) may contribute to poor perioperative risk, yet data on their incidence and associated factors in this population are limited.

Aims: To describe the incidence and nature of ARAEs in infants with gastroschisis and identify associated risk factors. A secondary aim was to assess the frequency and safety of general anesthesia administered solely for central venous catheter (CVC) procedures.

Methods: A retrospective cohort study of all infants with gastroschisis admitted to Red Cross War Memorial Children's Hospital between 2012 and 2021. ARAEs were defined using criteria from APRICOT and NECTARINE studies. Generalized estimating equations (GEE) were used to account for repeated anesthetic exposures per patient.

Results: Sixty-five infants underwent 196 general anesthetics (median 2 [IQR 1-4] per patient). Sixteen infants underwent 4 or more GAEs for CVC procedures alone. ARAEs occurred in 79 procedures (40.3%), affecting 51 patients (78.5%). Cardiovascular instability was most common, followed by respiratory complications. ARAEs were significantly more frequent during pathology-related surgery than during CVC procedures (45.7% vs. 12.5%; adjusted OR 0.17, 95% CI 0.08 to 0.35, p < 0.001).

Conclusions: ARAEs are common in infants with gastroschisis, particularly during pathology-related procedures. Potential lessons include careful fluid management, anticipatory extubation planning, and reducing repeated anesthetic exposure. Strengthening perioperative data systems in LMICs and conducting prospective studies are needed to identify modifiable risks and develop safe, context-specific care pathways to improve outcomes for infants with gastroschisis in resource-limited settings.

Keywords: adverse events; anesthesia; central venous catheters; developing countries; gastroschisis; general; intraoperative complications; newborn infant.