Geographical location determines survival of babies born, Study suggests

The survival of a baby born with a birth defect (congenital anomaly) is dependent on where the baby is born, a new study published in The Lancet has suggested.

The study by some scientists from 74 countries examined the risk of mortality for nearly 4000 babies born with birth defects in 264 hospitals around the world.

The study found that babies born with birth defects involving the intestinal tract have a one in 20 chance of dying in a high-income country compared to one in five in a middle-income country and two in five in a low-income country.

Gastroschisis, a birth defect where a baby is born with their intestines protruding through a hole by the umbilicus has the greatest difference in mortality with 90 per cent of babies dying in low-income countries compared with one per cent in high-income countries.

In high-income countries, most of these babies would be able to live a full life without disability.

Principal Investigator Dr Naomi Wright has devoted the last four years to studying these disparities in outcome.

She said: “Geography should not determine outcomes for babies who have correctable surgical conditions.

“The Sustainable Development Goal to ‘end preventable deaths in newborns and children under 5 years old by 2030’ is unachievable without urgent action to improve surgical care for babies in low- and middle-income countries,” she said.

There is need to focus on improving surgical care for newborns in low- and middle-income countries.

Over the last 25 years, there has been great success in reducing deaths in children under 5 years by preventing and treating infectious diseases.

However, there has been little focus on improving surgical care for babies and children and indeed the proportion of deaths related to surgical diseases continues to rise.

Birth defects are now the 5th leading cause of death in children under 5 years of age globally, with most deaths occurring in the newborn period.

Birth defects involving the intestinal tract have a particularly high mortality in low- and middle-income countries as many are not compatible with life without emergency surgical care after birth.

The study highlights the importance of care received before or after the corrective operation at the surgical centre.

Babies treated at hospitals without access to ventilation and intravenous nutrition when needed had a higher chance of dying.

Furthermore, not having skilled anesthetic support and not using a surgical safety checklist at the time of operation were associated with a higher chance of death.

Global Project Steering Committee Member, Prof. Emmanuel Ameh, Chief Consultant Paediatric Surgeon at the National Hospital, Abuja, Nigeria, is coordinating a massive international project to have countries roll out National Surgical, Obstetric and Anaesthesia plans, which will incorporate many elements of the missing pieces.

He also leads the Global Initiative for Children’s Surgery which is another organisation that has prescribed minimum standards for the surgical care of children globally.

Improving survival from these conditions in low- and middle-income countries involves three key elements: enhancing antenatal diagnosis and delivery at a hospital with children’s surgical care.

Others include iimproving care for babies born at primary and secondary care facilities, with safe and quick transfer to a tertiary surgical centre; and improved care for babies at the surgical centre.

Alongside local initiatives, surgical care for newborns and children need to be integrated into national and international child health policy and should no longer be neglected within global child health.

The National Lead for the Study is Dr Taiwo Lawal of the University College Hospital, Ibadan.

He emphasised the need for stakeholders and policy drivers to use the opportunity to dodge the global bullet of widening gap between the global north and south and reduce unmet surgical needs in children.