1
|
Predictors of length of stay for simple gastroschisis: analysis of ACS NSQIP-P database. Pediatr Surg Int 2022; 38:1371-1376. [PMID: 35876903 DOI: 10.1007/s00383-022-05189-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE We aimed to assess predictors of length of stay for simple gastroschisis utilizing the NSQIP-Pediatric Database. METHODS The NSQIP-P Participant Use Data File was queried to identify patients with simple gastroschisis. We defined short length of stay (LOS) as patients discharged home ≤ 30 days from birth. We compared patients with short LOS versus prolonged LOS > 30 days. Predictors and outcomes were evaluated. RESULTS There were 888 patients with simple gastroschisis identified. Half of patients had LOS ≤ 30 days. Patients with LOS ≤ 30 were younger at repair (median age 1 day vs. 3 days, p = 0.0001), had higher birth weight (median 2.5 kg vs. 2.4 kg, p = 0.0001), and were less premature (37 week vs. 36 weeks, p = 0.0001). However, only gestational age and weight at birth were significant predictors of LOS on multivariate analysis (p = 0.0001). Prolonged LOS patients had more instances of ventilation, oxygen supplementation, sepsis (n = 2/446 or 0.4% vs. n = 9/442 or 2%, p = 0.003), bleeding/transfusion (n = 7/446 or 1.6% vs. n = 43/442 or 9.7%, p = 0.0001), line infections (n = 1/446 or 0.2% vs. n = 12/442, p = 0.001), and reoperations (n = 9/446 or 2% vs. n = 26/442 or 5.9%, p = 0.003). CONCLUSION Prematurity and birth weight are significant predictors of length of stay in simple gastroschisis patients. Prenatal counseling should continue to be one of the main factors to improve the outcomes for patients with gastroschisis. Type of study Retrospective cohort study. Level of evidence Level IV.
Collapse
|
2
|
Ferreira RG, Mendonça CR, Gonçalves Ramos LL, de Abreu Tacon FS, Naves do Amaral W, Ruano R. Gastroschisis: a systematic review of diagnosis, prognosis and treatment. J Matern Fetal Neonatal Med 2021; 35:6199-6212. [PMID: 33899664 DOI: 10.1080/14767058.2021.1909563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The present systematic review aims to investigate the diagnosis, prognosis, delivery assistance, pregnancy results and postnatal management in gastroschisis. STUDY DESIGN The following data sources were evaluated: The CINAHL, Embase and MEDLINE/PubMed databases were searched, observational and intervention studies published over the past 20 years. The quality of the studies was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). RESULTS A total of 3770 infants diagnosed with gastroschisis were included (44 studies); 1534 fetuses were classified as simple gastroschisis and 288 as complex gastroschisis. Intrauterine fetal demise occurred in 0.47% and elective termination occurred in 0.13%. Preterm delivery occurred in 23.23% and intrauterine growth restriction in 4.43%. Cesarean section delivery was performed in 54.6%. Neonatal survival was 91.29%. The main neonatal complications were: sepsis (11.78%), necrotizing enterocolitis (2.33%), short bowel syndrome (1.37%), bowel obstruction (0.79%), and volvulus (0.23%). Immediate surgical repair was performed in 80.1% with primary closure in 69%. The average to oral feeding was 33 (range: 11-124.5) days. Average hospital duration was 38 days and 89 days in neonates with simple and complex grastroschisis, respectively. CONCLUSIONS The present systematic review provides scientific data for counseling families with fetal gastroschisis.
Collapse
Affiliation(s)
- Rui Gilberto Ferreira
- Postgraduate program in Health Sciences, Universidade Federal de Goiás, Goiania, Brazil.,Department of Obstetrics and Gynaecology, Hospital das Clínicas, Universidade Federal de Goiás, Goiania, Brazil
| | | | | | | | - Waldemar Naves do Amaral
- Postgraduate program in Health Sciences, Universidade Federal de Goiás, Goiania, Brazil.,Department of Obstetrics and Gynaecology, Hospital das Clínicas, Universidade Federal de Goiás, Goiania, Brazil
| | - Rodrigo Ruano
- Department of Obstetrics and Gynecology, Pediatrics and Physiology, Division of Maternal-Fetal Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| |
Collapse
|
3
|
Shalaby A, Obeida A, Khairy D, Bahaaeldin K. Assessment of gastroschisis risk factors in Egypt. J Pediatr Surg 2020; 55:292-295. [PMID: 31759649 DOI: 10.1016/j.jpedsurg.2019.10.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 10/26/2019] [Indexed: 01/15/2023]
Abstract
AIM Mortality in infants born with gastroschisis (GS) in low-to-middle-income countries (LMICs) is high. This study aimed to assess factors which might affect outcome in Egypt in order to improve survival. METHODS A prospective study over a 15-month duration was completed. Variables assessed covered patient, maternal, antenatal, treatment, and complications. The Gastroschisis Prognostic Score (GPS) was used to predict outcome. A validated questionnaire was used to assess socioeconomic status. The main outcome was mortality. RESULTS Twenty-four cases were studied. Median gestational age was 37 (26-40) weeks, and 9 (38%) were preterm. Mortality occurred in 15 (62%) infants. Median transfer time was 8 (1.5-35) hours, and 64% survived if transferred before 8 h. Median maternal age was 20 (16-27) years. All families were of a low or very-low socioeconomic level. Only 25% had antenatal scans. Most cases were simple GS, and only 3 (12.5%) were complex GS. Median length of stay was 14 (1-52) days, TPN duration was 12 (0-49) days, and days to full feeds was 5 (3-11) days. The GPS score ranged from 0 to 6 in the studied cases and negatively correlated with outcome (rS = -0.98; p = 0.03). CONCLUSION The mortality of GS in Egypt is very high, mainly due to sepsis and prematurity. Young maternal age and poor socioeconomic status are linked to GS. The GPS is a good indicator of morbidity and mortality in a LMIC setting. Survival improved with better resuscitation and strict management protocols. More effort is needed to improve antenatal detection, and transfer time should be ideally below 8 h. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Aly Shalaby
- Department of Pediatric Surgery, Cairo University Specialized Pediatric Hospital.
| | - Alaa Obeida
- Department of Pediatric Surgery, Cairo University Specialized Pediatric Hospital
| | - Dalia Khairy
- Department of Pediatrics, Cairo University Specialized Pediatric Hospital
| | - Khaled Bahaaeldin
- Department of Pediatric Surgery, Cairo University Specialized Pediatric Hospital
| |
Collapse
|
4
|
Vanishing gastroschisis visualized by antenatal ultrasound: a case report and review of literature. Eur J Obstet Gynecol Reprod Biol 2018; 228:186-190. [PMID: 29980113 DOI: 10.1016/j.ejogrb.2018.06.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 06/13/2018] [Indexed: 11/23/2022]
Abstract
We report a case of vanishing gastroschisis visualized by antenatal ultrasound with a 7-year long term follow-up. Currently, the child is still dependent on daily parenteral nutrition with no signs of hepatotoxicity. To our knowledge, it's the fourth case with a long-term follow-up. Vanishing gastroschisis is a rare complication of gastroschisis. However, physicians should be aware of it because its prognosis is worse than classical gastroschisis. When a vanishing gastroschisis is visualized or suspected by antenatal ultrasound, prenatal counseling is required with explanations about the risk of short bowel syndrome, the need of parenteral nutrition and related complications (inflammatory colitis, sepsis, liver failure and organ transplant). Mortality rate was initially around 93%, and dropped to 27% after the years 2000 (versus 10% for classical gastroschisis). After birth, all children will require surgery, and sometimes autologous gastro-intestinal reconstruction. Most survivors (68%) could be taken off the TPN. Unfortunately, long-term outcomes for children with vanishing gastroschisis are still missing in current literature.
Collapse
|
5
|
Amin R, Domack A, Bartoletti J, Peterson E, Rink B, Bruggink J, Christensen M, Johnson A, Polzin W, Wagner AJ. National Practice Patterns for Prenatal Monitoring in Gastroschisis: Gastroschisis Outcomes of Delivery (GOOD) Provider Survey. Fetal Diagn Ther 2018; 45:125-130. [PMID: 29791899 DOI: 10.1159/000487541] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 02/06/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Gastroschisis is an abdominal wall defect with increasing incidence. Given the lack of surveillance guidelines among maternal-fetal medicine (MFM) specialists, this study describes current practices in gastroschisis management. MATERIALS AND METHODS An online survey was administered to MFM specialists from institutions affiliated with the North American Fetal Therapy Network (NAFTNet). Questions focused on surveillance timing, testing, findings that changed clinical management, and delivery plan. RESULTS Responses were obtained from 29/29 (100%) NAFTNet centers, comprising 143/371 (39%) providers. The majority had a regimen for antenatal surveillance in patients with stable gastroschisis (94%; 134/141). Antenatal testing began at 32 weeks for 68% (89/131) of MFM specialists. The nonstress test (55%; 72/129), biophysical profile (50%; 63/126), and amniotic fluid index (64%; 84/131) were used weekly. Estimated fetal weight (EFW) was performed monthly by 79% (103/131) of providers. At 28 weeks, abnormal EFW (77%; 97/126) and Doppler ultrasound (78%; 99/127) most frequently altered management. In stable gastroschisis, 43% (60/140) of providers delivered at 37 weeks, and 29% (40/ 140) at 39 weeks. DISCUSSION Gastroschisis management differs among NAFTNet centers, although the majority initiate surveillance at 32 weeks. Timing of delivery still requires consensus. Prospective studies are necessary to further optimize practice guidelines and patient care.
Collapse
Affiliation(s)
- Ruchi Amin
- Pediatric Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin,
| | - Aaron Domack
- Pediatric Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Joseph Bartoletti
- Pediatric Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Erika Peterson
- Maternal Fetal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Britton Rink
- Maternal and Fetal Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Jennifer Bruggink
- Pediatric Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Anthony Johnson
- Maternal and Fetal Medicine, University of Texas Health Sciences Center, Houston, Texas, USA
| | - William Polzin
- Maternal and Fetal Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Amy J Wagner
- Pediatric Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| |
Collapse
|
6
|
Abstract
We report a case of gastroschisis in male twins. Both twins were preterm and low birth weight, with intestinal malrotation; they were diagnosed by antenatal ultrasound at 20 weeks of gestation. Immediately after delivery, they underwent evaluation and early surgical one-stage repair under anesthesia. One of the twins was found to have duodenal perforation at laparotomy, at the horizontal part near Treitz ligament. Both twins stayed in hospital for 30 days and were in good health at discharge.
Collapse
|
7
|
Fouad D, Lee GJ, Upadhyaya M, Drake D. Inflammatory duodenal necrosis complicating gastroschisis. J Indian Assoc Pediatr Surg 2016; 21:190-192. [PMID: 27695214 PMCID: PMC4980883 DOI: 10.4103/0971-9261.186551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Babies with gastroschisis have an increased risk of necrotizing enterocolitis (NEC) that can lead to short bowel syndrome, a long-term parenteral nutrition requirement, and its associated complications. To our knowledge, this is the first case report of recurrent duodenal ischemia and necrosis associated with gastroschisis in the absence of NEC totalis.
Collapse
Affiliation(s)
- Dina Fouad
- Department of Paediatric Surgery, Evelina London Children's Hospital, London SE1 7EH, United Kingdom
| | - Geraint J Lee
- Department of Neonatology, St Thomas' Hospital, London SE1 7EH, United Kingdom
| | - Manasvi Upadhyaya
- Department of Paediatric Surgery, Evelina London Children's Hospital, London SE1 7EH, United Kingdom
| | - David Drake
- Department of Paediatric Surgery, Evelina London Children's Hospital, London SE1 7EH, United Kingdom
| |
Collapse
|
8
|
Friedman AM, Ananth CV, Siddiq Z, D'Alton ME, Wright JD. Gastroschisis: epidemiology and mode of delivery, 2005-2013. Am J Obstet Gynecol 2016; 215:348.e1-9. [PMID: 27026476 PMCID: PMC5003749 DOI: 10.1016/j.ajog.2016.03.039] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 03/07/2016] [Accepted: 03/21/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Gastroschisis is a severe congenital anomaly the etiology of which is unknown. Research evidence supports attempted vaginal delivery for pregnancies complicated by gastroschisis in the absence of obstetric indications for cesarean delivery. OBJECTIVE The objectives of the study evaluating pregnancies complicated by gastroschisis were to determine the proportion of women undergoing planned cesarean vs attempted vaginal delivery and to provide up-to-date epidemiology on the risk factors associated with this anomaly. STUDY DESIGN This population-based study of US natality records from 2005 through 2013 evaluated pregnancies complicated by gastroschisis. Women were classified based on whether they attempted vaginal delivery or underwent a planned cesarean (n = 24,836,777). Obstetrical, medical, and demographic characteristics were evaluated. Multivariable log-linear regression models were developed to determine the factors associated with the mode of delivery. Factors associated with the occurrence of the anomaly were also evaluated in log-linear models. RESULTS Of 5985 pregnancies with gastroschisis, 63.5% (n = 3800) attempted vaginal delivery and 36.5% (n = 2185) underwent a planned cesarean delivery. The rate of attempted vaginal delivery increased from 59.7% in 2005 to 68.8% in 2013. Earlier gestational age and Hispanic ethnicity were associated with lower rates of attempted vaginal delivery. Factors associated with the occurrence of gastroschisis included young age, smoking, high educational attainment, and being married. Protective factors included chronic hypertension, black race, and obesity. The incidence of gastroschisis was 3.1 per 10,000 pregnancies and did not increase during the study period. CONCLUSION Attempted vaginal delivery is becoming increasingly prevalent for women with a pregnancy complicated by gastroschisis. Recommendations from the research literature findings may be diffusing into clinical practice. A significant proportion of women with this anomaly still deliver by planned cesarean, suggesting further reduction of surgical delivery for this anomaly is possible.
Collapse
Affiliation(s)
- Alexander M Friedman
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY.
| | - Cande V Ananth
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Zainab Siddiq
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Mary E D'Alton
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Jason D Wright
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY
| |
Collapse
|
9
|
Kozlov YA, Novozhilov VA, Koval'kov KA, Rasputin AA, Baradieva PZ, Us GP, Kuznetsova NN. [Congenital defects of abdominal wall]. Khirurgiia (Mosk) 2016:74-81. [PMID: 27447007 DOI: 10.17116/hirurgia2016574-81] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Yu A Kozlov
- City Ivano-Matreninskaya Children's Clinical Hospital, Irkutsk; Irkutsk State Medical Academy of Postgraduate Education
| | - V A Novozhilov
- City Ivano-Matreninskaya Children's Clinical Hospital, Irkutsk; Irkutsk State Medical Academy of Postgraduate Education; Irkutsk State Medical University
| | | | - A A Rasputin
- City Ivano-Matreninskaya Children's Clinical Hospital, Irkutsk
| | | | - G P Us
- City Ivano-Matreninskaya Children's Clinical Hospital, Irkutsk
| | - N N Kuznetsova
- City Ivano-Matreninskaya Children's Clinical Hospital, Irkutsk
| |
Collapse
|
10
|
Rosa RFM, Michelon L, Masiero Á, Faria AEV, De Souza VF, Dietrich C, Targa LV, Provenzi VO, Pires SRS, Zen PRG. Gastroschisis in a fetus with a congenital neuroblastoma: Association or coincidence? ACTA ACUST UNITED AC 2016; 106:208-12. [PMID: 26875914 DOI: 10.1002/bdra.23484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 12/18/2015] [Accepted: 12/22/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND Gastroschisis is the most common abdominal wall defect. It is characterized by herniation of the intestine and other abdominal organs through a defect in the abdominal wall. Neuroblastoma is the most common malignant tumor observed during the neonatal period. It is a neuroendocrine tumor derived from neural crest cells that develops into the adrenal gland. CASE We report on the undescribed association between gastrochisis and congenital neuroblastoma, diagnosised during the prenatal period. The mother was a 20-year-old healthy pregnant woman in her second pregnancy. Obstetric ultrasound examination showed a fetus presenting an abdominal wall defect on the right side of the umbilical cord, compatible with gastroschisis, and a hyperechogenic and spherical solid lesion on the left adrenal gland. Fetal magnetic resonance imaging disclosed similar features associated to a heterogeneous aspect of the liver. The diagnosis of metastatic neuroblastoma was confirmed after birth through liver biopsy. At 2 days of life, the prothrombrin time was abnormal, and the patient needed vitamin K. CONCLUSION We cannot rule out the possibility that a clotting defect, commonly observed in disseminated malignancies such as a metastatic neuroblastoma may be associated with the etiology of the gastroschisis, as this defect may result from a thrombosis occurring around 3 to 4 weeks of gestation, a period when neuroblasts development occurs into the adrenal medulla. However, we cannot exclude the possibility that both events may have occurred simultaneously by chance.
Collapse
Affiliation(s)
- Rafael F M Rosa
- Clinical Genetics, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) and Complexo Hospitalar Santa Casa de Porto Alegre (CHSCPA), RS, Brazil.,Clinical Genetics, Hospital Materno Infantil Presidente Vargas (HMIPV), RS, Brazil.,Graduate Program in Pathology, UFCSPA, RS, Brazil.,Fetal Medicine, HMIPV, RS, Brazil
| | - Laura Michelon
- Graduation in Medicine, Universidade Luterana do Brasil (ULBRA), RS, Brazil
| | - Átila Masiero
- Graduation in Medicine, Universidade Luterana do Brasil (ULBRA), RS, Brazil
| | | | | | | | | | | | | | - Paulo R G Zen
- Clinical Genetics, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) and Complexo Hospitalar Santa Casa de Porto Alegre (CHSCPA), RS, Brazil.,Graduate Program in Pathology, UFCSPA, RS, Brazil
| |
Collapse
|
11
|
Stüber TN, Frieauff E, Weiß C, Zollner U, Wöckel A, Meyer T, Rehn M. Prenatal sonographic ultrasound predictors for the outcome in fetal gastroschisis: a retrospective analysis. Arch Gynecol Obstet 2015; 293:1001-6. [PMID: 26525691 DOI: 10.1007/s00404-015-3936-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 10/21/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE To identify predictive ultrasound signs for unfavorable outcome in fetal gastroschisis (GS). METHODS This is a retrospective cohort study among pregnant women with the prenatal diagnosis of GS between 1998 and 2011 at the University of Wuerzburg, Germany. Analysis included prenatal ultrasound scans, neonatal intensive care unit (NICU) records, and pediatric records. The collected variables included maternal and fetal demographics, as well as an analysis of predictors for unfavorable fetal outcome. Unfavorable outcome was defined by more than 2 postnatal surgical interventions, intestinal resections, and long time to oral feeding (≥4 weeks). RESULTS 35 cases of fetal GS were diagnosed, whereby 23 cases met the inclusion criteria and were evaluated by prenatal ultrasound and postnatal outcome. Based on the postnatal situation, 15 patients were classified in a good prognosis group and 8 patients in a poor prognosis group. Fetuses with poor prognosis were presented later during pregnancy (21.1 ± 6 vs. 26.9 ± 5.3 weeks; p < 0.01) and delivered at earlier gestational age (35.6 ± 0.8 vs. 33.4 ± 1.4 weeks; p < 0.01) with lower birth weight (2074 ± 306.3 vs. 2559 ± 255.4 g; p < 0.01). There were no differences in prenatal findings like growth restriction, amniotic fluid index, or Doppler results between good and poor prognosis group. However, early detected and long-lasting bowel dilatation was associated with poor prognosis. CONCLUSION Late presentation and early gestational age at delivery are associated with poor prognosis in neonates with GS. Furthermore, early onset as well as long duration of bowel dilatation is associated with poor fetal outcome, while other ultrasound characteristics are not able to predict poor prognosis of GS.
Collapse
Affiliation(s)
- Tanja Nadine Stüber
- Department of Obstetrics and Gynecology, University of Wuerzburg, Josef-Schneider-Str. 4, 97080, Wuerzburg, Germany.
| | - Eric Frieauff
- Children`s Hospital, University of Wuerzburg, Josef-Schneider-Str. 2, 97080, Wuerzburg, Germany
| | - Claire Weiß
- Department of Obstetrics and Gynecology, University of Wuerzburg, Josef-Schneider-Str. 4, 97080, Wuerzburg, Germany
| | - Ursula Zollner
- Department of Obstetrics and Gynecology, University of Wuerzburg, Josef-Schneider-Str. 4, 97080, Wuerzburg, Germany
| | - Achim Wöckel
- Department of Obstetrics and Gynecology, University of Wuerzburg, Josef-Schneider-Str. 4, 97080, Wuerzburg, Germany
| | - Thomas Meyer
- Department of Paediatric Surgery, University of Wuerzburg, Oberduerrbacherstr. 6, 97080, Wuerzburg, Germany
| | - Monika Rehn
- Department of Obstetrics and Gynecology, University of Wuerzburg, Josef-Schneider-Str. 4, 97080, Wuerzburg, Germany
| |
Collapse
|
12
|
Frybova B, Vlk R, Kokesova A, Rygl M. Isolated prenatal ultrasound findings predict the postnatal course in gastroschisis. Pediatr Surg Int 2015; 31:381-7. [PMID: 25697276 DOI: 10.1007/s00383-015-3675-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE The aim of the study was to identify which prenatal ultrasonographic findings in fetuses with gastroschisis correlate with complicated postnatal outcome. METHODS Ultrasound findings at the 30th week of pregnancy and medical reports were statistically analyzed to identify independent prenatal ultrasonographic predictors of postnatal outcome. RESULTS Completed prenatal data were gathered from 64 pregnancies. Prenatal intra-abdominal bowel dilatation (cutoff 10 mm) correlated with the presence of atresia (p < 0.01), longer administration of parenteral nutrition, extended hospital stay (median 53 vs. 21 days; 68 vs. 36 days, both p < 0.05), and greater number of additional surgical procedures (p < 0.05). Infants with antenatal presence of thickened bowel wall (greater than or equal to 3 mm) required longer administration of parenteral nutrition (median 34 vs. 20 days; p < 0.01) and prolonged stay (median 44 vs. 37 days; p < 0.05). Presence of oligohydramnion (amniotic fluid index below 8 cm) was connected with longer administration of parenteral nutrition in newborns (median 30 vs. 16 days; p < 0.05). CONCLUSION The isolated presence of oligohydramnion with amniotic fluid index below 8 cm, thickened bowel wall equal to or more than 3 mm and the prenatal intra-abdominal dilatation with 10 mm cutoff had significant predictive value for the adverse postnatal outcome of patients with gastroschisis.
Collapse
Affiliation(s)
- Barbora Frybova
- Department of Paediatric Surgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, V Úvalu 84, 15006, Prague 5, Czech Republic,
| | | | | | | |
Collapse
|
13
|
Carvalho NS, Helfer TM, Serni PDO, Terasaka OA, Boute T, Araujo Júnior E, Nardozza LMM, Moron AF, Rolo LC. Postnatal outcomes of infants with gastroschisis: a 5-year follow-up in a tertiary referral center in Brazil. J Matern Fetal Neonatal Med 2015; 29:418-22. [PMID: 25747953 DOI: 10.3109/14767058.2014.1002764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate postnatal outcomes in fetuses with gastroschisis. METHODS This is a retrospective study (2009-2013) of patients with gastroschisis at the Hospital São Paulo (Federal University of São Paulo, Brazil). RESULTS A total of 44 infants with gastroschisis were examined. The mean maternal age was 21.1 years and mean gestational age at delivery was 36.1 weeks. Delivery occurred before 34 weeks in 13.6%, between 34 and 36 weeks and 6 d in 40.9%, and after 37 weeks in 45.5%. The mean birth weight was 2349 g, with 37.2% small-for-gestational age infants. The mean umbilical cord blood pH was 7.32. Bowel resection and delayed fascial closure was performed in 14.6% and 19.5%, respectively. The mean hospitalization time in the neonatal intensive care unit was 52.7 d. Neonatal infection was detected in 52.4%, with a positive blood culture; 77.3% of those cases were coagulase negative staphylococci. The overall rate of mortality was 25%; 18.2% before birth, 45.4% during the neonatal period, and 36.4% in infants. The main cause of postnatal death was septicemia (55.5%). CONCLUSIONS Despite advances in perinatal care and surgical techniques, infants with gastroschisis still present high rates of complications and death.
Collapse
Affiliation(s)
- Natália Silva Carvalho
- a Department of Obstetrics , Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP) , São Paulo-SP , Brazil
| | - Talita Micheletti Helfer
- a Department of Obstetrics , Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP) , São Paulo-SP , Brazil
| | - Priscila de Oliveira Serni
- a Department of Obstetrics , Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP) , São Paulo-SP , Brazil
| | - Ohanna Ana Terasaka
- a Department of Obstetrics , Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP) , São Paulo-SP , Brazil
| | - Tatiane Boute
- a Department of Obstetrics , Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP) , São Paulo-SP , Brazil
| | - Edward Araujo Júnior
- a Department of Obstetrics , Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP) , São Paulo-SP , Brazil
| | | | - Antonio Fernandes Moron
- a Department of Obstetrics , Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP) , São Paulo-SP , Brazil
| | - Liliam Cristine Rolo
- a Department of Obstetrics , Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP) , São Paulo-SP , Brazil
| |
Collapse
|
14
|
2014 First-trimester ultrasound forum from the Korean Society of Ultrasound in Obstetrics and Gynecology. Obstet Gynecol Sci 2015; 58:1-9. [PMID: 25629012 PMCID: PMC4303746 DOI: 10.5468/ogs.2015.58.1.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 08/01/2014] [Accepted: 10/01/2014] [Indexed: 12/13/2022] Open
Abstract
A first-trimester ultrasound scan has become an essential part of antenatal care. The Korean Society of Ultrasound in Obstetrics and Gynecology held a first-trimester ultrasound forum on April 5, 2014. The forum aimed to present an updated review of the literature on the topic of first-trimester ultrasound in specific lectures and to host a panel discussion on several important issues regarding first-trimester scans. The forum provided evidence- and consensus-based best practice patterns for obstetricians in Korea. Here, we report the review and checklists presented from the forum.
Collapse
|
15
|
Abstract
PURPOSE OF REVIEW To review prognostic parameters reported recently in the evaluation of abdominal wall defects in the first trimester. RECENT FINDINGS Evaluation of abdominal wall defects in the first trimester is based principally on associated structural or chromosomal anomalies. In the case of gastroschisis, which is rarely associated with other anomalies, evaluation of prenatal or postnatal outcome is based mainly on the course of pregnancy. In the case of isolated omphalocele in the first trimester, recent studies have evaluated parameters that could help predict prenatal or postnatal outcome. SUMMARY We review recent studies using new parameters to diagnose abdominal wall defects in the first trimester and to provide early prenatal counselling to parents regarding prenatal and postnatal prognosis.
Collapse
|
16
|
Gamba P, Midrio P. Abdominal wall defects: prenatal diagnosis, newborn management, and long-term outcomes. Semin Pediatr Surg 2014; 23:283-90. [PMID: 25459013 DOI: 10.1053/j.sempedsurg.2014.09.009] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Omphalocele and gastroschisis represent the most frequent congenital abdominal wall defects a pediatric surgeon is called to treat. There has been an increased reported incidence in the past 10 years mainly due to the diffuse use of prenatal ultrasound. The early detection of these malformations, and related associated anomalies, allows a multidisciplinary counseling and planning of delivery in a center equipped with high-risk pregnancy assistance, pediatric surgery, and neonatology. At present times, closure of defects, even in multiple stages, is always possible as well as management of most of cardiac-, urinary-, and gastrointestinal-associated malformations. The progress, herein discussed, in the care of newborns with abdominal wall defects assures most of them survive and reach adulthood. Some aspects of transition of medical care will also be considered, including fertility and cosmesis.
Collapse
Affiliation(s)
- Piergiorgio Gamba
- Pediatric Surgery, Department of Woman and Child Health, University Hospital, Via Giustiniani 3, Padua 35121, Italy.
| | - Paola Midrio
- Pediatric Surgery, Department of Woman and Child Health, University Hospital, Via Giustiniani 3, Padua 35121, Italy
| |
Collapse
|
17
|
Carnaghan H, Pereira S, James CP, Charlesworth PB, Ghionzoli M, Mohamed E, Cross KMK, Kiely E, Patel S, Desai A, Nicolaides K, Curry JI, Ade-Ajayi N, De Coppi P, Davenport M, David AL, Pierro A, Eaton S. Is early delivery beneficial in gastroschisis? J Pediatr Surg 2014; 49:928-33; discussion 933. [PMID: 24888837 DOI: 10.1016/j.jpedsurg.2014.01.027] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 01/27/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Gastroschisis neonates have delayed time to full enteral feeds (ENT), possibly due to bowel exposure to amniotic fluid. We investigated whether delivery at <37weeks improves neonatal outcomes of gastroschisis and impact of intra/extra-abdominal bowel dilatation (IABD/EABD). METHODS A retrospective review of gastroschisis (1992-2012) linked fetal/neonatal data at 2 tertiary referral centers was performed. Primary outcomes were ENT and length of hospital stay (LOS). Data (median [range]) were analyzed using parametric/non-parametric tests, positive/negative predictive values, and regression analysis. RESULTS Two hundred forty-six patients were included. Thirty-two were complex (atresia/necrosis/perforation/stenosis). ENT (p<0.0001) and LOS (p<0.0001) were reduced with increasing gestational age. IABD persisted to last scan in 92 patients, 68 (74%) simple (intact/uncompromised bowel), 24 (26%) complex. IABD or EABD diameter in complex patients was not significantly greater than simple gastroschisis. Combined IABD/EABD was present in 22 patients (14 simple, 8 complex). When present at <30weeks, the positive predictive value for complex gastroschisis was 75%. Two patients with necrosis and one atresia had IABD and collapsed extra-abdominal bowel from <30weeks. CONCLUSION Early delivery is associated with prolonged ENT/LOS, suggesting elective delivery at <37weeks is not beneficial. Combined IABD/EABD or IABD/collapsed extra-abdominal bowel is suggestive of complex gastroschisis.
Collapse
Affiliation(s)
- Helen Carnaghan
- UCL Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | - Susana Pereira
- The Harris Birthright Centre for Fetal Medicine, King's College Hospital, London, UK
| | | | | | - Marco Ghionzoli
- UCL Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | - Elkhouli Mohamed
- Fetal Medicine Unit, University College London Hospital, London, UK
| | - Kate M K Cross
- UCL Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | - Edward Kiely
- UCL Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | - Shailesh Patel
- Paediatric Surgery Unit, King's College Hospital, London, UK
| | - Ashish Desai
- Paediatric Surgery Unit, King's College Hospital, London, UK
| | - Kypros Nicolaides
- The Harris Birthright Centre for Fetal Medicine, King's College Hospital, London, UK
| | - Joseph I Curry
- UCL Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | - Niyi Ade-Ajayi
- Paediatric Surgery Unit, King's College Hospital, London, UK
| | - Paolo De Coppi
- UCL Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | - Mark Davenport
- Paediatric Surgery Unit, King's College Hospital, London, UK
| | - Anna L David
- Fetal Medicine Unit, University College London Hospital, London, UK
| | - Agostino Pierro
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Simon Eaton
- UCL Institute of Child Health and Great Ormond Street Hospital for Children, London, UK.
| |
Collapse
|
18
|
Faugstad TM, Brantberg A, Blaas HGK, Vogt C. Prenatal examination and postmortem findings in fetuses with gastroschisis and omphalocele. Prenat Diagn 2014; 34:570-6. [DOI: 10.1002/pd.4350] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 01/14/2014] [Accepted: 02/26/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Tone Maeland Faugstad
- Faculty of Medicine; Norwegian University of Science and Technology (NTNU); Trondheim Norway
| | - Anne Brantberg
- National Center for Fetal Medicine, Department of Obstetrics and Gynecology; St Olavs Hospital, Trondheim University Hospital; Trondheim Norway
| | - Harm-Gerd K. Blaas
- National Center for Fetal Medicine, Department of Obstetrics and Gynecology; St Olavs Hospital, Trondheim University Hospital; Trondheim Norway
- Department of Laboratory Medicine, Children's and Women's Health; Norwegian University of Science and Technology (NTNU); Trondheim Norway
| | - Christina Vogt
- Department of Laboratory Medicine, Children's and Women's Health; Norwegian University of Science and Technology (NTNU); Trondheim Norway
- Department of Pathology and Medical Genetics; St Olavs Hospital, Trondheim University Hospital; Trondheim Norway
| |
Collapse
|
19
|
Lepigeon K, Van Mieghem T, Vasseur Maurer S, Giannoni E, Baud D. Gastroschisis--what should be told to parents? Prenat Diagn 2014; 34:316-26. [PMID: 24375446 DOI: 10.1002/pd.4305] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 12/13/2013] [Accepted: 12/14/2013] [Indexed: 11/09/2022]
Abstract
Gastroschisis is a common congenital abdominal wall defect. It is almost always diagnosed prenatally thanks to routine maternal serum screening and ultrasound screening programs. In the majority of cases, the condition is isolated (i.e. not associated with chromosomal or other anatomical anomalies). Prenatal diagnosis allows for planning the timing, mode and location of delivery. Controversies persist concerning the optimal antenatal monitoring strategy. Compelling evidence supports elective delivery at 37 weeks' gestation in a tertiary pediatric center. Cesarean section should be reserved for routine obstetrical indications. Prognosis of infants with gastroschisis is primarily determined by the degree of bowel injury, which is difficult to assess antenatally. Prenatal counseling usually addresses gastroschisis issues. However, parental concerns are mainly focused on long-term postnatal outcomes including gastrointestinal function and neurodevelopment. Although infants born with gastroschisis often endure a difficult neonatal course, they experience few long-term complications. This manuscript, which is structured around common parental questions and concerns, reviews the evidence pertaining to the antenatal, neonatal and long-term implications of a fetal gastroschisis diagnosis and is aimed at helping healthcare professionals counsel expecting parents.
Collapse
Affiliation(s)
- Karine Lepigeon
- Materno-fetal & Obstetrics Research Unit, Department of Obstetrics and Gynecology, University Hospital, 1011, Lausanne, Switzerland
| | | | | | | | | |
Collapse
|
20
|
Outcomes of early versus late intestinal operations in patients with gastroschisis and intestinal atresia: results from a prospective national database. J Pediatr Surg 2013; 48:2022-6. [PMID: 24094951 DOI: 10.1016/j.jpedsurg.2013.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 03/05/2013] [Accepted: 04/09/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Gastroschisis may be complicated by intestinal atresia, necrosis, and/or perforation. In the absence of an urgent indication, intestinal procedures are often delayed to allow for bowel recovery. This practice has not been evaluated. METHODS We queried a prospective Canadian database of all patients with gastroschisis born between 2005 and 2011. Patients with intestinal atresia who underwent an intestinal operation during the first 21 days of life (EARLY GROUP) were compared with those who underwent operations later (LATE GROUP). RESULTS Of 629 gastroschisis patients, 78 (12.4%) had intestinal complications; 27 patients (4.3%) had intestinal operations for atresia without necrosis or perforation - 14 EARLY and 13 LATE. Baseline clinical parameters were similar between the two groups. There was a decreased incidence of the following complications in the EARLY group but none reached statistical significance: post-operative bowel obstruction (28.6% vs. 61.5%, p = 0.1); line sepsis (14.3% vs. 30.8 %, p = 0.4); and wound infection (14.3% vs. 46.1%, p = 0.1). Earlier tolerance of enteral feeding in the EARLY group was manifested by younger age at first enteral feeding (14.8 + 2.6 vs. 44.7 + 7.4 days, p = 0.002) and higher tolerance of enteral feeding at 28 days of life [less patients exclusively on TPN (28.6% vs. 61.5%, p = 0.06), and more patients on more than 50 cc kg(-1)day(-1) of enteral feeding (42.9% vs. 7.7%, p = 0.08)]. CONCLUSIONS Early intestinal operations in patients with gastroschisis and intestinal atresia are not associated with increased complications, and allow patients to receive and tolerate enteral feeding earlier.
Collapse
|
21
|
Blondiaux E, Guilbaud L, Auber F, Rosenblatt J, Richard F, Jouannic JM, le Pointe HD, Garel C. A challenging case of late-onset gastroschisis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 40:610-611. [PMID: 22581588 DOI: 10.1002/uog.11153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
|
22
|
Wilson MS, Carroll MA, Braun SA, Walsh WF, Pietsch JB, Bennett KA. Is preterm delivery indicated in fetuses with gastroschisis and antenatally detected bowel dilation? Fetal Diagn Ther 2012; 32:262-6. [PMID: 22813923 DOI: 10.1159/000338925] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 04/18/2012] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Due to the controversy surrounding diagnostic ultrasound evaluations and elective preterm delivery of fetuses with gastroschisis, we sought to calculate the predictive value of bowel dilation in fetuses with gastroschisis and evaluate the effect of preterm delivery on neonatal outcomes. MATERIALS AND METHODS Ultrasounds and medical records of 103 mother-infant pairs with fetal gastroschisis were reviewed. Eighty-nine pairs met the criteria. Intestinal complications, gestational age at delivery, birth weight, and number of abdominal surgeries were documented. RESULTS Forty-eight fetuses (54%) had bowel dilation and 41 (46%) did not. The positive predictive value of bowel dilation for complicated gastroschisis was 21%. There were 50 (56%) preterm and 39 (44%) term deliveries. The mean birth weight was 2,114 g (SD = 507) and 2,659 g (SD = 687), p = 0.001. For infants delivered preterm, the mean number of postnatal abdominal surgeries was 2.1 (SD = 1.1) as compared to 1.3 (SD = 0.5) surgical procedures for those infants delivered at term gestation. This was not statistically significant. With respect to hospital stay for each group, the mean length of neonatal intensive care unit admission was 48 days (SD = 33) in the preterm group and 35 days (SD = 50) in the term group, which was not statistically significant. DISCUSSION Ultrasound-detected bowel dilation was not predictive of important intestinal complications. Our data did not substantiate any benefit for elective preterm delivery of neonates with gastroschisis.
Collapse
Affiliation(s)
- Megan S Wilson
- Junior League Center for Advanced Maternal Fetal Care, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | | | | | | | | | | |
Collapse
|
23
|
Mousty E, Chalouhi GE, El Sabbagh A, Khen-Dunlop N, Kuleva M, Salomon LJ, Ville Y. Secondary bladder herniation in isolated gastroschisis justifies increased surveillance. Prenat Diagn 2012; 32:888-92. [PMID: 22718102 DOI: 10.1002/pd.3928] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2011] [Revised: 05/22/2012] [Accepted: 05/26/2012] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To assess the perinatal outcome of fetuses with gastroschisis complicated by secondary bladder herniation. POPULATION AND MATERIALS: This was a retrospective study of all cases of isolated gastroschisis associated with bladder herniation managed at our institution. Prenatal ultrasound, obstetrical and perinatal information were collected. Pathology reports were also gathered. RESULTS Out of 105 cases of gastroschisis managed at our institution, six (5.7%) were associated with secondary bladder herniation, two of them being diagnosed postnatally. Median gestational age at diagnosis of bladder herniation was 33.6 weeks (range 31-36) in five female and one male fetuses. Bladder herniation was associated with bowel dilatation in four cases (67%) and with pyelic dilatation in one case (17%). Despite increased surveillance, one male fetus died in utero. In four other cases, cesarean section was performed for fetal distress (three cases) or hyperechogenic bowels (one case). The five survivors had primary abdominal closure (n = 2) or staged repair (n = 3) with uneventful follow-up. CONCLUSION Bladder herniation was present in 6% of apparently isolated gastroschisis. There was one intrauterine fetal death and four other cases were delivered for fetal distress. Increased surveillance seems justified.
Collapse
Affiliation(s)
- E Mousty
- Department of Obstetrics and Fetal Medicine, Necker-Enfants-Malades Medical School, Paris Descartes University, 149 rue de Sèvres, 75015, Paris, France
| | | | | | | | | | | | | |
Collapse
|
24
|
Kuleva M, Salomon LJ, Benoist G, Ville Y, Dumez Y. The value of daily fetal heart rate home monitoring in addition to serial ultrasound examinations in pregnancies complicated by fetal gastroschisis. Prenat Diagn 2012; 32:789-96. [DOI: 10.1002/pd.3903] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- M. Kuleva
- Department of Obstetrics and Gynecology, Hôpital Necker Enfants Malades, Assistance Publique, Hôpitaux de Paris; Université Paris Descartes; Paris; France
| | | | | | | | - Y. Dumez
- Department of Obstetrics and Gynecology, Hôpital Necker Enfants Malades, Assistance Publique, Hôpitaux de Paris; Université Paris Descartes; Paris; France
| |
Collapse
|
25
|
Ghionzoli M, James CP, David AL, Shah D, Tan AWC, Iskaros J, Drake DP, Curry JI, Kiely EM, Cross K, Eaton S, De Coppi P, Pierro A. Gastroschisis with intestinal atresia--predictive value of antenatal diagnosis and outcome of postnatal treatment. J Pediatr Surg 2012; 47:322-8. [PMID: 22325384 DOI: 10.1016/j.jpedsurg.2011.11.022] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Accepted: 11/10/2011] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this study is to evaluate (1) the predictive value of fetal bowel dilatation (FBD) for intestinal atresia in gastroschisis and (2) the postnatal management and outcome of this condition. METHODS A retrospective review of all gastroschisis cases diagnosed in our fetal medicine unit between 1992 and 2010 and treated postnatally in our center was performed. RESULTS One hundred thirty cases had full postnatal data available. Intestinal atresia was found at surgery in 14 neonates (jejunum, n = 6; ileum, n = 3; ascending colon, n = 3; multiple, n = 2). Polyhydramnios and FBD were more likely in the atresia group compared with infants with no atresia (P = .0003 and P = .005, respectively). Fetal bowel dilatation had 99% negative predictive value (95% confidence interval, 0.9-0.99) and 17% positive predictive value (95% confidence interval, 0.1-0.3) for atresia. Treatment of intestinal atresia included primary anastomosis (n = 5), delayed anastomosis (n = 2), and stoma formation followed by anastomosis (n = 7). Infants with atresia had longer duration of parenteral nutrition, higher incidence of sepsis, and cholestasis compared with infants with no atresia (P = .0003). However, the presence of atresia did not increase mortality. CONCLUSIONS Polyhydramnios and FBD are associated with atresia. Absence of FBD in gastroschisis excludes intestinal atresia. In our experience, atresia is associated with a longer duration of parenteral nutrition but does not influence mortality. These findings may be relevant for antenatal counseling.
Collapse
Affiliation(s)
- Marco Ghionzoli
- Surgery Unit, Institute of Child Health and Great Ormond Street Hospital, London, WC1N 1EH, England
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Olischar M, Davidson AJ, Lee KJ, Hunt RW. Effects of morphine and midazolam on sleep-wake cycling in amplitude-integrated electroencephalography in post-surgical neonates ≥ 32 weeks of gestational age. Neonatology 2012; 101:293-300. [PMID: 22286323 DOI: 10.1159/000334636] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 10/08/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Studies of children who undergo major non-cardiac surgery in the neonatal period are needed so that subsequent abnormal neurodevelopment can be better understood. OBJECTIVE It was the aim of our study to describe the influence of analgesic and sedative medication on the predominant background pattern and the development of sleep-wake cycling (SWC), as measured on amplitude-integrated electroencephalography (aEEG), in newborn infants born ≥ 32 weeks' gestation after major non-cardiac surgery. METHODS This prospective study included infants ≥ 32(+0) weeks' gestation admitted to the Neonatal Intensive Care Unit at The Royal Children's Hospital in Melbourne who were undergoing major non-cardiac surgery. Data on morphine and midazolam given after surgery were recorded and the BrainZ Monitor was applied post-operatively. The maximum levels of morphine and midazolam were assessed as predictors of time to aEEG outcomes using linear regression. RESULTS Forty-seven eligible infants were included. Emergence of SWC was observed at a mean of 13 h after surgery. The maximum dose of morphine or midazolam was not predictive of time to either any or developed SWC. CONCLUSIONS Despite high doses of morphine and midazolam, SWC was observed on aEEG in neonates ≥ 32 weeks' gestational age soon after major non-cardiac surgery. The aEEG background pattern was not affected by the maximum dose of either morphine or midazolam.
Collapse
Affiliation(s)
- Monika Olischar
- Department of Neonatology, University Children's Hospital, Vienna, Austria
| | | | | | | |
Collapse
|
27
|
Payne NR, Simonton SC, Olsen S, Arnesen MA, Pfleghaar KM. Growth restriction in gastroschisis: quantification of its severity and exploration of a placental cause. BMC Pediatr 2011; 11:90. [PMID: 22004141 PMCID: PMC3214135 DOI: 10.1186/1471-2431-11-90] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Accepted: 10/17/2011] [Indexed: 11/21/2022] Open
Abstract
Background Gastroschisis patients are commonly small for gestational age (SGA, birth weight [BW] < 10th centile). However, the extent, symmetry and causes of that growth restriction remain controversial. Methods We compared BW, crown-heel length (LT), occipitofrontal circumference (OFC) and ponderal index (PI) in 179 gastroschisis cases and 895 matched controls by univariate and multiple regression. Fetal ultrasounds (N = 80) were reviewed to determine onset of growth restriction. Placental histology was examined in 31 gastroschisis patients whose placental tissue was available and in 29 controls. Results Gastroschisis cases weighed less than controls (BW = 2400 ± 502 g vs. 2750 ± 532 g, p < 0.001) and their BW frequency curve was shifted to the left, indicating lower BW as a group compared to controls (p < 0.001 by Kolmogorov-Smirnov test). BW differences varied from -148 g at 33 weeks to -616 g at 38 weeks gestation. Intrauterine growth restriction was symmetric with gastroschisis patients having a shorter LT (45.7 ± 3.3 vs. 48.4 ± 2.7 cm, p < 0.001), smaller OFC (31.9 ± 1.9 vs. 32.9 ± 1.6 cm, p < 0.001), but larger ponderal index (2.51 ± 0.37 vs. 2.40 ± 0.16, p < 0.001) compared to controls. Gastroschisis patients had a similar reduction in BW (-312 g, 95% confidence interval [CI] = -367, -258) compared to those with chromosomal abnormalities (-239 g, CI = -292, -187). Growth deficits appeared early in the second trimester and worsened as gestation increased. Placental chorangiosis was more common in gastroschisis patients than controls, even after removing all SGA patients (77% vs. 42%, p = 0.02). Conclusions Marked, relatively symmetric intrauterine growth restriction is an intrinsic part of gastroschisis. It begins early in the second trimester, and is associated with placental chorangiosis.
Collapse
Affiliation(s)
- Nathaniel R Payne
- Department of Epidemiology, Michigan State University, East Lansing, MI 48824, USA.
| | | | | | | | | |
Collapse
|
28
|
Abstract
Gastroschisis (GS) continues to increase in frequency, with several studies now reported an incidence of between 4 and 5 per 10,000 live births. The main risk factor would seem to be young maternal age, and it is in this group that the greatest increase has occurred. Whilst various geographical regions confer a higher risk, the impact of several other putative risk factors, including smoking and illicit drug use, may be less important than when first identified in early epidemiological studies. Over 90% of cases of GS will now be diagnosed on antenatal ultrasound, but its value in determining the need for early delivery remains unclear. There would appear no clear evidence for either routine early delivery or elective caesarean section for infants with antenatally diagnosed GS. Delivery at a centre with paediatric surgical facilities reduces the risk of subsequent morbidity and should represent the standard of care. The relative roles of primary closure, staged closure and ward reduction, with or without general anaesthesia, appear less clear with considerable variation between centres in both the use of these techniques and subsequent surgical outcomes. Survival rates continue to improve, with rates well in excess of 90% now routine. The limited long-term developmental data available would suggest that normal or near-normal outcomes may be expected although there remains a need for further studies.
Collapse
|
29
|
Lobo JD, Kim AC, Davis RP, Segura BJ, Alpert H, Teitelbaum DH, Geiger JD, Mychaliska GB. No free ride? The hidden costs of delayed operative management using a spring-loaded silo for gastroschisis. J Pediatr Surg 2010; 45:1426-32. [PMID: 20638519 DOI: 10.1016/j.jpedsurg.2010.02.047] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Revised: 02/11/2010] [Accepted: 02/12/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE The ideal management of gastroschisis (primary vs staged closure) has not yet been established. Despite the ease of silo placement, anecdotal experience shows that silos do not always offer benefit. The aim of this study was to highlight concerns regarding use of spring loaded silos and compare outcomes to primary closure. METHODS Thirty-seven neonates with gastroschisis treated with either primary (n = 10) or staged closure with a spring-loaded silo (n = 27) were reviewed (1998-2007). Variables included ventilator days, daily intravenous fluid, hospital days, and complication rates. SPSS (SPSS Inc, Chicago, Ill) was used to perform t test and chi(2) analyses (significance P < .05). RESULTS Survival for primary closure was 100% (10/10) compared to 89% (24/27) for staged closure (P = .548). Patients managed with silos required prolonged ventilation (16.1 +/- 4 days vs 3.6 +/- 1 days; P < or = .05) and greater intravenous fluids on days 3, 4, and 5 of life (132 +/- 25 mL/kg per day vs 104 +/- 18 mL/kg per day; P < or = .01). Although there was no difference in the complication rates between the groups, several problems were evident in the silo group: 15% (4/27) required silo replacement, 44% (12/27) required fascial defect enlargement for silo placement, and 19% (5/27) required mesh at closure. No significant differences in recovery of intestinal function were observed. Three silo patients developed ischemic complications because of vascular insufficiency at the level of the abdominal wall, leading to significant intestinal loss, ventilator and total parenteral nutrition dependence, and increased hospital stay. CONCLUSIONS Patients managed with a silo had longer ventilator requirements and greater fluid needs. This Specific technical complications leading to bowel ischemia were notable in the silo group. The silo should be carefully placed to avoid bowel twisting and the funnel effect. Larger prospective studies should be performed to provide decision-making criteria for the use of a silo vs primary closure.
Collapse
Affiliation(s)
- Jennifer D Lobo
- Section of Pediatric Surgery, Department of Surgery, The University of Michigan Medical School and The C.S. Mott Children's Hospital, Box 0245, Ann Arbor, MI 48109, USA
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Benjamin BG, Ethen MK, Van Hook CL, Myers CA, Canfield MA. Gastroschisis prevalence in Texas 1999-2003. ACTA ACUST UNITED AC 2010; 88:178-85. [PMID: 19950387 DOI: 10.1002/bdra.20642] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The worldwide prevalence of gastroschisis is increasing. Maternal age, race/ethnicity, and place of residence have been associated with increased risk. METHODS We obtained descriptive characteristics of mothers of infants with gastroschisis and mothers of all live births from the Texas Birth Defects Registry and Texas vital records for 1999-2003. We calculated prevalence, crude prevalence ratios, and prevalence ratios adjusted for maternal age, parity, education, race/ethnicity, and geographic entity (Mexican border proximity, urban/rural residence, health service region, and county). RESULTS We observed 764 cases of gastroschisis among 1,827,317 live births, for a prevalence of 4.18 per 10,000 births (95% confidence interval 3.88-4.48). Prevalence increased during 1999-2003 (p for trend <0.02). Infants of young and nulliparous mothers were at greatest risk in crude analyses. Other characteristics associated with increased risk were 12 or fewer years of education, border residence, and Hispanic ethnicity. Black mothers were at lower risk. When adjusted for maternal age, race/ethnicity, education, parity, and residence, we found that border residence, educational level, and Hispanic race/ethnicity were no longer significant, but young mothers and nulliparous mothers remained at higher risk, and blacks at reduced risk. Differences in prevalence observed between regions and counties largely disappeared when adjusted for maternal factors. No significant difference between urban and rural residence was found. CONCLUSION The prevalence of gastroschisis increased in Texas during 1999-2003. Black mothers were at lower risk, and Hispanic mothers were at no greater risk than whites. No differences were found between urban/rural or border/nonborder residents.
Collapse
Affiliation(s)
- Bonna G Benjamin
- Department of Pediatrics, Texas Tech University Health Sciences Center, Amarillo, Texas 79106, USA.
| | | | | | | | | |
Collapse
|
31
|
Clark RH, Walker MW, Gauderer MWL. Prevalence of gastroschisis and associated hospital time continue to rise in neonates who are admitted for intensive care. J Pediatr Surg 2009; 44:1108-12. [PMID: 19524725 DOI: 10.1016/j.jpedsurg.2009.02.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2009] [Accepted: 02/17/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study was to evaluate recent trends in the prevalence of gastroschisis. METHODS The study used a retrospective review of a deidentified neonatal intensive care patient data set. To control for ascertainment bias, the prevalence of omphalocele was calculated to provide an internal comparison to another anomaly requiring surgical intervention. RESULTS During the study period (1997-2007), there were 473,366 discharges from the neonatal intensive care unit in the data set. There were 2057 (5.3/1000 discharges) neonates who had a gastroschisis and 853 (1.8/1000 discharges) who had an omphalocele. Between 1997 and 2004, the reported rate of gastroschisis increased from 2.9 to 6.1/1000 discharges, a relative increase of 210% (P < .001). Since 2004, the values have remained relatively stable at between 5.5 and 6.2/1000 discharges. Between 1997 and 2007, the hospital days for patients with gastroschisis/total hospital days increased from 0.6% to 1.3%, a relative increase of 220% (P < .001). In contrast, the reported rate of neonates with and the number of hospital days attributed to neonates with omphalocele has not changed significantly. CONCLUSION The prevalence and the number of hospital days needed to care for neonates with gastroschisis have continued to increase since 2001.
Collapse
Affiliation(s)
- Reese H Clark
- The Pediatrix-Obstetrix Center for Research and Education, Sunrise, FL 33323-2825, USA.
| | | | | |
Collapse
|
32
|
Durkin EF, Shaaban A. Commonly encountered surgical problems in the fetus and neonate. Pediatr Clin North Am 2009; 56:647-69, Table of Contents. [PMID: 19501697 DOI: 10.1016/j.pcl.2009.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Neonatal surgical care requires a current understanding of pre- and postnatal intervention for a myriad of congenital anomalies. This article includes an update of the recent information on commonly encountered fetal and neonatal surgical problems, highlighting specific areas of controversy and challenges in diagnosis. The authors hope that this article is useful for trainees and practitioners involved in any aspect of fetal and neonatal care.
Collapse
Affiliation(s)
- Emily F Durkin
- Department of Surgery, University of Wisconsin, School of Medicine and Public Health, H4/325 Clinical Science Center, Madison, WI 53798, USA
| | | |
Collapse
|