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Gastroschisis prognostic score successfully identifies Brazilian newborns with high-risk gastroschisis. J Pediatr Surg 2022; 57:298-302. [PMID: 35321798 DOI: 10.1016/j.jpedsurg.2022.02.009] [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] [Received: 08/31/2021] [Revised: 01/31/2022] [Accepted: 02/12/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND The Gastroschisis Prognostic Score (GPS) stratifies patients as high or low risk based on the visual assessment of intestinal matting, atresia, perforation, or necrosis. Despite being a simple score, its applicability to low and middle-income countries (LMICs) remains unknown. We tested the hypothesis that GPS can predict outcomes in LMICs, by assessing the prognostic value of the GPS in a middle-income country. METHODS This prospective study followed all newborns with gastroschisis in a Brazilian neonatal unit based in a public hospital from 2015-2019. Infants were stratified into low and high-risk cohorts based on the GPS. In addition to basic demographics, data collected included duration of parenteral nutrition (TPN), mechanical ventilation (MV), length of stay (LOS), suspicion of infection that led to the use of antibiotics, and mortality. Univariate and multivariate analyses were conducted to identify which outcomes the GPS independently predicted. RESULTS Sixty-one newborns with gastroschisis were treated during the study period. The mean birth weight, gestational age, and 5' Apgar score were 2258 g, 36 weeks, and 9. Twenty-four infants (39.3%) were identified as low-risk (GPS < 2) and 37 (60.7%) as high-risk (GPS > 2). The high-risk group presented with prolonged TPN use (p<0.001), MV (p<0.001), and LOS (p:0.002). GPS did not predict antibiotic therapy or mortality. CONCLUSION In the first study in a middle-income country, the GPS predicted several important clinical outcomes. The GPS is a reliable tool for parental counseling and resource allocation in diverse settings. LEVEL OF EVIDENCE II.c (cohort prospective).
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Kapapa M, Rieg T, Serra A. Does meconium contaminated amniotic fluid affect intestinal wall thickness and functional outcome in patients with anterior abdominal wall defects? Afr J Paediatr Surg 2022; 19:46-51. [PMID: 34916352 PMCID: PMC8759423 DOI: 10.4103/ajps.ajps_8_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Gastroschisis (GS) and omphalocele (OC) are congenital abdominal wall defects, the main difference between is the direct exposure of intestinal loops in amniotic fluid in children with a GS. This leads to a reduced primary closure rate and a higher number of intraoperative abnormalities and post-operative complications. AIMS AND OBJECTIVES We analysed abdominal wall defect patients over an 11-year period, aiming to assess the influence of meconium-contaminated amniotic fluid. This study has different objectives to show the consequence of functional outcome of abdominal wall defects (AWD) children in reliance to colour of amniotic fluid, to assess the effect of reduced bowel exposure time to meconium contaminated amniotic fluid on edematous inflammatory thickening of the bowel loops, to show an positively influence in the number of primary AWD closures, to demonstrate a reduced incidence of post-natal complications and to verify a better outcome of OC children because of failing exposure to amniotic fluid. METHODS A retrospective, observational case-control design was used to compare GS (n = 36) and OC (n = 18) children. Physical data, colour of amniotic fluid, pre- and perinatal problems, operative complications and surgical technique, post-operative complications, duration of intensive care unit (ICU) stay, mechanical ventilation, parenteral nutrition, commencement of oral feeding and total hospital stay were collected. Data were analysed with descriptive methods, t-test and non-parametric tests such as Wilcoxon and Kruskal-Wallis were performed in addition to the analysis of variance, including post hoc testing accepting a confidence interval of 95% (P < 0.05) by using IBM SPSS software, version 23 (IBM, Illinois, USA). RESULTS Rate of meconium-contaminated amniotic fluid is significantly higher in GS compared to OC (P < 0.001), delivery problems such as congenital infections are also significantly higher (P < 0.001), this yields in significantly more bowel loops anomalies and problems during surgery (P < 0.036) but had no significant influence on primary abdominal wall closures rate (P = 0.523). The post-surgical outcome of OC was significantly better as compared to GS. Within the GS, those with swollen intestines had significantly longer ICU stays (P = 0.045) due to extended mechanical ventilation (P = 0.007), parenteral nutrition (P = 0.011) and delayed initiation of oral feeding (P < 0.001. Same results were found for the duration of ICU stay (P = 0.008), mechanical ventilation (P = 0.006), parenteral nutrition (P = 0.011) and delayed initiation of oral feeding (P < 0.001) in secondary closures as compared to primary abdominal wall closures in the GS group. CONCLUSIONS Worsen functional short-term outcome of GS children was directly addicted to meconium contamination of amniotic fluid due to swollen intestines and because of this more post-surgical problem including significantly extended hospital stays were observed.
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Affiliation(s)
- Melanie Kapapa
- Department of Surgery, Division of Pediatric Surgery, University Ulm Medical Centre, Eythstrasse, Ulm, Germany
| | - Teresa Rieg
- Department of Gynaecology and Obstetrics, Hospital Heidenheim, Heidenheim an der Brenz, Germany
| | - Alexandre Serra
- Department of Surgery, Division of Pediatric Surgery, University Ulm Medical Centre, Eythstrasse, Ulm, Germany
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Chabra S, Peterson SE, Cheng EY. Development of a prenatal clinical care pathway for uncomplicated gastroschisis and literature review. J Neonatal Perinatal Med 2021; 14:75-83. [PMID: 32145003 DOI: 10.3233/npm-190277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Gastroschisis is an abdominal wall defect wherein the bowel is herniated into the amniotic fluid. Controversy exists regarding optimal prenatal surveillance strategies that predict fetal well-being and help guide timing of delivery. Our objective was to develop a clinical care pathway for prenatal management of uncomplicated gastroschisis at our institution. METHODS We performed a review of literature from January 1996 to May 2017 to evaluate prenatal ultrasound (US) markers and surveillance strategies that help determine timing of delivery and optimize outcomes in fetal gastroschisis. RESULTS A total 63 relevant articles were identified. We found that among the US markers, intraabdominal bowel dilatation, polyhydramnios, and gastric dilatation are potentially associated with postnatal complications. Prenatal surveillance strategy with monthly US starting at 28weeks of gestational age (wGA) and twice weekly non-stress testing beginning at 32wGA is recommended to optimize fetal wellbeing. Timing of delivery should be based on obstetric indications and elective preterm delivery prior to 37wGA is not indicated. CONCLUSIONS Close prenatal surveillance of fetal gastroschisis is necessary due to the high risk for adverse outcomes including intrauterine fetal demise in the third trimester. Decisions regarding the timing of delivery should take into consideration the additional prematurity-associated morbidity.
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Affiliation(s)
- Shilpi Chabra
- Department of Pediatrics, Division of Neonatology, Seattle Children's Hospital and University of Washington, Seattle, WA, USA
| | - Suzanne E Peterson
- Department of Obstetrics/Gynecology, Division of Maternal-Fetal Medicine Swedish Medical Center, Seattle, WA, USA
| | - Edith Y Cheng
- Department of Obstetrics/Gynecology, Division of Maternal-Fetal Medicine, Seattle Children's Hospital and University of Washington Medical Center, Seattle, WA, USA
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Di Filippo D, Henry A, Patel J, Jiwane A, Welsh AW. Fetal abdominal wall defects in an Australian tertiary setting: contemporary characteristics, ultrasound accuracy, and outcome. J Matern Fetal Neonatal Med 2019; 34:1269-1276. [PMID: 31242785 DOI: 10.1080/14767058.2019.1633303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE In this study, we aimed to comprehensively evaluate risk factors, ultrasound estimation of fetal weight, prenatal management, and pregnancy outcomes of gastroschisis and omphalocele at a metropolitan Australian hospital. MATERIAL AND METHODS This was a retrospective single-center cohort study from 2006 to 2014 at a tertiary hospital with colocated neonatal surgical facilities. Demographic, pregnancy, ultrasound, birth and neonatal data were compared between gastroschisis and omphalocele. Correlation between routine (Hadlock 1 &2) and specific (Siemer) estimated fetal weight (EFW) estimation formulae with birth weight (BW) was made for those 50 gastroschisis cases with ≥2 third trimester scans and last scan ≤2 weeks prior to birth. RESULTS There were 126 abdominal wall defects: 83 gastroschisis and 43 omphalocele. Consistent with international literature, the average maternal age was lower for gastroschisis and rates of smoking higher, while there were more intrauterine deaths and pregnancy terminations in omphalocele. Gastroschisis mothers were more likely living outside Sydney, had more infections in pregnancy and were followed with a larger number of antenatal visits, with a shorter period from the last visit to birth. In omphalocele pregnancies, amniocentesis was more likely performed, with more abnormal results than in gastroschisis fetuses. All EFW formulae had a good correlation between Z score for the last US and actual BW (ICC 0.693-0.815), with Hadlock 2 being the best. Siemer formula had the best correlation from first to the last scan. Gastroschisis newborns were born earlier (36.8 versus 38.2 wks p = .001), with smaller birthweight (2.52 versus 3.03 kg, p < .001), a longer request of intensive care (central line, parenteral nutrition, intubation) and second surgery, along with more multisystem complications (average 1.5 versus 0.7, p = .004) and a longer hospital stay (58.8 versus 36.8 d, p < .001). CONCLUSION Demographic, antenatal, and pregnancy outcome data for abdominal wall defects correlated well with the international literature. Hadlock 1-2 gave the most consistent EFW estimate, with all formulae showing good correlation.
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Affiliation(s)
- Daria Di Filippo
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Amanda Henry
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Jamie Patel
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Ashish Jiwane
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Alec W Welsh
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia.,Department of Maternal Fetal Medicine, Royal Hospital for Women, Sydney, Australia
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Oakes MC, Porto M, Chung JH. Advances in prenatal and perinatal diagnosis and management of gastroschisis. Semin Pediatr Surg 2018; 27:289-299. [PMID: 30413259 DOI: 10.1053/j.sempedsurg.2018.08.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Gastroschisis is a congenital, ventral wall defect associated with bowel evisceration. The defect is usually to the right of the umbilical cord insertion and requires postnatal surgical correction. The fetus is at risk for complications such as intrauterine growth restriction, preterm delivery, and intrauterine fetal demise. In addition, complex cases, defined by the presence of intestinal complications such as bowel atresia, stenosis, perforation, or ischemia, occur in up to one third of pregnancies affected by gastroschisis. As complex gastroschisis is associated with increased morbidity and mortality, research has focused on the prenatal detection of this high risk subset of cases. The purpose of this review is to discuss the prenatal, diagnostic approach to the identification of gastroschisis, to describe potential signs of complex gastroschisis on prenatal ultrasound, to review current guidelines for antepartum management and delivery planning, and to summarize results of both past and current intervention trials in fetuses with gastroschisis.
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Affiliation(s)
- Megan C Oakes
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California Irvine Medical Center, Orange, CA, USA
| | - Manuel Porto
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California Irvine Medical Center, Orange, CA, USA
| | - Judith H Chung
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California Irvine Medical Center, Orange, CA, USA.
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Kojima Y, Ozawa K, Sugibayashi R, Wada S, Sago H. Stomach herniation prior to nonreassuring fetal status in a case of fetal gastroschisis. J Obstet Gynaecol Res 2018; 44:1322-1325. [PMID: 29797442 DOI: 10.1111/jog.13662] [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: 08/04/2017] [Accepted: 03/23/2018] [Indexed: 11/29/2022]
Abstract
The neonatal prognosis in gastroschisis is generally good; however, intrauterine fetal death (IUFD) and nonreassuring fetal status (NRFS) sometimes occur in fetal cases of gastroschisis. Previously, we reported stomach herniation as a possible risk factor for IUFD or NRFS in fetuses with gastroschisis. We report a case of fetal gastroschisis showing stomach herniation and increased velocity of the umbilical venous (UV) flow the day before NRFS by electronic fetal monitoring (EFM). A 27-year-old pregnant woman was followed up from 16 weeks' gestation due to fetal gastroschisis. At 33 + 1 weeks' gestation, EFM displayed a reassuring fetal state, while the ultrasound examination revealed fetal stomach herniation and an increased flow velocity of the UV in the abdomen. One day later, EFM displayed NRFS, and the patient underwent emergency caesarean section. This case showed stomach herniation preceding the occurrence of NRFS. Stomach herniation may be a predictor of NRFS in fetuses with gastroschisis.
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Affiliation(s)
- Yuki Kojima
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Katsusuke Ozawa
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Rika Sugibayashi
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Seiji Wada
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Haruhiko Sago
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
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Duncan J, Chotai P, Slagle A, Talati A, Huang E, Schenone M. Mode of delivery in pregnancies with gastroschisis according to delivery institution. J Matern Fetal Neonatal Med 2018; 32:2957-2960. [PMID: 29562799 DOI: 10.1080/14767058.2018.1450860] [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] [Indexed: 10/17/2022]
Abstract
Purpose: We aim to compare the mode of delivery in pregnancies with gastroschisis delivered in nonacademic institutions with those delivered in an academic center. Material and methods: Chart review from 2008 to 2015 was performed. Cesarean delivery rate (CDR), attempted vaginal delivery rate (AVR), planned cesarean rate (PCR) and adverse neonatal outcomes were compared among pregnancies with gastroschisis delivered in nonacademic hospitals with those delivered in an academic institution. Parametric and nonparametric statistical analysis was performed when appropriate. A multivariable logistic regression mode was utilized to control for confounders. A p value < .05 was considered significant. Results: Mode of delivery was documented in 94 cases (88%). CDR (76.7 versus 41.2%; odds ratios (OR), 4.7; 95%CI, 1.9-11.6) and PCR (55 versus 6.4%; OR 17.9; 95%CI, 4.8-67.4) were higher in those delivered in nonacademic centers. AVR was lower in the nonacademic group (45 versus 93.6%; OR 0.02; 95%CI, 0.01-0.2). Neonatal intensive care length of stay (56 days [IQR, 34-102 days] versus 36 days [IQR, 26-60 days; p = .018]) was longer in the nonacademic group. Other neonatal adverse outcomes studied were not statistically different between groups. Conclusions: In our population, delivery at nonacademic institutions in pregnancies with gastroschisis may be associated with higher cesarean delivery rates. These findings may add information for the delivery planning of pregnancies complicated by this condition. Rationale: In our study we aim to compare the mode of delivery in pregnancies with gastroschisis delivered in nonacademic institutions with those delivered in an academic center. Our results suggest, that delivery at nonacademic institutions in pregnancies with gastroschisis may be associated with higher cesarean delivery rates. These findings may add information for the delivery planning of pregnancies complicated by this condition.
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Affiliation(s)
- Jose Duncan
- a University of Tennessee Health Science Center , Memphis , TN , USA
| | - Pranit Chotai
- a University of Tennessee Health Science Center , Memphis , TN , USA
| | - Anna Slagle
- a University of Tennessee Health Science Center , Memphis , TN , USA
| | - Ajay Talati
- a University of Tennessee Health Science Center , Memphis , TN , USA
| | - Eunice Huang
- a University of Tennessee Health Science Center , Memphis , TN , USA
| | - Mauro Schenone
- a University of Tennessee Health Science Center , Memphis , TN , USA
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Perry H, Healy C, Wellesley D, Hall NJ, Drewett M, Burge DM, Howe DT. Intrauterine death rate in gastroschisis following the introduction of an antenatal surveillance program: Retrospective observational study. J Obstet Gynaecol Res 2017; 43:492-497. [DOI: 10.1111/jog.13245] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 10/14/2016] [Accepted: 10/21/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Helen Perry
- Wessex Fetal Medicine Unit; Princess Anne Hospital; Southampton, Hampshire UK
| | - Costa Healy
- Department of Paediatric Surgery and Urology; University Hospitals Southampton; Southampton, Hampshire UK
| | - Diana Wellesley
- Wessex Clinical Genetics Department; Princess Anne Hospital; Southampton, Hampshire UK
| | - Nigel J. Hall
- Department of Paediatric Surgery and Urology; Southampton, Hampshire UK
- Faculty of Medicine; Southampton, Hampshire UK
| | | | - David M. Burge
- Department of Paediatric Surgery and Urology; University Hospitals Southampton; Southampton, Hampshire UK
- University of Southampton; Southampton, Hampshire UK
| | - David T. Howe
- Wessex Fetal Medicine Unit; Princess Anne Hospital; Southampton, Hampshire UK
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Robertson JA, Kimble RM, Stockton K, Sekar R. Antenatal ultrasound features in fetuses with gastroschisis and its prediction in neonatal outcome. Aust N Z J Obstet Gynaecol 2016; 57:52-56. [PMID: 27874184 DOI: 10.1111/ajo.12565] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 10/04/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Gastroschisis is the most common major congenital anomaly managed by paediatric surgeons. The significance of certain associated antenatal ultrasound features in determining fetal outcome is under discussion. AIM The study aims to define if associated antenatal ultrasound features of gastroschisis are useful prognostic markers for fetal outcome. By establishing the significance of features, including extra- and intra-abdominal bowel dilatation, stomach herniation, stomach dilatation, bowel matting, growth restriction, abnormal umbilical artery (UA) Doppler ultrasounds, and abnormal amniotic fluid volume, it is hoped clinicians will have enhanced ability to counsel parents about the likely outcomes for their infant. MATERIALS AND METHODS Retrospective analysis of ultrasound images, reports and medical records of 101 pregnancies affected by fetal gastroschisis managed by the Royal Brisbane and Women's Hospital Maternal and Fetal Medicine Department over a 13 and a half year period was performed. The presence of ultrasound features during antenatal surveillance corresponded to fetal outcome measures, including the diagnosis of postnatal complex gastroschisis, the number of operations required, length of parenteral feeding and length of stay in neonatal intensive care. RESULTS The only statistically significant predictor of complex cases of gastroschisis was extra-abdominal bowel dilatation. Although a statistically significant feature, approximately three-quarters (44/59) of all infants with gastroschisis with associated extra-abdominal bowel dilatation had simple gastroschisis. CONCLUSIONS Extra-abdominal bowel dilatation is a statistically significant marker of complex gastroschisis and associated morbidity. Its presence in infants who had uncomplicated outcomes, suggests that clinically, its usefulness in antenatal counselling is still debatable.
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Affiliation(s)
| | - Roy M Kimble
- Department of Paediatric Surgery, Burns and Trauma, Lady Cilento Hospital, Brisbane, Queensland, Australia
| | - Kellie Stockton
- Department of Physiotherapy, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
| | - Renuka Sekar
- Department of Maternal Fetal Medicine Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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Bauseler A, Funke K, Möllers M, Hammer K, Steinhard J, Borowski M, Müller V, Klockenbusch W, Schmitz R. Outcome of fetuses with gastroschisis after modification of prenatal management strategies. Arch Gynecol Obstet 2015; 294:239-43. [DOI: 10.1007/s00404-015-3961-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 11/06/2015] [Indexed: 12/13/2022]
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