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Jaczyńska R, Mikulska B, Nimer A, Mydlak D, Sawicka E, Maciejewski T. Prenatal ultrasound markers for prediction of complex gastroschisis-single-center retrospective cohort study. J Perinatol 2024; 44:1325-1334. [PMID: 38898181 DOI: 10.1038/s41372-024-02009-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 04/22/2024] [Accepted: 05/14/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVE To evaluate prenatal ultrasound markers for distinguishing simple gastroschisis (sGS) from complex gastroschisis (cGS) and identifying fetuses at risk of complications. STUDY DESIGN A retrospective cohort study analyzed 61 fetuses with isolated gastroschisis at a tertiary center from 2011 to 2021, utilizing serial ultrasounds from 14 to 35 weeks' gestation. A general linear model, quantile regression, and logistic regression assessed ultrasound markers, fetal weeks, and gastroschisis risk, yielding predictive models. RESULTS IABL dilatation showed the highest PPV but low NPV. Non-free floating bowel loops (NFFBL) indicated the best PPV to NPV ratio. Combinations of markers yielded the highest predictive value for cGS. EABL collapsed and non-free floating bowel loops were significant, consistent risk factors. CONCLUSIONS Prenatal ultrasounds can predict cGS risk, particularly using IABL dilatation and NFFBL as markers. Accurate assessment requires considering gestational age, qualitative symptoms, emphasizing experienced perinatologists' role and monitoring, particularly after 30 weeks of gestation.
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Affiliation(s)
- Renata Jaczyńska
- Department of Obstetrics and Gyneacology, Institute of Mother and Child, Warsaw, Poland.
| | - Boyana Mikulska
- Department of Obstetrics and Gyneacology, Institute of Mother and Child, Warsaw, Poland
| | - Anna Nimer
- Department of Obstetrics and Gyneacology, Institute of Mother and Child, Warsaw, Poland
| | - Dariusz Mydlak
- Department of Pediatric and Adolescent Surgery, Institute of Mother and Child, Warsaw, Poland
| | - Ewa Sawicka
- Department of Pediatric and Adolescent Surgery, Institute of Mother and Child, Warsaw, Poland
| | - Tomasz Maciejewski
- Department of Obstetrics and Gyneacology, Institute of Mother and Child, Warsaw, Poland
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Burgos CM, Irvine W, Vivanti A, Conner P, Machtejeviene E, Peters N, Sabria J, Torres AS, Tognon C, Sgró A, Kouvisalo A, Langeveld-Benders H, Sfeir R, Miserez M, Qvist N, Lokosiute-Urboniene A, Zahn K, Brendel J, Prat J, Eaton S, Benachi A. European reference network for rare inherited congenital anomalies (ERNICA) evidence based guideline on the management of gastroschisis. Orphanet J Rare Dis 2024; 19:60. [PMID: 38347519 PMCID: PMC10860293 DOI: 10.1186/s13023-024-03062-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 02/03/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND The European Reference Network for rare Inherited Congenital Anomalies, ERNICA, guidelines for gastroschisis cover perinatal period to help teams to improve care. METHOD A systematic literature search including 136 publications was conducted. Research findings were assessed following the GRADE methodology. The evidence to decision framework was used to determine the strength and direction of recommendations. RESULTS The mode or timing of delivery do not impact neonatal mortality, risk of NEC or time on parenteral nutrition (PN). Intra or extra abdominal bowel dilatation predict complex gastroschisis and longer length of hospital stay but not increased perinatal mortality. Outcomes after Bianchi procedure and primary fascia closure under anesthesia are similar. Sutureless closure decreases the rate of surgical site infections and duration of ventilation compared to surgical closure. Silo-staged closure with or without intubation results in similar outcomes. Outcomes of complex gastroschisis (CG) undergoing early or delayed surgical repair are similar. Early enteral feeds starting within 14 days is associated with lower risk of surgical site infection. RECOMMENDATIONS The panel suggests vaginal birth between 37 and 39 w in cases of uncomplicated gastroschisis. Bianchi's approach is an option in simple gastroschisis. Sutureless closure is suggested when general anesthesia can be avoided, sutured closure. If anesthesia is required. Silo treatment without ventilation and general anesthesia can be considered. In CG with atresia primary intestinal repair can be attempted if the condition of patient and intestine allows. Enteral feeds for simple gastroschisis should start within 14 days.
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Affiliation(s)
- Carmen Mesas Burgos
- Department of Pediatric Surgery, Karolinska University Hospital, Eugeniavägen 23, C11:33, 17176, Stockholm, Sweden.
| | - Willemijn Irvine
- Department of Evidence Based Medicine and Methodology, Qualicura Healthcare Support Agency, Breda, The Netherlands
| | - Alexandre Vivanti
- Department of Obstetrics and Gynecology, Antoine Béclère Hospital, Paris Saclay University, Clamart, France
| | - Peter Conner
- Center for Maternal and Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Egle Machtejeviene
- Department of Gynecology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania
| | - Nina Peters
- Department of Gynecology and Obstetrics, Erasmus MC, Rotterdam, The Netherlands
| | - Joan Sabria
- Center for Maternal and Fetal Medicine, Hospital St Joan de Dieu, Barcelona, Spain
| | | | - Costanza Tognon
- Department of Neonatology, University of Padua, Padua, Italy
| | - Alberto Sgró
- Department of Pediatric Surgery, University of Padua, Padua, Italy
| | - Antti Kouvisalo
- Department of Pediatric Surgery, Helsinki University Hospital, Helsinki, Finland
| | | | - Rony Sfeir
- Department of Pediatric Surgery, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Marc Miserez
- Department of Surgery, UZ Leuven, Louvain, Belgium
| | - Nils Qvist
- Department of Pediatric Surgery, Odense University Hospital, Odense, Denmark
| | - Ausra Lokosiute-Urboniene
- Department of Pediatric Surgery, Lithuanian University of Health Sciences Kauno Klinikos, Kaunas, Lithuania
| | - Katrin Zahn
- Department of Pediatric Surgery, Mannheim, Germany
| | - Julia Brendel
- Department of Pediatric Surgery, Hannover Medical University, Hanover, Denmark
| | - Jordi Prat
- Department of Pediatric Surgery, Hospital S Joan de Diu, Barcelona, Spain
| | - Simon Eaton
- Department of Pediatric Surgery, Erasmus MC, Rotterdam, The Netherlands
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Alexandra Benachi
- Department of Obstetrics and Gynecology, Antoine Béclère Hospital, Paris Saclay University, Clamart, France
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Jaczyńska R, Mydlak D, Mikulska B, Nimer A, Maciejewski T, Sawicka E. Perinatal Outcomes of Neonates with Complex and Simple Gastroschisis after Planned Preterm Delivery-A Single-Centre Retrospective Cohort Study. Diagnostics (Basel) 2023; 13:2225. [PMID: 37443619 DOI: 10.3390/diagnostics13132225] [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: 06/08/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
This research analysed early neonatal outcomes of complex and simple gastroschisis following planned elective preterm delivery in relation to prenatal ultrasound assessment of bowel conditions. A retrospective study of 61 neonates with prenatal gastroschisis diagnosis, birth, and management at a single tertiary centre from 2011 to 2021 showed a 96.72% survival rate with no intrauterine fatalities. Most cases (78.7%) were simple gastroschisis. Neonates with complex gastroschisis had longer hospital stays and time to full enteral feeding compared to those with simple gastroschisis-75.4 versus 35.1 days and 58.1 versus 24.1 days, respectively. A high concordance of 86.90% between the surgeon's and perinatologist's bowel condition assessments was achieved. The caesarean delivery protocol demonstrated safety, high survival rate, primary closure, and favourable outcomes compared to other reports. Prenatal ultrasound effectively evaluated bowel conditions and identified complex gastroschisis cases.
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Affiliation(s)
- Renata Jaczyńska
- Department of Obstetrics and Gyneacology, Institute of Mother and Child, 01-211 Warsaw, Poland
| | - Dariusz Mydlak
- Department of Pediatrics Surgery, Institute of Mother and Child, 01-211 Warsaw, Poland
| | - Boyana Mikulska
- Department of Obstetrics and Gyneacology, Institute of Mother and Child, 01-211 Warsaw, Poland
| | - Anna Nimer
- Department of Obstetrics and Gyneacology, Institute of Mother and Child, 01-211 Warsaw, Poland
| | - Tomasz Maciejewski
- Department of Obstetrics and Gyneacology, Institute of Mother and Child, 01-211 Warsaw, Poland
| | - Ewa Sawicka
- Department of Pediatrics Surgery, Institute of Mother and Child, 01-211 Warsaw, Poland
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Sun RC, Hessami K, Krispin E, Pammi M, Mostafaei S, Joyeux L, Deprest J, Keswani S, Lee TC, King A, Belfort MA, Shamshirsaz AA. Prenatal ultrasonographic markers for prediction of complex gastroschisis and adverse perinatal outcomes: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2022; 107:371-379. [PMID: 34607856 DOI: 10.1136/archdischild-2021-322612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/17/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE We sought to perform a meta-analysis of the predictive value of antenatal ultrasonographic markers of bowel dilation, gastric dilation, polyhydramnios and abdominal circumference that predict complex gastroschisis and adverse perinatal outcomes DATA SOURCES: PubMed, Web of Science, Scopus and Embase were searched for relevant articles up to December 2020. Studies reporting prenatal ultrasonographic markers including intra-abdominal bowel dilation (IABD), extra-abdominal bowel dilation (EABD), bowel wall thickness, polyhydramnios, abdominal circumference <5th percentile, gastric dilation (GD) and bowel dilation not otherwise specified (BD-NOS) were included. The primary outcome was prediction of complex gastroschisis; secondary outcomes were length of hospital stay for newborn, time to full enteral feeding, postnatal mortality rate, incidence of necrotising enterocolitis and short bowel syndrome. RESULTS Thirty-six studies were included in this meta-analysis. We found significant associations between complex gastroschisis and IABD (OR=5.42; 95% CI 3.24 to 9.06), EABD (OR=2.27; 95% CI 1.40 to 3.66), BD-NOS (OR=6.27; 95% CI 1.97 to 19.97), GD (OR=1.88; 95% CI 1.22 to 2.92) and polyhydramnios (OR=6.93; 95% CI 3.39 to 14.18). Second trimester IABD and EABD have greater specificity for the prediction of complex gastroschisis than third trimester values with specificity of 95.6% (95% CI 58.1 to 99.7) and 94.6% (95% CI 86.7 to 97.9) for the second trimester IABD and EABD, respectively. CONCLUSION Prenatal ultrasonographic markers, especially the second trimester IABD and EABD, can identify fetuses that develop complex gastroschisis. Furthermore, these specific ultrasonographic markers can identify those babies at the highest risk for severe complications of this congenital anomaly and hence selected for future antenatal interventions.
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Affiliation(s)
- Raphael C Sun
- Division of Pediatric Surgery, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon, USA.,Division of Fetal Therapy and Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Kamran Hessami
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Eyal Krispin
- Division of Fetal Therapy and Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Mohan Pammi
- Section of Neonatology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Shayan Mostafaei
- Department of Biostatistics, Faculty of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran (the Islamic Republic of)
| | - Luc Joyeux
- MyFetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, Leuven, Belgium
| | - Jan Deprest
- Department of Obstetrics and Gynecology, Division Woman and Child, Fetal Medicine Unit, Katholieke Universiteit Leuven, Leuven, Belgium.,Institute of Women's Health, University College London Hospitals, University College London Medical School, London, UK
| | - Sundeep Keswani
- Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Timothy C Lee
- Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Alice King
- Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Michael A Belfort
- Division of Fetal Therapy and Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Alireza A Shamshirsaz
- Division of Fetal Therapy and Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
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Vinit N, Talbotec C, De Tristan MA, Salomon LJ, Giuseppi A, Rousseau V, Beaudoin S, Lambe C, Ville Y, Sarnacki S, Goulet O, Chardot C, Lapillonne A, Khen-Dunlop N. Predicting Factors of Protracted Intestinal Failure in Children with Gastroschisis. J Pediatr 2022; 243:122-129.e2. [PMID: 34748742 DOI: 10.1016/j.jpeds.2021.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/26/2021] [Accepted: 11/01/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To identify prenatal and neonatal predictors of short bowel syndrome-related intestinal failure (SBS-IF) in gastroschisis. STUDY DESIGN This retrospective study included all patients with gastroschisis born between 2000 and 2017 who were enrolled in our home parenteral nutrition program, and all patients with gastroschisis born in our institution who survived 2 weeks, during the same time period. Prenatal ultrasound features, neonatal status, anatomic features, oral feeding, and parenteral nutrition dependency were analyzed. RESULTS Among 180 patients, 35 required long-term parenteral nutrition (SBS-IF group) and 145 acquired full oral feeding within 6 months (oral feeding group). The mean follow-up was 7.9 years (IQR, 1.6-17.5 years) and 5.0 years (IQR, 0.1-18.2 years), respectively. Both bowel matting (OR, 14.23; 1.07-16.7; P = .039) and secondarily diagnosed atresia or stenosis (OR, 17.78; 3.13-100.98; P = .001) were independent postnatal predictors of SBS-IF. Eighteen children (51% of the SBS-IF group) were still dependent on artificial nutrition at the last follow-up. patients with SBS-IF who achieved full oral feeding had a median residual small-bowel length of 74 cm (IQR, 51-160 cm) vs 44 cm (IQR, 10-105 cm) for those still dependent on artificial nutrition (P = .02). An initial residual small bowel length of more than 50 cm was the best predictive cut-off for nutritional autonomy, with a sensitivity of 67% and a specificity of 100%. CONCLUSIONS Bowel matting, complex gastroschisis, and secondary intestinal obstruction were associated with SBS-IF in gastroschisis. For patients with SBS-IF, a small bowel length of more than 50 cm was predictive of secondary nutritional autonomy.
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Affiliation(s)
- Nicolas Vinit
- Department of Pediatric Surgery and Transplantation, Necker-Enfants Malades Hospital, APHP, Paris, France.
| | - Cécile Talbotec
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Intestinal Failure Rehabilitation Center, Necker-Enfants Malades Hospital, APHP, Paris, France
| | | | - Laurent J Salomon
- Department of Obstetrics, Fetal Medicine and Surgery, Necker-Enfants Malades Hospital, APHP, Paris, France; Neonatal Intensive Care Unit, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Agnès Giuseppi
- Neonatal Intensive Care Unit, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Véronique Rousseau
- Department of Pediatric Surgery and Transplantation, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Sylvie Beaudoin
- Department of Pediatric Surgery and Transplantation, Necker-Enfants Malades Hospital, APHP, Paris, France; Paris Descartes School of Medicine, Paris Center University, Paris, France
| | - Cécile Lambe
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Intestinal Failure Rehabilitation Center, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Yves Ville
- Department of Obstetrics, Fetal Medicine and Surgery, Necker-Enfants Malades Hospital, APHP, Paris, France; Neonatal Intensive Care Unit, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Sabine Sarnacki
- Department of Pediatric Surgery and Transplantation, Necker-Enfants Malades Hospital, APHP, Paris, France; Neonatal Intensive Care Unit, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Olivier Goulet
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Intestinal Failure Rehabilitation Center, Necker-Enfants Malades Hospital, APHP, Paris, France; Neonatal Intensive Care Unit, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Christophe Chardot
- Department of Pediatric Surgery and Transplantation, Necker-Enfants Malades Hospital, APHP, Paris, France; Paris Descartes School of Medicine, Paris Center University, Paris, France
| | - Alexandre Lapillonne
- Neonatal Intensive Care Unit, Necker-Enfants Malades Hospital, APHP, Paris, France; Paris Descartes School of Medicine, Paris Center University, Paris, France
| | - Naziha Khen-Dunlop
- Department of Pediatric Surgery and Transplantation, Necker-Enfants Malades Hospital, APHP, Paris, France; Paris Descartes School of Medicine, Paris Center University, Paris, France
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6
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Identifying prenatal ultrasound predictors and the ideal neonatal management of closing gastroschisis: the key is prevention. J Perinatol 2021; 41:2789-2794. [PMID: 33790403 DOI: 10.1038/s41372-021-01006-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 11/24/2020] [Accepted: 02/11/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the optimal approaches to initial surgical management and the potential for prenatal ultrasound detection of patients with closing gastroschisis. STUDY DESIGN We performed a retrospective analysis of patients born with gastroschisis to determine clinical and surgical outcomes and the ability to determine prognosis by prenatal imaging. Data collected included operative findings and postoperative outcome, as well as prenatal imaging features from a subset of cases with and without closing gastroschisis. Statistical analyses were performed as appropriate. RESULTS We included 197 patients with gastroschisis. No statistical significance was seen in outcomes between closing gastroschisis patients undergoing resection versus intracorporeal parking (n = 18). Ultrasound review was performed on 33 of these patients, 11 with closing gastroschisis, and 22 without. Significantly more closing gastroschisis patients had imaging indicative of progressive defect narrowing and defect diameter ≤8 mm after 30 weeks of gestation versus non-closing patients (p = 0.002). CONCLUSION Parking of extruded bowel offers potential for intestinal remodeling. In addition, prenatal ultrasound may be useful in detection of closing gastroschisis in utero.
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Ferreira RG, Mendonça CR, de Moraes CL, de Abreu Tacon FS, Ramos LLG, e Melo NC, Sbragia L, do Amaral WN, Ruano R. Ultrasound Markers for Complex Gastroschisis: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10225215. [PMID: 34830497 PMCID: PMC8619043 DOI: 10.3390/jcm10225215] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/20/2021] [Accepted: 11/01/2021] [Indexed: 11/23/2022] Open
Abstract
Although gastroschisis is often diagnosed by prenatal ultrasound, there is still a gap in the literature about which prenatal ultrasound markers can predict complex gastroschisis. This systematic review and meta-analysis aimed to investigate the ultrasound markers that characterize complex gastroschisis. A systematic review of the literature was conducted according to the guidelines of PRISMA. The protocol was registered (PROSPERO ID CRD42020211685). Meta-analysis was displayed graphically on Forest plots, which estimate prevalence rates and risk ratios, with 95% confidence intervals, using STATA version 15.0. The combined prevalence of intestinal complications in fetuses with complex gastroschisis was 27.0%, with a higher prevalence of atresia (about 48%), followed by necrosis (about 25%). The prevalence of deaths in newborns with complex gastroschisis was 15.0%. The predictive ultrasound markers for complex gastroschisis were intraabdominal bowel dilatation (IABD) (RR 3.01, 95% CI 2.22 to 4.07; I2 = 15.7%), extra-abdominal bowel dilatation (EABD) (RR 1.55, 95% CI 1.01 to 2.39; I2 = 77.1%), and polyhydramnios (RR 3.81, 95% CI 2.09 to 6.95; I2 = 0.0%). This review identified that IABD, EABD, and polyhydramnios were considered predictive ultrasound markers for complex gastroschisis. However, evidence regarding gestational age at the time of diagnosis is needed.
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Affiliation(s)
- Rui Gilberto Ferreira
- Postgraduate Program in Health Sciences, Universidade Federal de Goiás, Goiânia 74650-050, GO, Brazil; (C.R.M.); (C.L.d.M.); (F.S.d.A.T.); (W.N.d.A.)
- Department of Obstetrics and Gynaecology, Hospital das Clínicas, Universidade Federal de Goiás, Goiânia 74605-020, GO, Brazil
- Correspondence: (R.G.F.); (R.R.)
| | - Carolina Rodrigues Mendonça
- Postgraduate Program in Health Sciences, Universidade Federal de Goiás, Goiânia 74650-050, GO, Brazil; (C.R.M.); (C.L.d.M.); (F.S.d.A.T.); (W.N.d.A.)
| | - Carolina Leão de Moraes
- Postgraduate Program in Health Sciences, Universidade Federal de Goiás, Goiânia 74650-050, GO, Brazil; (C.R.M.); (C.L.d.M.); (F.S.d.A.T.); (W.N.d.A.)
| | - Fernanda Sardinha de Abreu Tacon
- Postgraduate Program in Health Sciences, Universidade Federal de Goiás, Goiânia 74650-050, GO, Brazil; (C.R.M.); (C.L.d.M.); (F.S.d.A.T.); (W.N.d.A.)
| | | | - Natalia Cruz e Melo
- Departamento de Ginecologia, Universidade de São Paulo, São Paulo 04024-002, SP, Brazil;
| | - Lourenço Sbragia
- Division of Pediatric Surgery, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of Sao Paulo (USP), Ribeirão Preto 14049-900, SP, Brazil;
| | - Waldemar Naves do Amaral
- Postgraduate Program in Health Sciences, Universidade Federal de Goiás, Goiânia 74650-050, GO, Brazil; (C.R.M.); (C.L.d.M.); (F.S.d.A.T.); (W.N.d.A.)
| | - Rodrigo Ruano
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Science Center Houston (UTHealth), Houston 77030, TX, USA
- Correspondence: (R.G.F.); (R.R.)
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8
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Granger J, Do-Wyeld M, Cundy TP, Galek A, Stark MJ, Cord-Udy CL. Regional cluster of vanishing gastroschisis: A comparative study of antenatal and post-natal outcomes. J Paediatr Child Health 2020; 56:420-425. [PMID: 31614068 DOI: 10.1111/jpc.14644] [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: 04/30/2019] [Revised: 08/07/2019] [Accepted: 09/10/2019] [Indexed: 11/27/2022]
Abstract
AIM Vanishing gastroschisis describes the in utero spontaneous closure of the periumbilical defect. It is usually associated with intestinal loss due to ischaemia, necrosis and atresia. This comparative study aims to investigate the spectrum of pathology, antenatal ultrasound characteristics and post-natal outcomes. METHODS Our tertiary centre provides antenatal and post-natal care of major congenital anomalies for a population of 1.6 million. Medical records were retrospectively evaluated for all cases of vanishing gastroschisis from May 2014 to May 2015. Cases of normal variant gastroschisis born during the same period were used for comparison. Maximum antenatael bowel diameter measurements were compared using the Mann-Whitney U-test. RESULTS Six infants with vanishing gastroschisis were born during the study period, representing 50% of all live-born gastroschisis. Antenatal ultrasound showed progressively increasing intra-abdominal bowel dilatation, with antenatal intra-abdominal bowel diameter significantly greater in vanishing, than normal, variant gastroschisis (23.2 vs. 4.1 mm, P < 0.01). The classification of vanishing gastroschisis severity comprised two type I, three type II and one type III cases. Complete midgut atresia affected three infants, leading to overall mortality of 50% for the vanishing gastroschisis group versus 0% in the normal variant group (P = 0.05). CONCLUSION Vanishing gastroschisis is a severe, often catastrophic variant of gastroschisis. Aetiological factors contributing to the recent high incidence of this rare complication in our population of newborns remain unknown, prompting secondary prevention strategies to salvage the midgut. We propose closer antenatal surveillance for fetuses with intra-abdominal bowel dilatation >10 mm to prompt consideration of earlier delivery to improve morbidity and mortality.
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Affiliation(s)
- Jeremy Granger
- Department of Paediatric Surgery, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Montgommery Do-Wyeld
- Department of Paediatric Surgery, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Thomas P Cundy
- Department of Paediatric Surgery, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Alison Galek
- Division of Medical Imaging, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Michael J Stark
- Department of Neonatology, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Catherine L Cord-Udy
- Department of Paediatric Surgery, Women's and Children's Hospital, Adelaide, South Australia, Australia
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9
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Vanishing Gastroschisis with a Favorable Outcome after a 3-Year Follow-Up: A Case Report and Literature Review. Case Rep Obstet Gynecol 2020; 2020:8542087. [PMID: 31970004 PMCID: PMC6969982 DOI: 10.1155/2020/8542087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 12/23/2019] [Indexed: 01/14/2023] Open
Abstract
Vanishing gastroschisis (VG) is a severe complication of gastroschisis with a high mortality rate. We report here a case of VG with a favorable outcome after a 3-year follow-up. A 26-year-old primigravida woman was referred to Strasbourg University Hospital because her fetus was diagnosed with an isolated gastroschisis at 13-week gestation. The ultrasound evolution was marked by a progressive closure of the abdominal wall defect from 19-week gestation and the appearance of dilated intra-abdominal loops. The child was born with a closed abdominal wall except a small remnant at the level of the former gastroschisis orifice. Explorative laparotomy revealed extensive midgut atresia with only 50 cm of remaining midgut. A jejunocolic anastomosis was performed. The child is now 3 years old and has a favorable outcome with only 2 nights a week of parenteral nutrition. A total of 39 cases of VG type D from Perrone et al. classification are described in the literature from 1991 to 2019, among which 19 (48.7%) are alive at the time of publication but only 4 cases are described with a long-term follow-up of 3 years or more. This is the fifth case described with a favorable evolution after 3-year follow-up.
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10
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Affiliation(s)
- Sara A Mansfield
- Division of Pediatric Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN
| | - Tim Jancelewicz
- Division of Pediatric Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN
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Maisant C, Naepels P, Ricard J, Lanta-Delmas S, Gondry J, Chevreau J. [Correlation between prenatal and postnatal observations in case of gastroschisis: Experience in a prenatal referral diagnosis center]. ACTA ACUST UNITED AC 2019; 47:841-845. [PMID: 31614232 DOI: 10.1016/j.gofs.2019.10.002] [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: 05/15/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Ultrasonography plays a key role in surveillance of gastroschisis. Indeed, ultrasound should allow an early diagnosis of its specific complications all the while avoiding their over-diagnosis which could induce an unnecessary prematurity in these fragile children. The aim of this study was to evaluate the relevance of ultrasonography in the surveillance of this malformation. METHODS We conducted a retrospective single center study from 2008 until 2018 including all cases of apparently isolated gastroschisis followed during the prenatal period and surgically treated in our institution. Prenatal data gathered during the ultrasound follow-up were compared to those observed during surgery. RESULTS Thirty-one cases of gastroschisis were included. Regarding the abdominal wall defect, the latter was described prenatally as tight in seven cases with a weak correlation, and as situated to the right of the umbilical cord insertion in 11 cases with a high correlation to the per-operative observations. Sonographic observations were responsible for inducing birth in 14 cases (45%), of which 12 due to the presence of a specific gastroschisis complication, confirmed in five cases (42%, weak correlation). Pre- and post-natal correlation for compression/atresia/stenosis and eviscerated bowel inflammation were very weak in both cases, with a respective tendency of over- and under-diagnosis. CONCLUSIONS Diagnosing the specific complications of gastroschisis by ultrasound is difficult, even though ultrasonography is responsible for many anticipated births. Thus, this monitoring should be performed by experienced sonographers on devices with appropriate settings. In addition, reproducible parameters such as oligohydramnios or increased bowel dilations should alone be indications of anticipated birth.
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Affiliation(s)
- C Maisant
- Service de gynécologie-obstétrique du CHU Amiens-Picardie, site sud, avenue Laennec, 80009 Amiens cedex, France
| | - P Naepels
- Service de gynécologie-obstétrique du CHU Amiens-Picardie, site sud, avenue Laennec, 80009 Amiens cedex, France
| | - J Ricard
- Service de chirurgie pédiatrique du CHU Amiens-Picardie, site sud, avenue Laennec, 80009 Amiens cedex, France
| | - S Lanta-Delmas
- Service de gynécologie-obstétrique du CHU Amiens-Picardie, site sud, avenue Laennec, 80009 Amiens cedex, France
| | - J Gondry
- Service de gynécologie-obstétrique du CHU Amiens-Picardie, site sud, avenue Laennec, 80009 Amiens cedex, France
| | - J Chevreau
- Service de gynécologie-obstétrique du CHU Amiens-Picardie, site sud, avenue Laennec, 80009 Amiens cedex, France.
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Andrade WS, Brizot ML, Francisco RPV, Tannuri AC, Syngelaki A, Akolekar R, Nicolaides KH. Fetal intra-abdominal bowel dilation in prediction of complex gastroschisis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 54:376-380. [PMID: 31264279 DOI: 10.1002/uog.20367] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 05/28/2019] [Accepted: 06/03/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To investigate intra-abdominal bowel dilation (IABD) in the prediction of complex gastroschisis. METHODS This was a retrospective study of 174 singleton pregnancies with isolated fetal gastroschisis, resulting in live birth and with available ultrasound images from visits at both 20-22 and 30-32 weeks' gestation. IABD was measured as the greatest transverse diameter of the most dilated intra-abdominal bowel segment, by an operator blinded to postnatal outcome. The distribution of IABD measurements in those with complex and those with simple gastroschisis was determined and the best cut-off value to predict complex gastroschisis was selected using receiver-operating characteristics (ROC) curves. The area under the ROC curve (AUC), detection rate (DR), false-positive rate (FPR), positive predictive value (PPV) and negative predictive value (NPV) were determined. RESULTS The study population included 39 (22.4%) cases of complex and 135 (77.6%) cases of simple gastroschisis. In the prediction of complex gastroschisis, the AUC at 20-22 weeks' gestation was 0.742 (95% CI, 0.628-0.856) and the respective value for 30-32 weeks was 0.820 (95% CI, 0.729-0.910). At the IABD cut-off of 7 mm at 20-22 weeks, DR, FPR, PPV and NPV for complex gastroschisis were 61.5%, 6.7%, 72.7% and 89.4%, respectively, and at IABD cut-off of 14 mm at 30-32 weeks, the respective values were 64.9%, 5.9%, 75.0% and 90.7%. CONCLUSION Measurement of IABD at 20-22 or at 30-32 weeks' gestation is useful in the prediction of complex gastroschisis. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- W S Andrade
- Fetal Medicine Research Institute, King's College Hospital, London, UK
- Department of Obstetrics and Gynecology, São Paulo University Medical School, São Paulo, Brazil
| | - M L Brizot
- Department of Obstetrics and Gynecology, São Paulo University Medical School, São Paulo, Brazil
| | - R P V Francisco
- Department of Obstetrics and Gynecology, São Paulo University Medical School, São Paulo, Brazil
| | - A C Tannuri
- Division of Pediatric Surgery, Department of Pediatrics, São Paulo University Medical School, São Paulo, Brazil
| | - A Syngelaki
- Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - R Akolekar
- Department of Fetal Medicine, Medway Maritime Hospital, Gillingham, UK
| | - K H Nicolaides
- Fetal Medicine Research Institute, King's College Hospital, London, UK
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13
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Dewberry LC, Hilton SA, Zaretsky MV, Behrendt N, Galan HL, Marwan AI, Liechty KW. Examination of Prenatal Sonographic Findings: Intra-Abdominal Bowel Dilation Predicts Poor Gastroschisis Outcomes. Fetal Diagn Ther 2019; 47:245-250. [PMID: 31454815 DOI: 10.1159/000501592] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 06/19/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Gastroschisis is an anterior abdominal wall defect with variable outcomes. There are conflicting data regarding the prognostic value of sonographic findings. OBJECTIVES The aim of this study was to identify prenatal ultrasonographic features associated with poor neonatal outcomes. METHOD A retrospective review of 55 patients with gastroschisis from 2007 to 2017 was completed. Ultrasounds were reviewed for extra-abdominal intestinal diameter (EAID) and intra-abdominal intestinal diameter (IAID), echogenicity, visceral content within the herniation, amniotic fluid index, defect size, and abdominal circumference (AC). Ultrasound variables were correlated with full enteral feeding and the diagnosis of a complex gastroschisis. RESULTS Bivariate analysis demonstrated an increased time to full enteral feeds with increasing number of surgeries, EAID, and IAID. Additionally, there was a significant relationship between IAID and AC percentile with the diagnosis of complex gastroschisis. On multivariate analysis, only IAID was significant and increasing diameter had a 2.82 (95% CI 1.02-7.78) higher odds of a longer time to full enteral feeds and a 1.2 (95% CI 1.05-1.36) greater odds of the diagnosis of a complex gastroschisis. CONCLUSIONS Based on these findings, IAID is associated with a longer time to full enteral feeding and the diagnosis of complex gastroschisis.
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Affiliation(s)
- Lindel C Dewberry
- Department of Surgery, University of Colorado, Aurora, Colorado, USA
| | - Sarah A Hilton
- Department of Surgery, University of Colorado, Aurora, Colorado, USA
| | - Michael V Zaretsky
- Colorado Fetal Care Center, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Nicholas Behrendt
- Colorado Fetal Care Center, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Henry L Galan
- Colorado Fetal Care Center, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Ahmed I Marwan
- Division of Pediatric Surgery, Department of Surgery, University of Colorado, Aurora, Colorado, USA
| | - Kenneth W Liechty
- Division of Pediatric Surgery, Department of Surgery, University of Colorado, Aurora, Colorado, USA,
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Abstract
The importance of defining and implementing a culture of safety in pediatric surgery is being increasingly seen as essential to decreasing complications and improving outcomes. The concept of a safety culture is a universal one, but the elements of such a culture are different for every disease and anomaly treated. In this paper, I will review these elements as they pertain to the treatment of abdominal wall defects starting from fetal evaluation to post-discharge care.
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Affiliation(s)
- Sherif Emil
- Department of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, Room B04.2028, 1001 Decarie Boulevard, Montreal, QC H4A 3J1, Canada.
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15
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Vignes K, Hiett AK, Draus JM, Barton JR. Prenatal Diagnosis of a Vanishing Gastroschisis With Subsequent Neonatal Bowel Complications: A Case Study. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2019. [DOI: 10.1177/8756479318816950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Gastroschisis is a well-known birth defect in which bowel protrudes through a perforation in the fetal abdominal wall. High antenatal detection rates typically lead to good outcomes with modern neonatal treatments. Case: We describe a rare phenomenon in which gastroschisis appears to resolve antenatally, with associated bowel dilation and polyhydramnios. No evidence of an abdominal wall defect was seen at birth, but imaging was suggestive of bowel atresia. Surgical exploration showed a microcolon and most of the small bowel was absent. An extensive surgical repair was required, which resulted in short bowel syndrome. Conclusion: Gastroschisis that undergoes apparent resolution on sonography can be associated with necrosis due to strangulation of the exteriorized bowel and short bowel syndrome. This is associated with high neonatal morbidity and mortality.
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Affiliation(s)
- Katherine Vignes
- Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY, USA
| | - A. Kinney Hiett
- Maternal Fetal Medicine, Boonshoft School of Medicine, Wright State University, Dayton, OH, USA
| | - John M. Draus
- Department of Pediatric Surgery, Kentucky Children’s Hospital, University of Kentucky, Lexington, KY, USA
| | - John R. Barton
- Perinatal Diagnostic Center, Baptist Health Lexington, Lexington, KY, USA
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Abstract
Currently, the most important determinant of gastroschisis outcomes in high resource settings is whether the condition is associated with intestinal complications, such as atresia, necrosis, perforation, or volvulus. This form of the anomaly, known as complex gastroschisis, accounts for most of the mortality and a disproportionate burden of the morbidity from gastroschisis. There is some disagreement about what constitutes complex gastroschisis, and little consensus on the type and timing of surgical interventions. This article establishes a clear definition of complex gastroschisis. Surgical approaches to treatment of the diverse presentations of complex gastroschisis will be described and the timing of such interventions will be discussed. Contemporary outcomes of complex gastroschisis will be reviewed. Finally, a non-congenital intestinal complications that may arise in gastroschisis patients will be discussed.
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Affiliation(s)
- Sherif Emil
- Department of Pediatric Surgery; The Montreal Children's Hospital, McGill University Health Centre, Room B04.2028, 1001 Decarie Boulevard, Montreal, QC, Canada H4A 3J1.
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17
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Laje P, Fraga MV, Peranteau WH, Hedrick HL, Khalek N, Gebb JS, Moldenhauer JS, Johnson MP, Flake AW, Adzick NS. Complex gastroschisis: Clinical spectrum and neonatal outcomes at a referral center. J Pediatr Surg 2018; 53:1904-1907. [PMID: 29628208 DOI: 10.1016/j.jpedsurg.2018.03.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 02/05/2018] [Accepted: 03/08/2018] [Indexed: 02/07/2023]
Abstract
AIM OF THE STUDY To evaluate the outcomes of neonates with complex gastroschisis (GC), and correlate outcomes with each type of complication. METHODS Retrospective review of patients with complex GC owing to prenatal and/or postnatal abdominal complications; 2008-2016. Primary outcomes: time to discontinue parenteral nutrition (off-PN), length of stay (LOS) and neonatal survival. MAIN RESULTS We treated 58 patients with complex gastroschisis owing to abdominal complications, which were: intestinal necrosis at birth (n=9), intestinal atresia (n=16), medical necrotizing enterocolitis (NEC) (n=15), surgical NEC (n=1), in utero volvulus (n=1), vanishing gastroschisis (n=2), severe intestinal dysmotility (n=1), delayed abdominal closure (n=3), abdominal compartment syndrome (n=2) and hiatal hernia/severe gastroesophageal reflux disease (GERD; n=11). The off-PN time and LOS of the whole group were 92 (35-255) and 119 (42-282) days, significantly longer than those of a demographically equivalent contemporaneous series of 125 patients with uncomplicated gastroschisis (off-PN 32 [12-105] days [p<0.001]; LOS 41 [18-150] days [p<0.001]). Patients with intestinal necrosis at birth or with intestinal atresia had the longest off-PN and LOS times (133 [38-255] / 157 [43-282] and 114 [36-222] / 143 [42-262] days, respectively), followed by patients with complications of the abdominal wall closure (n=5) (69 [43-93] / 89 [58-110] days), patients with hiatal hernias/severe GERD who required fundoplication (63 [35-84] / 89 [57-123] days) and patients who developed medical NEC (67 [35-103] / 76 [50-113] days). Short-bowel syndrome/PN-dependence occurred in 6/58 (10%) patients (2 vanishing gastroschisis, 1 in utero volvulus, 2 intestinal atresias and 1 bowel necrosis at birth). There were no neonatal mortalities. CONCLUSION Gastroschisis can be complicated by a wide variety of prenatal and postnatal events. The most severe outcomes occur in patients with bowel necrosis at birth, intestinal atresias, or vanishing gastroschisis. Complications, however, did not affect neonatal survival in our experience. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Pablo Laje
- Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Maria V Fraga
- Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - William H Peranteau
- Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Holly L Hedrick
- Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nahla Khalek
- Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Juliana S Gebb
- Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Julie S Moldenhauer
- Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mark P Johnson
- Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alan W Flake
- Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - N Scott Adzick
- Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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