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Pratheeppanyapat T, Tepmalai K, Singhavejsakul J, Khorana J. The factors associated with successful early enteral feeding in gastroschisis. Pediatr Surg Int 2018; 34:743-748. [PMID: 29802444 DOI: 10.1007/s00383-018-4282-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/22/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Gastroschisis is the most common congenital abdominal wall defect. Due to the exposure of midgut to amniotic fluid, the recovery of bowel function is often delayed. This study aimed to identify the factors associated with the successful early enteral feeding in gastroschisis and to develop further guidelines of treatment. METHODS A retrospective cohort study of gastroschisis babies from January 2006 to December 2015 was done. Exclusion criteria were incomplete data and death. Successful early enteral feeding was defined when full feeding was achieved within 21 days of life. RESULTS One hundred and five gastroschisis patients were divided into a successful early-feeding group (n = 56, 53%) and a non-successful early-feeding group (n = 49, 46%). In multivariable analysis, significant factors for successful feeding clustered by primary treatment were female (RR = 1.38, P value < 0.001), gestational age > 36 weeks (RR = 1.23, P value < 0.001), age at surgery less than 10 h (RR = 1.15, P value < 0.001), postoperative extubation time < 4 days (RR = 1.39, P value < 0.001), and age when feeding started less than 10 days (RR = 35.69, P value < 0.001). CONCLUSION Several factors were found to be associated with successful early enteral feeding. The modifiable factors found in this study were surgery within 10 h, early postoperative extubation within 4 days, and feeding started before 10 days of life. These will guide the management of gastroschisis to achieve successful early enteral feeding.
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Affiliation(s)
- Theerayuth Pratheeppanyapat
- Division of Pediatric Surgery, Department of Surgery, Chiang Mai University Hospital, 110 Intavaroros Road, Muang Chiang Mai District, Chiang Mai, 50200, Thailand
| | - Kanokkan Tepmalai
- Division of Pediatric Surgery, Department of Surgery, Chiang Mai University Hospital, 110 Intavaroros Road, Muang Chiang Mai District, Chiang Mai, 50200, Thailand
| | - Jesda Singhavejsakul
- Division of Pediatric Surgery, Department of Surgery, Chiang Mai University Hospital, 110 Intavaroros Road, Muang Chiang Mai District, Chiang Mai, 50200, Thailand
| | - Jiraporn Khorana
- Division of Pediatric Surgery, Department of Surgery, Chiang Mai University Hospital, 110 Intavaroros Road, Muang Chiang Mai District, Chiang Mai, 50200, Thailand.
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Marshall Niles SG, Mitchell-Fearon K, Gill MI, DeSouza CJ, Fearon IC, Abel CA, James BA, McLennon NJ. Mortality-related factors in gastroschisis - a Jamaican perspective. J Pediatr Surg 2017; 52:530-533. [PMID: 27842958 DOI: 10.1016/j.jpedsurg.2016.10.045] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 09/11/2016] [Accepted: 10/13/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the mortality rate of patients treated with gastroschisis at a Jamaican pediatric hospital, and to identify factors that contribute significantly to mortality. METHODS Eighty-five patients were treated with gastroschisis between November 1, 2006 and November 30, 2015. Of these, 80 records were recovered and reviewed retrospectively. Records were analyzed for maternal and patient characteristics, and details of the clinical course. Death during admission was the primary outcome measure. RESULTS 63 of the 80 patients died during admission, giving a mortality rate of 78.8%. Sepsis was the main cause of death (82.4%). 27 patients (33.8%) had complicated gastroschisis (necrosis, perforation and/or atresia), all of whom died. Only preterm gestational age, complicated gastroschisis, and the lack of parenteral nutrition were found to be statistically associated with increased mortality. CONCLUSION Our mortality rate is higher than those quoted in high-income countries, and correlates to those found in low- to middle-income countries. Mortality in our cohort was significantly associated with prematurity, complicated gastroschisis, and the lack of parenteral nutrition. Efforts to improve outcome must focus on improving antenatal care, establishing transfer protocols, and optimizing nutrition for all patients with gastroschisis. STUDY TYPE Prognostic/Retrospective Study LEVEL OF EVIDENCE: Level II.
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Affiliation(s)
- Sarah G Marshall Niles
- Department of Pediatric Surgery, Bustamante Hospital for Children, Arthur Wint Drive, Kingston 5, Jamaica, West Indies.
| | - Kathryn Mitchell-Fearon
- Department of Community Health and Psychiatry, University of the West Indies, Mona Campus, Kingston 7, Jamaica, West Indies
| | - Mitchell I Gill
- Department of Pediatric Surgery, Bustamante Hospital for Children, Arthur Wint Drive, Kingston 5, Jamaica, West Indies
| | - Claudine J DeSouza
- Department of Pediatric Surgery, University Hospital of the West Indies, Mona, Kingston 7, Jamaica, West Indies
| | - Ian C Fearon
- Department of Pediatric Surgery, Bustamante Hospital for Children, Arthur Wint Drive, Kingston 5, Jamaica, West Indies
| | - Colin A Abel
- Department of Pediatric Surgery, Bustamante Hospital for Children, Arthur Wint Drive, Kingston 5, Jamaica, West Indies
| | - Brian A James
- Department of Anaesthesia and Intensive Care, Bustamante Hospital for Children
| | - Noel J McLennon
- Department of Pediatric Surgery, Bustamante Hospital for Children, Arthur Wint Drive, Kingston 5, Jamaica, West Indies
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D'Antonio F, Virgone C, Rizzo G, Khalil A, Baud D, Cohen-Overbeek TE, Kuleva M, Salomon LJ, Flacco ME, Manzoli L, Giuliani S. Prenatal Risk Factors and Outcomes in Gastroschisis: A Meta-Analysis. Pediatrics 2015; 136:e159-69. [PMID: 26122809 DOI: 10.1542/peds.2015-0017] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Gastroschisis is a congenital anomaly with increasing incidence, easy prenatal diagnosis and extremely variable postnatal outcomes. Our objective was to systematically review the evidence regarding the association between prenatal ultrasound signs (intraabdominal bowel dilatation [IABD], extraabdominal bowel dilatation, gastric dilatation [GD], bowel wall thickness, polyhydramnios, and small for gestational age) and perinatal outcomes in gastroschisis (bowel atresia, intra uterine death, neonatal death, time to full enteral feeding, length of total parenteral nutrition and length of in hospital stay). METHODS Medline, Embase, and Cochrane databases were searched electronically. Studies exploring the association between antenatal ultrasound signs and outcomes in gastroschisis were considered suitable for inclusion. Two reviewers independently extracted relevant data regarding study characteristics and pregnancy outcome. All meta-analyses were computed using individual data random-effect logistic regression, with single study as the cluster unit. RESULTS Twenty-six studies, including 2023 fetuses, were included. We found significant positive associations between IABD and bowel atresia (odds ratio [OR]: 5.48, 95% confidence interval [CI] 3.1-9.8), polyhydramnios and bowel atresia (OR: 3.76, 95% CI 1.7-8.3), and GD and neonatal death (OR: 5.58, 95% CI 1.3-24.1). No other ultrasound sign was significantly related to any other outcome. CONCLUSIONS IABD, polyhydramnios, and GD can be used to an extent to identify a subgroup of neonates with a prenatal diagnosis of gastroschisis at higher risk to develop postnatal complications. Data are still inconclusive on the predictive ability of several signs combined, and large prospective studies are needed to improve the quality of prenatal counseling and the neonatal care for this condition.
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Affiliation(s)
- Francesco D'Antonio
- Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, United Kingdom
| | - Calogero Virgone
- Department of Paediatric and Neonatal Surgery, St George's Healthcare National Health Service Trust and University of London, London, United Kingdom
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Università di Roma Tor Vergata, Roma, Italy
| | - Asma Khalil
- Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, United Kingdom
| | - David Baud
- Materno-Fetal and Obstetrics Research Unit, Department of Obstetrics and Gynaecology, University Hospital, Lausanne, Switzerland
| | - Titia E Cohen-Overbeek
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Marina Kuleva
- Maternité, Hôpital Necker-Enfants Malades, Assistance Publique des Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - Laurent J Salomon
- Maternité, Hôpital Necker-Enfants Malades, Assistance Publique des Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - Maria Elena Flacco
- Department of Medicine and Aging Sciences, University of Chieti-Pescara, Chieti, Italy; and EMISAC (Epidemiologia e Management dell'Invecchiamento, e Salubrità degli Ambienti Confinati), CeSI Biotech, Chieti, Italy
| | - Lamberto Manzoli
- Department of Medicine and Aging Sciences, University of Chieti-Pescara, Chieti, Italy; and EMISAC (Epidemiologia e Management dell'Invecchiamento, e Salubrità degli Ambienti Confinati), CeSI Biotech, Chieti, Italy
| | - Stefano Giuliani
- Department of Paediatric and Neonatal Surgery, St George's Healthcare National Health Service Trust and University of London, London, United Kingdom;
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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.
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Gover A, Albersheim S, Sherlock R, Claydon J, Butterworth S, Kuzeljevic B. Outcome of patients with gastroschisis managed with and without multidisciplinary teams in Canada. Paediatr Child Health 2014. [DOI: 10.1093/pch/19.3.128] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ayala Gover
- Division of Neonatology, Pediatrics, BC Women's Hospital and Health Centre, BC Children's Hospital
| | - Susan Albersheim
- Division of Neonatology, Pediatrics, BC Women's Hospital and Health Centre, BC Children's Hospital
| | - Rebecca Sherlock
- Division of Neonatology, Pediatrics, BC Women's Hospital and Health Centre, BC Children's Hospital
| | - Jennifer Claydon
- Division of Neonatology, Pediatrics, BC Women's Hospital and Health Centre, BC Children's Hospital
| | - Sonia Butterworth
- Division of Pediatric General Surgery, Surgery, Children's Hospital of British Columbia
| | - Boris Kuzeljevic
- Clinical Research Support Unit, Child and Family Research Institute, Vancouver, British Columbia
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Delivery room surgery: an applicable therapeutic strategy for gastroschisis in developing countries. World J Pediatr 2014; 10:69-73. [PMID: 24464667 DOI: 10.1007/s12519-014-0455-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 05/13/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND The survival rate of infants with gastroschisis has improved significantly. It is over 90% in developed countries, but 50% in developing countries. This study aimed to investigate the factors improving the survival rate of infants with gastroschisis in developing countries. METHODS Neonates meeting the inclusion criteria, who presented to our center since the establishment of delivery room surgery, were enrolled into this retrospective study. Data were evaluated specifically to determine the role of delivery room surgery in reducing the mortality and morbidity of infants with gastroschisis and to identify factors optimizing the conditions of outborn infants. RESULTS A total of 64 infants were identified. The overall survival rate of the infants was 60.9%. The survival rate of infants in inborns was 76.5%, and the survival rate of infants in outborns was 43.3%. Infants of the outborn group took more time to reach full enteral feeding, and were more likely to require a prolonged stay in hospital when compared with those of the inborn group. Logistic analysis identified that the surgical technique, the presence of sepsis and intestinal necrosis could be expected to influence the outcome of gastroschisis. CONCLUSIONS The strategy of delivery of patients in a center prepared to perform delivery room closure of gastroschisis appears to improve the survival of patients with gastroschisis. Further reduction in mortality rates will depend on improved conditions of outborn infants.
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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: 17] [Impact Index Per Article: 1.5] [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.
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8
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van Manen M, Hendson L, Wiley M, Evans M, Taghaddos S, Dinu I. Early childhood outcomes of infants born with gastroschisis. J Pediatr Surg 2013; 48:1682-7. [PMID: 23932607 DOI: 10.1016/j.jpedsurg.2013.01.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 12/17/2012] [Accepted: 01/07/2013] [Indexed: 12/12/2022]
Abstract
PURPOSE To describe neonatal and childhood outcomes of a contemporary cohort of infants with gastroschisis. METHODS Observational, single center, inception cohort of children born with gastroschisis from January 2005 to December 2008. RESULTS Of 63 infants, 61 survived to hospital discharge and 39 were seen for follow-up. Complications included sepsis (37%), necrotizing enterocolitis (10%), parenteral nutrition related cholestasis (25%), and short bowel syndrome (13%). Of survivors, 5% had visual impairment and 10% had hearing loss. No child tested had mental delay or cerebral palsy. Early gestational age predicted death or disability (OR 0.60, 95% CI 0.38, 0.96; p=0.033). There was a high incidence of prescription medications for presumed gastroesophageal reflux (90%). Some infants continued to require tube feeds (15%). There were improvements in longitudinal growth reflected in increasing z-scores. CONCLUSIONS Although children with gastroschisis are at risk for disability, childhood outcomes are encouraging.
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Affiliation(s)
- Michael van Manen
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
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Aljahdali A, Mohajerani N, Skarsgard ED. Effect of timing of enteral feeding on outcome in gastroschisis. J Pediatr Surg 2013; 48:971-6. [PMID: 23701769 DOI: 10.1016/j.jpedsurg.2013.02.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 02/03/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Timely initiation of enteral nutrition is pivotal to outcome optimization in gastroschisis (GS). The purpose of our study was to analyze the effect of timing of first feeds on outcome. METHOD GS cases accrued between May 2005 and August 2011 were abstracted from a national database. Risk variables evaluated included GA, illness severity, bowel injury severity, and post-closure days to first feed (DTF). The outcomes analyzed included duration of TPN, LOS, and infectious complications. Descriptive, univariate, and multivariate regression analyses were conducted. RESULTS The study cohort comprised 570 cases (16% with "high risk" bowel injury). Group distribution by DTF was: 0-7 days (12%), 8-14 days (44%), 15-21 days (26%), and >21 days (17%), with a mean DTF of 17 ± 15 days. Mean durations of TPN and LOS were 44 ± 56 and 112 ± 71 days, respectively. DTF subgroups were comparable, except for a greater proportion of "high risk bowel injury" in DTF>21 days. Initiation of feeds between 8 and 21 days was associated with fewer TPN days and reduced LOS. Multivariate analyses revealed that TPN duration, LOS, and infectious complications were independently predicted by DTF. CONCLUSIONS Post-closure DTF predicts outcome in GS, with best outcomes observed when feeds are started 7 days post-closure.
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Affiliation(s)
- Akram Aljahdali
- Department of Surgery, Division of Pediatric Surgery, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
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Kunz SN, Tieder JS, Whitlock K, Jackson JC, Avansino JR. Primary fascial closure versus staged closure with silo in patients with gastroschisis: a meta-analysis. J Pediatr Surg 2013; 48:845-57. [PMID: 23583145 PMCID: PMC4103994 DOI: 10.1016/j.jpedsurg.2013.01.020] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 12/15/2012] [Accepted: 01/07/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND/PURPOSE Gastroschisis is the most common congenital abdominal wall defect. Despite advances in the surgical closure of gastroschisis, consensus is lacking as to which method results in the best patient outcomes. The purpose of this meta-analysis was to compare short-term outcomes associated with primary fascial closure and staged repair with a silo in patients with gastroschisis. METHODS We reviewed Medline citations, as well as the Cochrane Database of Systematic Reviews, between January 1, 1996 and June 1, 2012. Articles were identified using the search term "gastroschisis" and [("treatment outcome" or "prognosis") or randomized controlled trials]. Case reports, reviews, letters, abstracts only, non-English abstracts, and studies that did not address at least one of the outcomes of interest were excluded from the meta-analysis. Two independent reviewers identified relevant articles for final inclusion. A standard data collection form created by the authors was used to extract study information, including study design, patient characteristics, and reported patient outcomes. The data were analyzed using standard meta-analytic techniques. RESULTS Twenty studies were included in the meta-analysis. In the five studies that selected closure method randomly or as a temporal shift in practice, silo was associated with better outcomes, with a significant reduction in ventilator days (p<0.0001), time to first feed (p=0.04), and infection rates (p=0.03). When all studies were included, primary closure was associated with improved outcomes. CONCLUSIONS Silo closure is associated with better clinical outcomes in the studies with the least selection bias. Larger prospective studies are needed to definitively determine the best closure technique.
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Affiliation(s)
- Sarah N Kunz
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
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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.
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Affiliation(s)
- Marco Ghionzoli
- Surgery Unit, Institute of Child Health and Great Ormond Street Hospital, London, WC1N 1EH, England
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Bradnock TJ, Marven S, Owen A, Johnson P, Kurinczuk JJ, Spark P, Draper ES, Knight M. Gastroschisis: one year outcomes from national cohort study. BMJ 2011; 343:d6749. [PMID: 22089731 PMCID: PMC3216470 DOI: 10.1136/bmj.d6749] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe one year outcomes for a national cohort of infants with gastroschisis. DESIGN Population based cohort study of all liveborn infants with gastroschisis born in the United Kingdom and Ireland from October 2006 to March 2008. SETTING All 28 paediatric surgical centres in the UK and Ireland. PARTICIPANTS 301 infants (77%) from an original cohort of 393. MAIN OUTCOME MEASURES Duration of parenteral nutrition and stay in hospital; time to establish full enteral feeding; rates of intestinal failure, liver disease associated with intestinal failure, unplanned reoperation; case fatality. RESULTS Compared with infants with simple gastroschisis (intact, uncompromised, continuous bowel), those with complex gastroschisis (bowel perforation, necrosis, or atresia) took longer to reach full enteral feeding (median difference 21 days, 95% confidence interval 9 to 39 days); required a longer duration of parenteral nutrition (median difference 25 days, 9 to 46 days) and a longer stay in hospital (median difference 57 days, 29 to 95 days); were more likely to develop intestinal failure (81% (25 infants) v 41% (102); relative risk 1.96, 1.56 to 2.46) and liver disease associated with intestinal failure (23% (7) v 4% (11); 5.13, 2.15 to 12.3); and were more likely to require unplanned reoperation (42% (13) v 10% (24); 4.39, 2.50 to 7.70). Compared with infants managed with primary fascial closure, those managed with preformed silos took longer to reach full enteral feeding (median difference 5 days, 1 to 9) and had an increased risk of intestinal failure (52% (50) v 32% (38); 1.61, 1.17 to 2.24). Event rates for the other outcomes were low, and there were no other significant differences between these management groups. Twelve infants died (4%). CONCLUSIONS This nationally representative study provides a benchmark against which individual centres can measure outcome and performance. Stratifying neonates with gastroschisis into simple and complex groups reliably predicts outcome at one year. There is sufficient clinical equipoise concerning the initial management strategy to embark on a multicentre randomised controlled trial comparing primary fascial closure with preformed silos in infants suitable at presentation for either treatment to determine the optimal initial management strategy and define algorithms of care.
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Affiliation(s)
- Timothy J Bradnock
- Department of Paediatric Surgery, Royal Hospital for Sick Children, Glasgow, Scotland, UK
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Hussain U, Daemen A, Missfelder-Lobos H, De Moor B, Timmerman D, Bourne T, Lees C. Umbilical artery pulsatility index and fetal abdominal circumference in isolated gastroschisis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 38:538-542. [PMID: 21308833 DOI: 10.1002/uog.8947] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To investigate changes in abdominal circumference (AC) and umbilical artery pulsatility index (UA-PI) with gestation in fetuses with isolated gastroschisis, and to determine whether a relationship exists between UA-PI and fetal AC. METHODS Data from 58 pregnancies with isolated gastroschisis diagnosed at between 24 and 36 weeks' gestation were included in the study. Z-scores were calculated with respect to expected UA-PI values in normal pregnancies after log-transformation. AC-Z-scores were calculated with respect to expected size in normal pregnancies according to a standard chart. Functional linear discriminant analysis (FLDA) was applied to generate 50(th), 5(th) and 95(th) percentile curves for changes in both AC and UA-PI with gestational age in fetuses with gastroschisis. These curves were compared with the standard curves, as were the means. UA-PI was also plotted against AC. For this relationship, a robust Spearman correlation coefficient was obtained with FLDA. RESULTS In fetuses with gastroschisis, there was a highly significant negative correlation between UA-PI and AC, normalized for gestation using Z-scores (median correlation coefficient, - 0.289; median P = 0.000023). Moreover, compared with standard curves AC was lower and UA-PI higher in the gestational-age range studied. Both the AC and UA-PI curves showed a significantly different rate of change with gestation compared with the normal ranges. The mean values for fetuses with gastroschisis compared with the standard AC and UA-PI range curves were significantly different for AC throughout gestation, and for UA-PI from 32 weeks' gestation. CONCLUSIONS In fetal gastroschisis, it is well known that AC tends to be smaller, though UA-PI has not been reported to be abnormal in any consistent way. There is a clear relationship between the fetus's AC for gestation and UA-PI, which is not the case for normally grown fetuses. The data suggest that the growth restriction seen in gastroschisis may be explained by hypoxia, and not simply by the classical explanation of extra-abdominal displacement of the abdominal viscera.
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Affiliation(s)
- U Hussain
- Division of Fetal Medicine, Addenbrooke's Hospital, Cambridge, UK
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Kassa AM, Lilja HE. Predictors of postnatal outcome in neonates with gastroschisis. J Pediatr Surg 2011; 46:2108-14. [PMID: 22075340 DOI: 10.1016/j.jpedsurg.2011.07.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Revised: 07/03/2011] [Accepted: 07/04/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND/PURPOSE The optimal management of neonates with gastroschisis is unclear, and there is a significant morbidity. We performed a review of neonates with gastroschisis treated at our center of pediatric surgery over the last 21 years to determine predictive factors of outcome. METHODS Single-center retrospective analysis of 79 neonates with gastroschisis (1989-2009) was done. Length of hospital stay (LOS), days of parenteral nutrition (PN), and survival were outcome measures. Univariate and multiple regression analyses were used. RESULTS Overall survival was 92%, and primary closure was achieved in 80%. Median LOS was 25 days, and median duration on PN, 17 days. Intestinal atresia, closed gastroschisis, secondary closure, and sepsis were the primary variables associated with poor outcome independent of other variables, but prematurity also affected outcome. Route of delivery and associated malformations were not related to poorer outcome. Necrotizing enterocolitis did not occur in any of our patients. CONCLUSION Outcome in our patients was favorable as measured by survival, LOS, and days on PN. Primary predictors of poor outcome were factors related to short bowel syndrome and secondary closure, indicating a need to further improve treatment of short bowel syndrome.
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Affiliation(s)
- Ann-Marie Kassa
- Department of Women's and Children's Health, Uppsala University, 751 05 Uppsala, Sweden
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Tsai MH, Huang HR, Chu SM, Yang PH, Lien R. Clinical features of newborns with gastroschisis and outcomes of different initial interventions: primary closure versus staged repair. Pediatr Neonatol 2010; 51:320-5. [PMID: 21146795 DOI: 10.1016/s1875-9572(10)60062-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2009] [Revised: 12/31/2009] [Accepted: 01/21/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Gastroschisis requires surgical management soon after birth. Few publications have reached conclusion regarding the differences of outcomes between primary closure (PC) and a staged repair with silo pouch reduction (SR); as the initial management of gastroschisis. METHODS A retrospective review was conducted in 44 newborns with gastroschisis between 1996 and 2007 at Chang Gung Children's Hospital. We recorded and analyzed basic demographic data, including birth body weight, gestational age, size of the wall defect, initial operative procedure, outcomes, and mortality. RESULTS The male-to-female ratio was 21:23. Patients had a low birth body weight (2263 ± 539g, mean ± SD) and were borderline premature (gestational age = 36.3 ± 1.86 weeks). Thirty-two patients received PC and 12 received SR as the initial treatment. Seven of the newborn infants died because of delayed initial surgical intervention (n = 2), operation-related complications (n = 4), or underlying multiple congenital anomalies (n = 1). The mortality rate was 16%. When comparing PC and SR (excluding "complicated" gastroschisis), there were no significant differences in survival, days of ventilator use, days to reach full enteral feeding, and hospitalization. CONCLUSION PC and SR are comparable as initial treatment modalities for gastroschisis. In addition to underlying gastrointestinal anomalies, the factors that led to significant morbidity in our study were bowel gangrene or perforation resulting from postponed surgical management and the development of abdominal compartment syndrome.
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Affiliation(s)
- Ming-Horng Tsai
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chiayi, Taiwan
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Kronfli R, Bradnock TJ, Sabharwal A. Intestinal atresia in association with gastroschisis: a 26-year review. Pediatr Surg Int 2010; 26:891-4. [PMID: 20676892 DOI: 10.1007/s00383-010-2676-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/15/2010] [Indexed: 11/26/2022]
Abstract
PURPOSE We reviewed our experience with gastroschisis (GS) complicated by intestinal atresia over the last 26 years. Our aim was to determine the effect of different management strategies employed and the morbidity associated with this condition in our unit. METHODS A retrospective casenote review was carried out. Data regarding the operative management of the GS and atresia was recorded. Primary outcome measures included time to commence and establish full enteral feeds, duration of parenteral nutrition, complications and outcome. RESULTS Of 179 neonates with GS, 23 also had intestinal atresia. 13 underwent primary closure of the defect, 5 had patch closure and 5 had a silo placed. 4 atresias were 'missed' at first operation. The 19 recognised atresias were managed either by stoma formation, primary anastomosis or deferred management with subsequent primary anastomosis. There was wide variation in the outcomes of patients in each group. CONCLUSION Differences in outcome between the management strategies are likely to reflect an inherent variability in patient condition, site of atresia, and bowel suitability for anastomosis at first surgery, rather than the mode of surgical management. Individual management plans should be tailored to the clinical condition of each patient.
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Garcia L, Brizot M, Liao A, Silva MM, Tannuri AC, Zugaib M. Bowel dilation as a predictor of adverse outcome in isolated fetal gastroschisis. Prenat Diagn 2010; 30:964-9. [DOI: 10.1002/pd.2596] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Kandasamy Y, Whitehall J, Gill A, Stalewski H. Surgical management of gastroschisis in North Queensland from 1988 to 2007. J Paediatr Child Health 2010; 46:40-4. [PMID: 19943863 DOI: 10.1111/j.1440-1754.2009.01615.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AIM To review outcomes of gastroschises originating in North Queensland and repaired in the neonatal centre in Townsville from 1988-2007, and compare these outcomes with published data from other centres. METHODS A retrospective chart review of outcomes after primary operative repair (POR) with wound closure in fascial layers in the theatre, primary non-operative repair (PNOR) with apposition of the umbilical cord and adhesive dressing in the ward, secondary repair (SR) after a silo, and complex repair (CR) of cases with obstruction, perforation or atresiae. Epidemiological data of babies originating in North Queensland but managed in Brisbane were secured from Mater Mothers' Hospital and the Royal Hospital for Children. RESULTS Fifty cases were treated in Townsville: 16 by PNOR, 22 by POR, 6 by SR and 6 by CR. Outcomes of uncomplicated cases treated by PNOR, POR and SR were similar. Outcomes of complicated cases after CR were significantly worse. No significant differences were found between PNOR in Townsvillle and published outcomes after SR from four overseas units. No differences were detected in outcomes of inborn and outborn babies, those delivered by vaginal or caesarean birth or between indigenous and non-indigenous babies. Three (6%) died. Gastroschisis is increasing in North Queensland, particularly in younger mothers. The incidence is 2-3 times higher in indigenous mothers. CONCLUSION No significant differences were found between PNOR and other techniques for uncomplicated cases. PNOR avoids the use of theatre and staff, reducing delay and cost, and the need to transport a sick baby.
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Affiliation(s)
- Yoga Kandasamy
- Department of Neonatology, The Townsville Hospital, 100 Angus Smith Drive Douglas, Queensland, Australia
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Payne NR, Pfleghaar K, Assel B, Johnson A, Rich RH. Predicting the outcome of newborns with gastroschisis. J Pediatr Surg 2009; 44:918-23. [PMID: 19433170 PMCID: PMC2703663 DOI: 10.1016/j.jpedsurg.2009.01.036] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Accepted: 01/15/2009] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of the study was to determine factors predicting outcome in newborns with gastroschisis. METHODS A retrospective analysis of 155 consecutive cases admitted from 1 January 1990 to 31 December 2007 was performed. Prenatal ultrasound findings were available for 89 of 155 (57%) patients and were compared with final outcome. Both univariate and multiple regression analyses were used. RESULTS All patients survived to discharge home. The primary outcome measure was length of stay. Multiple regression identified 4 factors associated with length of stay: (1) gestational age (P = .004), (2) nonelective silo (P < .001), (3) gastrointestinal (GI) complication (intestinal atresia, perforation, or resection) (P < .001), and (4) non-GI anomaly (P = .029). Non-GI anomalies occurred in 17 of 155 (11%) patients and tended to increase the risk of a nonelective silo or GI complication (59% vs 39%, P = .190). Dilated bowel (>10 mm) on prenatal ultrasound was associated with GI complications (22% vs 3%, P = .010). However, 78% of patients with dilated bowel on prenatal ultrasound did not have a GI complication. The absence of dilated bowel on prenatal ultrasound accurately predicted the absence of GI complications in 97% of cases. CONCLUSION Prematurity, nonelective silo, GI complications, and non-GI anomalies predict the short-term outcome of newborns with gastroschisis. Prenatal ultrasound serves primarily to predict the absence of GI complications.
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Affiliation(s)
- Nathaniel R Payne
- Division of Neonatology, Children's Hospital and Clinics of Minnesota, Minneapolis, MN 55404, USA.
| | - Kathleen Pfleghaar
- Division of Perinatology, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Barbara Assel
- Division of Perinatology, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Aubrey Johnson
- Division of Neonatology, Children's Hospital and Clinics of Minnesota, Minneapolis, Minnesota
| | - R, Hampton Rich
- Division of Surgery, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, and Pediatric Surgical Associates, Ltd., Minneapolis, Minnesota
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Marven S, Owen A. Contemporary postnatal surgical management strategies for congenital abdominal wall defects. Semin Pediatr Surg 2008; 17:222-35. [PMID: 19019291 DOI: 10.1053/j.sempedsurg.2008.07.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Early definitive closure of abdominal wall defects is possible in most cases. Staged reduction does offer distinct advantages, and mortality and morbidity may be better. Risk stratification may produce outcome and tailor management of difficult cases in the form of a clinical pathway. Stem cell technology may, in the future, offer the ideal allogenic prosthesis in complex cases.
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Affiliation(s)
- Sean Marven
- Sheffield Children's Hospital NHS Foundation Trust, Western Bank, United Kingdom.
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Nichol PF, Byrne JL, Dodgion C, Saijoh Y. Clinical considerations in gastroschisis: Incremental advances against a congenital anomaly with severe secondary effects. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2008; 148C:231-40. [DOI: 10.1002/ajmg.c.30180] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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David AL, Tan A, Curry J. Gastroschisis: sonographic diagnosis, associations, management and outcome. Prenat Diagn 2008; 28:633-44. [DOI: 10.1002/pd.1999] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Abstract
PURPOSE OF REVIEW Abdominal wall defects comprising both gastroschisis and omphalocele remain a source of significant morbidity and mortality, despite the advances in neonatal and pediatric surgical care. Survival has improved over the past few decades, especially with parenteral nutrition and surgical repair. Yet, still, many questions remain regarding the outcome of these anomalies. RECENT FINDINGS Outcomes of abdominal wall defects have been discussed more often in the recent publications, with analysis of databases and evaluation of prenatal series. There have been a number of new prenatal interventions in gastroschisis, and a better understanding of gestational outcomes from omphalocele. Papers have discussed the optimal surgical management of these defects as well. SUMMARY This review helps to bring together the most recent findings regarding outcomes and interventions for abdominal wall defects. It also illustrates the pressing need for a large prospective database to better understand these anomalies and provide better care.
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