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Camara S, Tenfa DY, Fatou SY, Yacine F, Fall M, Ndour O. Evaluation of the Management of Gastroschisis in Aristide Le Dantec University Hospital Center in Dakar: A Cross Sectional Study. Afr J Paediatr Surg 2024; 21:155-159. [PMID: 38520242 DOI: 10.4103/ajps.ajps_68_22] [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: 05/19/2022] [Accepted: 01/16/2023] [Indexed: 03/25/2024] Open
Abstract
INTRODUCTION The management of gastroschisis remains problematic in low- and middle-income countries with high perioperative mortality. The objective of this work was to make an initial assessment of our management of gastroschisis. MATERIALS AND METHODS This was a monocentric and cross-sectional study including all newborns with gastroschisis between January 2017 and December 2021 in the Pediatric Surgery and Anesthesia Resuscitation Department of the Aristide Le Dantec University Hospital Center from Dakar. The socio-demographic, diagnostic, therapeutic and evolutionary parameters were studied. RESULTS Eighteen cases of gastroschisis (11 males and 7 females). The mothers' mean age were 23.1 ± 5.7 years old. Only one antenatal diagnosis was made. The mean gestation age were 36.5 ± 1.5 weeks. On admission, the mean age was 16.8 ± 6.3 h and the mean weight 2244 ± 260.3 g. Gastroschisis was complex in four patients. Primary bowel reintegration was performed in 8 cases (44.4%) and progressive reintegration using an Applied Alexis retractor in 9 newborns (55.6%). Main complications were respiratory distress (28.3%) and sepsis (22.2%). The mean duration of return of oral feeding was 5.1 ± 1.9 days. Mortality was 94.4% (17/18). CONCLUSION Reducing gastroschisis-related mortality in our low-income countries remains a major challenge.
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Affiliation(s)
- Souleymane Camara
- Department of Pediatric Surgery, Aristide Le Dantec University Hospital, Dakar, Senegal
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Fatona O, Opashola K, Faleye A, Adeyanju T, Adekanmbi A, Etiubon E, Jesuyajolu D, Zubair A. Gastroschisis in Sub-Saharan Africa: a scoping review of the prevalence, management practices, and associated outcomes. Pediatr Surg Int 2023; 39:246. [PMID: 37584727 DOI: 10.1007/s00383-023-05531-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 08/17/2023]
Abstract
Gastroschisis is a congenital defect of the anterior abdominal wall characterized by a periumbilical abdominal wall defect with associated bowel protrusion. Limitations in the diagnosis and management of gastroschisis in Sub-Saharan African countries contribute to the high mortality rate. Few studies have been published despite its significant contribution to neonatal mortality in Sub-Saharan Africa. This review study explores the prevalence of gastroschisis, likewise the management and clinical outcomes. Full-text articles reporting the prevalence, management, and associated outcomes of gastroschisis in Sub-Saharan Africa were included. Data were extracted from databases such as PubMed, Google Scholar, and Ajol following a systematic search. The study was reported following the PRISMA-ScR guideline. A total of ten articles which included studies conducted from 1999 to 2022 fulfilled the criteria. The prevalence of gastroschisis varied widely, ranging from 0.026 to 1.75 with an overall mortality rate of 62.48%. Young maternal age is strongly associated with the incidence of gastroschisis. The study showed a slight male preponderance with a M: F ratio of 1.12:1. Staged closure with silos is the preferred method of management, it is explicitly linked to improved clinical outcomes. The prevalence rate and associated mortality of gastroschisis remain alarmingly high in most of the studies. There is a need for advanced diagnostic and management practices as well as increased awareness of gastroschisis to reduce mortality and improve survival outcomes.
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Affiliation(s)
- Omobolanle Fatona
- Paediatric Surgery Department, Surgery Interest Group of Africa, Lagos, Nigeria.
| | - Kehinde Opashola
- Paediatric Surgery Department, Surgery Interest Group of Africa, Lagos, Nigeria
| | - Abidemi Faleye
- Paediatric Surgery Department, Surgery Interest Group of Africa, Lagos, Nigeria
| | - Toluwanimi Adeyanju
- Paediatric Surgery Department, Surgery Interest Group of Africa, Lagos, Nigeria
| | - Azeezat Adekanmbi
- Paediatric Surgery Department, Surgery Interest Group of Africa, Lagos, Nigeria
| | - Etimbuk Etiubon
- Paediatric Surgery Department, Surgery Interest Group of Africa, Lagos, Nigeria
| | - Damilola Jesuyajolu
- Paediatric Surgery Department, Surgery Interest Group of Africa, Lagos, Nigeria
| | - Abdulahi Zubair
- Paediatric Surgery Department, Surgery Interest Group of Africa, Lagos, Nigeria
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Outcome and management in neonates with gastroschisis in the third millennium-a single-centre observational study. Eur J Pediatr 2022; 181:2291-2298. [PMID: 35226141 PMCID: PMC9110488 DOI: 10.1007/s00431-022-04416-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 02/02/2023]
Abstract
UNLABELLED Gastroschisis is one of the most common congenital malformations in paediatric surgery. However, there is no consensus regarding the optimal management. The aims of this study were to investigate the management and outcome and to identify predictors of outcome in gastroschisis. A retrospective observational study of neonates with gastroschisis born between 1999 and 2020 was undertaken. Data was extracted from the medical records and Cox regression analysis was used to identify predictors of outcome measured by length of hospital stay (LOS) and duration of parenteral nutrition (PN). In total, 114 patients were included. Caesarean section was performed in 105 (92.1%) at a median gestational age (GA) of 36 weeks (range 29-38) whereof (46) 43.8% were urgent. Primary closure was achieved in 82% of the neonates. Overall survival was 98.2%. One of the deaths was caused by abdominal compartment syndrome and one patient with intestinal failure-associated liver disease died from sepsis. None of the deceased patients was born after 2005. Median time on mechanical ventilation was 22 h. Low GA, staged closure, intestinal atresia, and sepsis were independent predictors of longer LOS and duration on PN. In addition, male sex was an independent predictor of longer LOS. CONCLUSION Management of gastroschisis according to our protocol was successful with a high survival rate, no deaths in neonates born after 2005, and favourable results in LOS, duration on PN, and time on mechanical ventilation compared to other reports. Multicentre registry with long-term follow-up is required to establish the best management of gastroschisis. WHAT IS KNOWN • Gastroschisis is one of the most common congenital malformations in paediatric surgery with increasing incidence. • There is no consensus among clinicians regarding the optimal management of gastroschisis. WHAT IS NEW • Although primary closure was achieved in 82% of the patients, mortality rate was very low (1.8%) with no deaths in neonates born after 2005 following the introduction of measurement of intraabdominal pressure at closure. • Low gestational age, staged closure, intestinal atresia, sepsis, and male sex were independent predictors of longer length of hospital stay.
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Ruschkowski B, Nasr A, Oltean I, Lawrence S, El Demellawy D. Examining the Relationship Between Gastroschisis and Placental Fetal Vascular Malperfusion. Pediatr Dev Pathol 2021; 24:531-541. [PMID: 34284667 PMCID: PMC8652372 DOI: 10.1177/10935266211029629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Gastroschisis is a congenital malformation characterized by intestinal herniation through an abdominal wall defect. Despite its unknown pathogenesis, known risk factors include maternal smoking, alcohol use, and young maternal age. Previous work has shown that gastroschisis is associated with placental delayed villous maturation, and the goal of this study was to assess for additional associated placental pathologies that may help clarify the pathogenesis of gastroschisis. METHODS We conducted a retrospective slide review of 29 placentas of neonates with gastroschisis. Additionally, we reviewed pathology reports from one control group of 30 placentas with other congenital malformations. Gross and histological data were collected based on a standardized rubric. RESULTS Gastroschisis was associated with increased placental fetal vascular malperfusion (FVM) in 62% of cases (versus 0% of controls, p < 0.0001). It was also associated with increased placental villous maldevelopment in 76% of cases (versus 3% of controls, p < 0.0001). CONCLUSION Our study demonstrates an association between gastroschisis and FVM. While FVM could be the consequence of vascular disruption due to the ventral location of gastroschisis, it could also reflect estrogen-induced thrombosis in early pregnancy. Further research is needed to separate these possibilities and determine the cause of the placental FVM observed in gastroschisis.
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Affiliation(s)
| | - Ahmed Nasr
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada,Department of Pediatric Surgery, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Irina Oltean
- Department of Pediatric Surgery, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Sarah Lawrence
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada,Department of Pediatrics, Neonatology Division, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Dina El Demellawy
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada,Department of Pathology, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada,Dina El Demellawy, Department of Pathology, Children's Hospital of Eastern Ontario, Ottawa, Ontario K1H 8L1, Canada.
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Caldeman C, Fogelström A, Oddsberg J, Mesas Burgos C, Löf Granström A. National birth prevalence, associated anomalies and mortality for gastroschisis in Sweden. Acta Paediatr 2021; 110:2635-2640. [PMID: 34036643 DOI: 10.1111/apa.15954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/11/2021] [Accepted: 05/24/2021] [Indexed: 12/20/2022]
Abstract
AIM An increased incidence has been reported for the congenital abdominal wall defect gastroschisis. The reason for this increasing trend is not known, nor the aetiology. The aim of this study was to examine the national birth prevalence in Sweden, the termination rate, associated anomalies and the mortality of gastroschisis within the cohort. METHODS A nationwide, population-based descriptive study of children born with gastroschisis in Sweden between 1/1 1997 and 31/12 2016 was conducted. The cohort was collected from the Swedish Medical Birth Register and the Swedish National Patient Register. Several other national registers were then interlinked to identify outcome data. RESULTS The study included 361 cases of gastroschisis, 54% female. The birth prevalence was 1.52 in 10,000 live births. The termination rate was 21%. The mortality within the cohort was 4.4% with a 1-year mortality of 3.9%. Most frequent associated anomalies were gastrointestinal (11.4%), musculoskeletal (9.8%) and cardiovascular anomalies (7.9%). CONCLUSION During the 20-year study period, a stable birth prevalence of 1.52 per 10 000 live births was seen in Sweden. The mortality was low, 4.4%, but the termination of pregnancies was high, 21%. Almost one-third had associated congenital anomalies where gastrointestinal anomalies were the most common.
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Affiliation(s)
- Cecilia Caldeman
- Division for Pediatric Surgery Astrid Lindgren Children’s HospitalKarolinska University Hospital Stockholm Sweden
- Department of Women’s and Children’s Health Karolinska Institute Stockholm Sweden
| | - Anna Fogelström
- Division for Pediatric Surgery Astrid Lindgren Children’s HospitalKarolinska University Hospital Stockholm Sweden
- Department of Women’s and Children’s Health Karolinska Institute Stockholm Sweden
| | - Jenny Oddsberg
- Division for Pediatric Surgery Astrid Lindgren Children’s HospitalKarolinska University Hospital Stockholm Sweden
- Department of Women’s and Children’s Health Karolinska Institute Stockholm Sweden
| | - Carmen Mesas Burgos
- Division for Pediatric Surgery Astrid Lindgren Children’s HospitalKarolinska University Hospital Stockholm Sweden
- Department of Women’s and Children’s Health Karolinska Institute Stockholm Sweden
| | - Anna Löf Granström
- Division for Pediatric Surgery Astrid Lindgren Children’s HospitalKarolinska University Hospital Stockholm Sweden
- Department of Women’s and Children’s Health Karolinska Institute Stockholm Sweden
- Department of Surgery Danderyd Hospital & Department of Clinical Sciences Danderyd HospitalKarolinska Institute Stockholm Sweden
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Abstract
PURPOSE Several studies have reported high prevalence of undescended testis (UDT) among boys with congenital abdominal wall defects (AWD). Due to rarity of AWDs, however, true prevalence of testicular maldescent among these boys is not known. We conducted a national register study to determine the prevalence of UDT among Finnish males with an AWD. METHODS All male infants with either gastroschisis or omphalocele born between Jan 1, 1998 and Dec 31, 2015 were identified in the Register of Congenital Malformations. The data on all performed operations were acquired from the Care Register for Health Care. The register data were examined for relevant UDT diagnosis and operation codes. RESULTS We identified 99 males with gastroschisis and 89 with omphalocele. UDT was diagnosed in 10 (10.1%) infants with gastroschisis and 22 (24.7%) with omphalocele. Majority of these required an operation; 8/99 (8.1%) gastroschisis and 19/89 (21.3%) omphalocele patients. UDT is more common among AWD patients than general population with the highest prevalence in omphalocele. CONCLUSIONS Cryptorchidism is more common among boys with an AWD than general population. Furthermore, omphalocele carries significantly higher risk of UDT and need for orchidopexy than gastroschisis. Due to high prevalence testicular maldescent, careful follow-up for UDT is recommended.
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Hariharan G, Jones N, Ee M, De Paoli A. Epidemiology and outcomes of gastroschisis in Tasmania. J Paediatr Child Health 2020; 56:1795-1798. [PMID: 32196139 DOI: 10.1111/jpc.14863] [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: 05/29/2019] [Revised: 01/21/2020] [Accepted: 03/01/2020] [Indexed: 11/30/2022]
Abstract
AIM To describe the epidemiology and outcomes of gastroschisis in Tasmania. METHODS A retrospective analysis of all pregnancies complicated by gastroschisis in Tasmania from 1996 to 2015 was undertaken (epidemiology cohort), and the presentation, surgical management and outcomes (surgery cohort) were reviewed for the period between September 1990 and July 2015. RESULTS Gastroschisis was detected in 58 pregnancies during the 20-year epidemiology cohort period, giving an incidence of 4.4 per 10 000 live births for the 20-year period. Two of the four stillbirths occurred after 36 weeks' gestation. Of the 65 babies with gastroschisis treated at the Royal Hobart Hospital, 51 had a staged surgical repair (silo in 47, stoma formation in 4), and 14 had a primary closure. Staged repair was associated with a significantly longer duration of ventilation and stay in the neonatal intensive care unit. There were six post-natal deaths, all born in the first epoch. Death was significantly associated with the condition of the intestine at delivery (P = 0.02). There were no deaths in babies with simple gastroschisis. Complex gastroschisis was significantly associated with longer duration of total parenteral nutrition (P = 0.0002) and longer stay in hospital (P = 0.03). CONCLUSIONS The incidence of gastroschisis in Tasmania is similar to that reported in other Australian regions and has not increased over the 20-year period of study. The high risk of stillbirth, and the significant association between mortality and the condition of the intestine at birth necessitates close fetal surveillance. Complex gastroschisis imposes a significant burden on hospital resources.
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Affiliation(s)
- Gopakumar Hariharan
- Department of Neonatal and Paediatric Intensive Care Unit (NPICU), Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Niall Jones
- Department of Paediatric Surgery, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Michael Ee
- Department of Paediatric Surgery, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Antonio De Paoli
- Department of Neonatal and Paediatric Intensive Care Unit (NPICU), Royal Hobart Hospital, Hobart, Tasmania, Australia
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Hawkins RB, Raymond SL, St. Peter SD, Downard CD, Qureshi FG, Renaud E, Danielson PD, Islam S. Immediate versus silo closure for gastroschisis: Results of a large multicenter study. J Pediatr Surg 2020; 55:1280-1285. [PMID: 31472924 PMCID: PMC7731615 DOI: 10.1016/j.jpedsurg.2019.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 08/07/2019] [Accepted: 08/13/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND/PURPOSE The optimal method to repair gastroschisis defects continues to be debated. The two primary methods are immediate closure (IC) or silo placement (SP). The purpose of this study was to compare outcomes between each approach using a multicenter retrospective analysis. We hypothesized that patients undergoing SP for ≤5 days would have largely equivalent outcomes compared to IC patients. METHODS Gastroschisis patient data were collected over a 7-year period. The cohort was separated into IC and SP groups. The SP group was further stratified based on time to closure (≤5 days, 6-10 days, >10 days). Characteristics and outcomes were compared between groups. Multivariate logistic regression was also performed. RESULTS 566 neonates with gastroschisis were identified including 224 patients in the IC group and 337 patients in the SP group. Among SP patients, 130 were closed within 5 days, 140 in 6-10 days, and 57 in >10 days. There were no significant differences in mortality, sepsis, readmission, or days to full enteral feeds between IC patients and SP patients who had a silo ≤5 days. IC patients had a significantly higher incidence of ventral hernias. Multivariate analysis revealed time to closure as a significant independent predictor of length of stay, ventilator duration, time to full enteral feeds, and TPN duration. CONCLUSIONS Our data show largely equivalent outcomes between patients who undergo immediate closure and those who have silos ≤5 days. We propose that closure within 5 days avoids many of the risks commonly attributed to delay in closure. LEVEL OF EVIDENCE Level II retrospective study.
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Affiliation(s)
- Russell B. Hawkins
- University of Florida College of Medicine, Department of Surgety, Division of Pediatric Surgery, Gainesville, FL, USA
| | - Steven L. Raymond
- University of Florida College of Medicine, Department of Surgety, Division of Pediatric Surgery, Gainesville, FL, USA
| | | | - Cynthia D. Downard
- University of Louisville, Department of Surgery, Division of Pediatric Surgery, Louisville, KY, USA
| | - Faisal G. Qureshi
- University of Texas Southwestern, Department of Surgery, Division of Pediatric Surgery, Dallas, TX, USA
| | - Elizabeth Renaud
- Alpert Medical School of Brown University, Department of Surgery, Division of Pediatric Surgery, Providence, RI, USA
| | | | - Saleem Islam
- University of Florida College of Medicine, Department of Surgery, Division of Pediatric Surgery, Gainesville, FL, USA.
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Belza C, Betts Z, de Silva N, Avitzur Y, Wales PW. Factors Related to the Development of Small-Bowel Bacterial Overgrowth in Pediatric Intestinal Failure: A Retrospective Cohort Study. JPEN J Parenter Enteral Nutr 2020; 44:1280-1284. [PMID: 32167608 DOI: 10.1002/jpen.1809] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 01/27/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Small bowel bacterial overgrowth (SBBO) is a challenge in the management of pediatric intestinal failure (PIF). Our goal was to determine the proportion of patients treated for SBBO and factors related to its development. METHODS We completed a retrospective analysis of PIF patients referred between 2008 and 2014. Data were collected on factors related to intestinal failure (IF) and SBBO. The cohort was stratified on the diagnosis of SBBO and refractory SBBO. Statistical testing completed using t-test, χ2 test, and logistic regression. RESULTS Thirty-five of 102 patients developed SBBO (34%), and 16 (16%) had refractory SBBO. SBBO was more likely in gastroschisis (40.0% vs 19.4%, P = .025), a shorter residual small bowel (SB) (45.4% vs 66.5%, P = .004), and patients were less likely to wean from parenteral nutrition (PN) (51.4% vs 85.1%, P < .0001). Refractory SBBO patients were likely to have gastroschisis (50.0% vs 22.1%, P = .020) and a shorter residual SB and large bowel remaining (23.2% vs 65.9%, P < .0001 and 60.6% vs 79.4%, P = .03, respectively) and less likely to wean from PN (37.5% vs 80.2%, P = .001). Logistic regression demonstrated that longer SB residual was protective (P = .001; odds ratio [OR], 0.95; 95% CI, 0.93-0.99), and short bowel syndrome (SBS) as a cause of IF was a risk factor (P = .001; OR, 0.04; 95% CI, 0.01-0.27). CONCLUSION A longer SB remnant was protective against SBBO. Patients with SBBO were more likely to have PIF caused by SBS.
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Affiliation(s)
- Christina Belza
- Transplant and Regenerative Medicine Centre, Toronto, Canada
| | - Zachary Betts
- Transplant and Regenerative Medicine Centre, Toronto, Canada
| | | | - Yaron Avitzur
- Transplant and Regenerative Medicine Centre, Toronto, Canada.,Division of Neonatology, Toronto, Canada
| | - Paul W Wales
- Transplant and Regenerative Medicine Centre, Toronto, Canada.,Division of Gastroenterology, Hepatology and Nutrition, Toronto, Canada.,Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Canada
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Oyinloye AO, Abubakar AM, Wabada S, Oyebanji LO. Challenges and Outcome of Management of Gastroschisis at a Tertiary Institution in North-Eastern Nigeria. Front Surg 2020; 7:8. [PMID: 32195264 PMCID: PMC7064440 DOI: 10.3389/fsurg.2020.00008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 02/17/2020] [Indexed: 01/16/2023] Open
Abstract
Introduction: Gastroschisis is a congenital anterior abdominal wall defect characterized by herniation of abdominal contents through a defect usually located to the right side of the umbilical cord. It occurs in about 1 in 2,000-4,000 live births and is slightly commoner in males. Management has remained challenging in the low and middle-income countries (LMICS), with high mortality rates. This study highlights the clinical presentation, treatment, outcomes, and challenges in the management of gastroschisis at a tertiary healthcare center in a resource-limited setting. Methods: This was a retrospective review of the records of all patients with gastroschisis managed over a period of 30 months (January 2016-June 2018). Data on patients' demographics, age, birth weight, clinical presentation, method of gastroschisis reduction and closure, complications, and outcomes were collated. Statistical analysis was performed using SPSS version 20. A p-value of >0.05 was considered significant. Results: Twenty-four patients with gastroschisis were managed. Of these, 18 patients had data available for analysis. There were 14 males, with a male-female ratio of 3.5:1. The median age at presentation was 11.0 h (range 1-36 h). Ten patients (55.6%) were delivered in a medical facility. One patient had type II jejunal atresia and transverse colonic atresia as associated anomalies. Improvised silos were applied by the bedside in 15 (83.3%) patients, while two patients (11.1%) had primary closure under general anesthesia. One patient died before definitive treatment could be done. Sterile urobags and female condoms were used for constructing improvised silos in 9 (60%) and 6 (40%) patients, respectively. Eight patients who had initial silo application had complete bowel reduction over a median time of 8.0 days (mean 10.0 ± 6.5 days, range 2-23 days). Total parenteral nutrition (TPN) was not available. The average time to commencement of feeding was 8.0 days ± 6.6 (median 6.0 days, range 2-22 days). Full feeding was achieved in five patients (two patients in the primary closure group and three from the silo group) over a mean time of 16.8 days ± 10.4 (median 14.0 days). Sepsis was the commonest complication. Four patients (22.2%) survived. Conclusion: Management of gastroschisis remains challenging in resource-limited regions.
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Affiliation(s)
- Adewale O Oyinloye
- Division of Pediatric Surgery, Department of Surgery, Federal Medical Center, Yola, Nigeria
| | - Auwal M Abubakar
- Division of Pediatric Surgery, Department of Surgery, Federal Medical Center, Yola, Nigeria
| | - Samuel Wabada
- Division of Pediatric Surgery, Department of Surgery, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Lateef O Oyebanji
- Division of Pediatric Surgery, Department of Surgery, Federal Medical Center, Yola, Nigeria
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Shalaby A, Obeida A, Khairy D, Bahaaeldin K. Assessment of gastroschisis risk factors in Egypt. J Pediatr Surg 2020; 55:292-295. [PMID: 31759649 DOI: 10.1016/j.jpedsurg.2019.10.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 10/26/2019] [Indexed: 01/15/2023]
Abstract
AIM Mortality in infants born with gastroschisis (GS) in low-to-middle-income countries (LMICs) is high. This study aimed to assess factors which might affect outcome in Egypt in order to improve survival. METHODS A prospective study over a 15-month duration was completed. Variables assessed covered patient, maternal, antenatal, treatment, and complications. The Gastroschisis Prognostic Score (GPS) was used to predict outcome. A validated questionnaire was used to assess socioeconomic status. The main outcome was mortality. RESULTS Twenty-four cases were studied. Median gestational age was 37 (26-40) weeks, and 9 (38%) were preterm. Mortality occurred in 15 (62%) infants. Median transfer time was 8 (1.5-35) hours, and 64% survived if transferred before 8 h. Median maternal age was 20 (16-27) years. All families were of a low or very-low socioeconomic level. Only 25% had antenatal scans. Most cases were simple GS, and only 3 (12.5%) were complex GS. Median length of stay was 14 (1-52) days, TPN duration was 12 (0-49) days, and days to full feeds was 5 (3-11) days. The GPS score ranged from 0 to 6 in the studied cases and negatively correlated with outcome (rS = -0.98; p = 0.03). CONCLUSION The mortality of GS in Egypt is very high, mainly due to sepsis and prematurity. Young maternal age and poor socioeconomic status are linked to GS. The GPS is a good indicator of morbidity and mortality in a LMIC setting. Survival improved with better resuscitation and strict management protocols. More effort is needed to improve antenatal detection, and transfer time should be ideally below 8 h. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Aly Shalaby
- Department of Pediatric Surgery, Cairo University Specialized Pediatric Hospital.
| | - Alaa Obeida
- Department of Pediatric Surgery, Cairo University Specialized Pediatric Hospital
| | - Dalia Khairy
- Department of Pediatrics, Cairo University Specialized Pediatric Hospital
| | - Khaled Bahaaeldin
- Department of Pediatric Surgery, Cairo University Specialized Pediatric Hospital
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Hobson D, Spence K, Trivedi A, Thomas G. Differences in attitudes to feeding post repair of Gastroschisis and development of a standardized feeding protocol. BMC Pediatr 2019; 19:475. [PMID: 31801489 PMCID: PMC6894280 DOI: 10.1186/s12887-019-1858-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 11/26/2019] [Indexed: 12/12/2022] Open
Abstract
Background The purpose of this study was to examine differences in attitudes to feeding in neonates with Gastroschisis between clinical groups and to develop a standardized feeding protocol. Confusion, inconsistencies in practice and lack of evidence could be contributing to avoidable delays in the establishment of enteral feeds resulting in lengthy requirements for central venous access, dependence on total parenteral nutrition (TPN), increased risk of sepsis, TPN related cholestasis and prolongation in length of hospital stay. Methods A national survey of clinicians (neonatologists, neonatal intensive care nurses and paediatric surgeons), looking after neonates with gastroschisis was undertaken to determine differences in feeding practice post repair. In addition, an audit of practice in one hospital was undertaken to examine variations in practices between clinicians. A feeding protocol was then developed using inputs from surgeons and neonatologists. Results Gastric aspirates and residuals were typically used as indicators of feed readiness and feed tolerance; however, there was very little consistency within and between clinical groups in definitions of tolerance or intolerance of feeds and in how to initiate and progress feeds. A feeding protocol with clear definition of feed readiness and a clear pathway to progression of feeds was developed to help overcome these variations in practice with the possibility that this might reduce the length of stay (LOS) and have other secondary benefits. The protocol included early introduction of enteral feeds particularly direct breast or sucking feeds. Conclusions Wide differences in attitudes to feeding neonates post Gastroschsis repair exist and the need for a consistent protocolized approach was felt. The feeding protocol we developed requires a change of practice and further clinical trials are needed to evaluate its effectiveness.
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Affiliation(s)
- Donna Hobson
- Grace Centre for Newborn Care, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia
| | - Kaye Spence
- Grace Centre for Newborn Care, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia. .,Western Sydney University, School of Nursing and Midwifery, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Amit Trivedi
- Grace Centre for Newborn Care, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia.,The Children's Hospital at Westmead Clinical School, The University of Sydney, Locked Bag 4001, Westmead, NSW, 2145, Australia
| | - Gordon Thomas
- The Children's Hospital at Westmead Clinical School, The University of Sydney, Locked Bag 4001, Westmead, NSW, 2145, Australia.,Department of Surgery, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia
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13
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Bergh C, Pinborg A, Wennerholm UB. Parental age and child outcomes. Fertil Steril 2019; 111:1036-1046. [PMID: 31155113 DOI: 10.1016/j.fertnstert.2019.04.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/13/2019] [Accepted: 04/18/2019] [Indexed: 10/26/2022]
Abstract
This review summarizes the impact of parental age on children's health outcomes beyond the perinatal period. In the last decades, delayed parenthood with both men and women has become a public health issue. For women, in particular, the size of this delay is substantial. For a few medical conditions, older parental age has a pronounced effect on child morbidity. For most other outcomes, a more modest effect is evident. Although these effects might be limited on an individual level, they have a substantial impact at the level of population health.
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Affiliation(s)
- Christina Bergh
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Anja Pinborg
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ulla-Britt Wennerholm
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital East, Gothenburg, Sweden
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14
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Girsen AI, Davis AS, Hintz SR, Fluharty E, Sherwin K, Trepman P, Desai A, Mansour T, Sylvester KG, Oshiro B, Blumenfeld YJ. Effects of gestational age at delivery and type of labor on neonatal outcomes among infants with gastroschisis †. J Matern Fetal Neonatal Med 2019; 34:2041-2046. [PMID: 31409162 DOI: 10.1080/14767058.2019.1656191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To investigate the effect of preterm gestational age (GA) on neonatal outcomes of gastroschisis and to compare the neonatal outcomes after spontaneous labor versus iatrogenic delivery both in the preterm and early term gestational periods. STUDY DESIGN A retrospective study of prenatally diagnosed gastroschisis cases born at Loma Linda University Medical Center and Lucile Packard Children's Hospital (Loma Linda, CA) between January 2009 and October 2016. A total of 194 prenatally diagnosed gastroschisis cases were identified and included in the analysis. We compared infants delivered <37 0/7 to those ≥37 0/7 weeks' gestation. Adverse neonatal outcome was defined as any of: sepsis, short bowel syndrome, prolonged ventilation, or death. Prolonged length of stay (LOS) was defined as ≥75th percentile value. Outcomes following spontaneous versus iatrogenic delivery were compared. Analyses were performed using chi-squared test or Fisher's exact test for categorical variables, and Student's t-test or Wilcoxon's rank-sum test for continuous variables. RESULTS One hundred and six neonates were born <37 weeks and 88 at ≥37 weeks. Adverse outcome was statistically similar among those born <37 weeks compared to ≥37 weeks (48 versus 34%, p = .07). Prolonged LOS was more frequent among neonates delivered <37 weeks (p = .03). Among neonates born <37 weeks, bowel atresia was more frequent in those with spontaneous versus iatrogenic delivery (p = .04). There was no significant difference in the adverse neonatal composite outcome between those with spontaneous preterm labor versus planned iatrogenic delivery at <37 weeks (n = 30 (58%) versus n = 21 (39%), p = .08). CONCLUSIONS Neonates with gastroschisis delivered <37 weeks had prolonged LOS whereas the rate of adverse neonatal outcomes was similar between those delivered preterm versus term. Neonates born after spontaneous preterm labor had a higher rate of bowel atresia compared to those born after planned iatrogenic preterm delivery.
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Affiliation(s)
- Anna I Girsen
- Department of Obstetrics & Gynecology, Stanford University, Stanford, CA, USA
| | - Alexis S Davis
- Department of Pediatrics, Stanford University, Stanford, CA, USA.,Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital Stanford, Stanford, CA, USA
| | - Susan R Hintz
- Department of Pediatrics, Stanford University, Stanford, CA, USA.,Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital Stanford, Stanford, CA, USA
| | - Elizabeth Fluharty
- Department of Pediatrics, Stanford University, Stanford, CA, USA.,Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital Stanford, Stanford, CA, USA
| | - Katie Sherwin
- Department of Obstetrics & Gynecology, Stanford University, Stanford, CA, USA
| | - Paula Trepman
- Department of Obstetrics & Gynecology, Stanford University, Stanford, CA, USA
| | - Arti Desai
- Department of Obstetrics & Gynecology, Loma Linda University, Stanford, CA, USA
| | - Trina Mansour
- Department of Obstetrics & Gynecology, Loma Linda University, Stanford, CA, USA
| | - Karl G Sylvester
- Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital Stanford, Stanford, CA, USA.,Department of Surgery, Stanford University, Stanford, CA, USA
| | - Bryan Oshiro
- Department of Obstetrics & Gynecology, Loma Linda University, Stanford, CA, USA
| | - Yair J Blumenfeld
- Department of Obstetrics & Gynecology, Stanford University, Stanford, CA, USA.,Fetal and Pregnancy Health Program, Lucile Packard Children's Hospital Stanford, Stanford, CA, USA
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15
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Raymond SL, Hawkins RB, St Peter SD, Downard CD, Qureshi FG, Renaud E, Danielson PD, Islam S. Predicting Morbidity and Mortality in Neonates Born With Gastroschisis. J Surg Res 2019; 245:217-224. [PMID: 31421366 DOI: 10.1016/j.jss.2019.07.065] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 07/15/2019] [Accepted: 07/19/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Gastroschisis is an increasingly common congenital abdominal wall defect. Due to advances in neonatal critical care and early surgical management, mortality from gastroschisis and associated complications has decreased to less than 10% in most series. However, it has been recognized that the outcome of gastroschisis has a spectrum and that the disorder affects a heterogeneous cohort of neonates. The goal of this study is to predict morbidity and mortality in neonates with gastroschisis using clinically relevant variables. METHODS A multicenter, retrospective observational study of neonates born with gastroschisis was conducted. Neonatal characteristics and outcomes were collected and compared. Prediction of morbidity and mortality was performed using multivariate clinical models. RESULTS Five hundred and sixty-six neonates with gastroschisis were identified. Overall survival was 95%. Median hospital length of stay was 37 d. Sepsis was diagnosed in 107 neonates. Days on parenteral nutrition and mechanical ventilation were considerable with a median of 27 and 5 d, respectively. Complex gastroschisis (atresia, perforation, volvulus), preterm delivery (<37 wk), and very low birth weight (<1500 g) were associated with worse clinical outcomes including increased sepsis, short bowel syndrome, parenteral nutrition days, and length of stay. The composite metric of birth weight, Apgar score at 5 min, and complex gastroschisis was able to successfully predict mortality (area under the curve, 0.81). CONCLUSIONS Clinical variables can be used in gastroschisis to distinguish those who will survive from nonsurvivors. Although these findings need to be validated in other large multicenter data sets, this prognostic score may aid practitioners in the identification and management of at-risk neonates.
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Affiliation(s)
- Steven L Raymond
- Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida
| | - Russell B Hawkins
- Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida
| | - Shawn D St Peter
- Pediatric Surgery, The Children's Mercy Hospital, Kansas City, Missouri
| | - Cynthia D Downard
- Division of Pediatric Surgery, Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Faisal G Qureshi
- Division of Pediatric Surgery, Department of Surgery, University of Texas Southwestern, Dallas, Texas
| | - Elizabeth Renaud
- Division of Pediatric Surgery, Department of Surgery, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Paul D Danielson
- Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Saleem Islam
- Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida.
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16
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Abstract
Fetal surgery and fetal therapy involve surgical interventions on the fetus in utero to correct or ameliorate congenital abnormalities and give a developing fetus the best chance at a healthy life. Historical use of biomaterials in fetal surgery has been limited, and most biomaterials used in fetal surgeries today were originally developed for adult or pediatric patients. However, as the field of fetal surgery moves from open surgeries to minimally invasive procedures, many opportunities exist for innovative biomaterials engineers to create materials designed specifically for the unique challenges and opportunities of maternal-fetal surgery. Here, we review biomaterials currently used in clinical fetal surgery as well as promising biomaterials in development for eventual clinical translation. We also highlight unmet challenges in fetal surgery that could particularly benefit from novel biomaterials, including fetal membrane sealing and minimally invasive myelomeningocele defect repair. Finally, we conclude with a discussion of the underdeveloped fetal immune system and opportunities for exploitation with novel immunomodulating biomaterials.
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Affiliation(s)
- Sally M Winkler
- Department of Bioengineering, University of California, Berkeley, CA, USA. and University of California, Berkeley-University of California, San Francisco Graduate Program in Bioengineering, Berkeley, CA, USA
| | - Michael R Harrison
- Division of Pediatric Surgery, UCSF Benioff Children's Hospital, San Francisco, CA, USA
| | - Phillip B Messersmith
- Department of Bioengineering, University of California, Berkeley, CA, USA. and Department of Materials Science and Engineering, University of California, Berkeley, CA, USA and Materials Sciences Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
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17
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Miranda ME, Emil S, de Mattos Paixão R, Piçarro C, Cruzeiro PCF, Campos BA, Pontes AK, Tatsuo ES. A 25-year study of gastroschisis outcomes in a middle-income country. J Pediatr Surg 2019; 54:1481-1486. [PMID: 30898402 DOI: 10.1016/j.jpedsurg.2019.02.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 01/22/2019] [Accepted: 02/17/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Survival of newborns with gastroschisis is significantly higher in high-income versus low and middle-income countries. We reviewed treatment and outcomes of gastroschisis in a middle-income country setting with increasing protocolized management. METHODS All newborns with gastroschisis treated during the period 1989-2013 at a single Brazilian academic surgical service were studied retrospectively. Protocolized diagnosis, delivery, nutrition, medical interventions, and surgical interventions were introduced in 2002. Outcomes before and after protocol introduction were studied using univariate and multivariate analysis. RESULTS One hundred fifty-six newborns were treated for gastroschisis: 35 (22.4%) and 121 (77.6%) before and after 2002, respectively. When compared to the earlier cohort, patients treated after 2002 had higher rates of prenatal diagnosis (90.9% vs. 60.0%, p < 0.001), delivery at a tertiary center (90.9% vs. 62.9%, p < 0.001), early closure (65.3% vs. 33.3%, p = 0.001), primary repair (55.4% vs. 31.4%, p = 0.013), monitoring of bladder pressure (62.0% vs. 2.9%, p = 0.001), PICC placement (71.1% vs. 25.7%, p < 0.001), early initiation of enteral feeding (54.5% vs. 20.0%, p < 0.001), and lower rates of electrolyte disturbances (53.7% vs. 85.7%, p = 0.001). Mortality decreased from 34.3% before 2002 to 24.8% (p = .27) after 2002 despite an increase in the complex gastroschisis rate from 11.4% to 15.7% during the same period. CONCLUSIONS Gastroschisis outcomes in a middle-income country can be gradually improved through targeted interventions and management protocols. TYPE OF STUDY Therapeutic. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Marcelo Eller Miranda
- Department of Surgery, School of Medicine, Universidade Federal de Minas Gerais; Pediatric Surgical Service, Hospital das Clínicas of the Universidade Federal de Minas Gerais/Empresa, Brasileira, de Serviços Hospitalares. Belo Horizonte, Minas Gerais, Brazil.
| | - Sherif Emil
- Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Ricardo de Mattos Paixão
- Department of Surgery, School of Medicine, Universidade Federal de Minas Gerais; Pediatric Surgical Service, Hospital das Clínicas of the Universidade Federal de Minas Gerais/Empresa, Brasileira, de Serviços Hospitalares. Belo Horizonte, Minas Gerais, Brazil
| | - Clécio Piçarro
- Department of Surgery, School of Medicine, Universidade Federal de Minas Gerais; Pediatric Surgical Service, Hospital das Clínicas of the Universidade Federal de Minas Gerais/Empresa, Brasileira, de Serviços Hospitalares. Belo Horizonte, Minas Gerais, Brazil
| | - Paulo Custódio Furtado Cruzeiro
- Department of Surgery, School of Medicine, Universidade Federal de Minas Gerais; Pediatric Surgical Service, Hospital das Clínicas of the Universidade Federal de Minas Gerais/Empresa, Brasileira, de Serviços Hospitalares. Belo Horizonte, Minas Gerais, Brazil
| | - Bernardo Almeida Campos
- Department of Surgery, School of Medicine, Universidade Federal de Minas Gerais; Pediatric Surgical Service, Hospital das Clínicas of the Universidade Federal de Minas Gerais/Empresa, Brasileira, de Serviços Hospitalares. Belo Horizonte, Minas Gerais, Brazil
| | - Andrey Kaliff Pontes
- Pediatric Surgical Service, Hospital das Clínicas of the Universidade Federal de Minas Gerais/Empresa, Brasileira, de Serviços Hospitalares. Belo Horizonte, Minas Gerais, Brazil
| | - Edson Samesima Tatsuo
- Department of Surgery, School of Medicine, Universidade Federal de Minas Gerais; Pediatric Surgical Service, Hospital das Clínicas of the Universidade Federal de Minas Gerais/Empresa, Brasileira, de Serviços Hospitalares. Belo Horizonte, Minas Gerais, Brazil
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18
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Narang A, Carlsen V, Long A, Battin M, Upadhyay V, Sadler L, Stone P. Anterior abdominal wall defects managed at a tertiary maternal-fetal medicine service in New Zealand: What counselling advice can we offer parents? Aust N Z J Obstet Gynaecol 2019; 59:805-810. [PMID: 30841012 DOI: 10.1111/ajo.12965] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 01/23/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Anterior abdominal wall defects, including gastroschisis and omphalocoele, are common fetal anomalies. The management remains complicated, and their diagnosis may lead to significant parental distress. Effective parental counselling may impact on parental perceptions of the defect and help guide pregnancy management. AIMS Using contemporary data, we aimed to describe clinical outcomes of patients with gastroschisis or omphalocoele in order to provide information for clinicians to assist in parental counselling. MATERIALS AND METHODS We followed a case-series of patients with anterior abdominal wall defects referred to our regional Maternal Fetal Medicine services from 2011 to 2016. Outcomes of interest antenatally included details of diagnosis, associated anomalies and outcomes of pregnancy and postnatally included the nature of surgical repair, hospital stay and secondary complications until initial discharge. RESULTS Eighty babies with gastroschisis were referred antenatally, and 72 were liveborn. Forty-nine babies with omphalocoele were referred antenatally, and 24 were liveborn. One further neonate with omphalocoele was postnatally diagnosed. Seventy-one neonates with gastroschisis progressed to operation, 30 developed complications post-surgery, and 68 survived until initial discharge. Twenty-two neonates with omphalocoele progressed to surgery, only two developed complications, and 21 survived until initial discharge. Eight of the surviving neonates with omphalocoele had associated structural abnormalities. The median hospital stay was 27 and eight days for gastroschisis and omphalocoele, respectively. CONCLUSION Neonates with gastroschisis can have complex postnatal periods. Omphalocoele is associated with high antenatal mortality, especially in the presence of associated abnormalities; however, surviving neonates may have uneventful postnatal periods.
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Affiliation(s)
- Apoorv Narang
- Faculty of Medical and Health Sciences, Auckland City Hospital, University of Auckland, Auckland, New Zealand
| | - Victoria Carlsen
- Department of Obstetrics and Gynaecology, Waikato Hospital, Hamilton, New Zealand
| | - Audrey Long
- Department of Obstetrics and Gynaecology, National Women's Health, Auckland, New Zealand
| | - Malcolm Battin
- Newborn Services, Auckland City Hospital, Auckland, New Zealand
| | - Vipul Upadhyay
- Department of Paediatric Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Lynn Sadler
- Women's Health, Auckland District Health Board, Auckland, New Zealand
| | - Peter Stone
- Maternal Fetal Medicine, School of Medicine, University of Auckland, Auckland, New Zealand
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19
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Abstract
Selection of outcome determinants and risk stratification are necessary to identify patients at higher risk for morbidity and mortality. This facilitates human and material resource allocation and allows for improved family counseling. While several different factors, including prenatal ultrasonographic bowel features, the timing and mode of delivery, and the features of bowel injury have been investigated in gastroschisis, there is still significant debate as to which of these best predicts outcome. This article reviews the different outcome predictors and risk prognostication schemata currently available in the literature to help guide clinicians caring for infants with gastroschisis.
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Affiliation(s)
- Hussein Wissanji
- Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Room B04.2318, 1001 Decarie Boulevard, Montreal, Quebec, Canada
| | - Pramod S Puligandla
- Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Room B04.2318, 1001 Decarie Boulevard, Montreal, Quebec, Canada.
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20
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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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21
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Vanishing gastroschisis visualized by antenatal ultrasound: a case report and review of literature. Eur J Obstet Gynecol Reprod Biol 2018; 228:186-190. [PMID: 29980113 DOI: 10.1016/j.ejogrb.2018.06.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 06/13/2018] [Indexed: 11/23/2022]
Abstract
We report a case of vanishing gastroschisis visualized by antenatal ultrasound with a 7-year long term follow-up. Currently, the child is still dependent on daily parenteral nutrition with no signs of hepatotoxicity. To our knowledge, it's the fourth case with a long-term follow-up. Vanishing gastroschisis is a rare complication of gastroschisis. However, physicians should be aware of it because its prognosis is worse than classical gastroschisis. When a vanishing gastroschisis is visualized or suspected by antenatal ultrasound, prenatal counseling is required with explanations about the risk of short bowel syndrome, the need of parenteral nutrition and related complications (inflammatory colitis, sepsis, liver failure and organ transplant). Mortality rate was initially around 93%, and dropped to 27% after the years 2000 (versus 10% for classical gastroschisis). After birth, all children will require surgery, and sometimes autologous gastro-intestinal reconstruction. Most survivors (68%) could be taken off the TPN. Unfortunately, long-term outcomes for children with vanishing gastroschisis are still missing in current literature.
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22
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Melov SJ, Tsang I, Cohen R, Badawi N, Walker K, Soundappan SSV, Alahakoon TI. Complexity of gastroschisis predicts outcome: epidemiology and experience in an Australian tertiary centre. BMC Pregnancy Childbirth 2018; 18:222. [PMID: 29890949 PMCID: PMC5996507 DOI: 10.1186/s12884-018-1867-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 05/30/2018] [Indexed: 01/18/2023] Open
Abstract
Background Gastroschisis is a congenital anomaly of the fetal abdominal wall, usually to the right side of umbilical insertion. It is often detected by routine antenatal ultrasound. Significant maternal and pediatric resources are utilised in the care of women and infants with gastroschisis. Increasing rates of gastroschisis worldwide have led institutions to review local data and investigate outcomes. A collaborative project was developed to review local epidemiology and investigate antenatal and neonatal factors influencing hospital length of stay (LOS) and total parental nutrition (TPN) in infants born with gastroschisis. Methods We performed a five-year review of infants born with gastroschisis (2011–2015) at a major Australian centre. Complex gastroschisis was defined as involvement of stenosis, atresia, ischemia, volvulus or perforation and closed or vanishing gastroschisis. We extracted data from files and databases at the two participating hospitals, a major maternal fetal medicine centre and the affiliated children’s hospital. Results There were 56 infants antenatally diagnosed with gastroschisis with no terminations, one stillbirth (2%) and one infant with ‘vanishing’ gastroschisis. The mean maternal age was 23.9 years (range, 15–39 years). The mean gestation at delivery was 36 weeks (range, 25–39+ 3 weeks). Of the 55 neonates who received surgical management, 62% had primary closure. The median LOS was 33 (IQR, 23–45) days and the median duration of TPN was 26 (IQR, 17–36) days. Longer days on TPN (median 35 vs 16 days, P = 0.03) was associated with antenatal finding of multiple dilated bowel loops. Postnatal diagnosis of complex gastroschisis was made in 16% of cases and was associated with both longer LOS (median 89 vs 30 days, P = 0.003) and days on TPN (median 46 vs 21 days, P = 0.009). Conclusion Complex gastroschisis was associated with greater days on TPN and LOS. We found no late-gestation stillbirths and a low overall rate of 1.8%, suggesting the risk for stillbirth associated with gastroschisis is lower than previously documented. This information may assist counselling families. Improved data collection worldwide may reveal causative factors and enable antenatal outcome predictors.
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Affiliation(s)
- Sarah J Melov
- Westmead Institute for Maternal and Fetal Medicine, Women's and Newborn Health, Westmead Hospital, Research & Education Network Building, Hawkesbury Rd, PO Box 533, Westmead, NSW, 2145, Australia.
| | - Irene Tsang
- Department of Paediatric Surgery, The Children's Hospital at Westmead, The Sydney Children's Hospital Network, Hawkesbury Rd, Westmead, NSW, 2145, Australia
| | - Ralph Cohen
- Department of Paediatric Surgery, The Children's Hospital at Westmead, The Sydney Children's Hospital Network, Hawkesbury Rd, Westmead, NSW, 2145, Australia.,The University of Sydney, Sydney, NSW, Australia
| | - Nadia Badawi
- Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, The Sydney Children's Hospital Network, Hawkesbury Rd, Westmead, Wentworthville, NSW, 2145, Australia.,The University of Sydney, Sydney, NSW, Australia.,Cerebral Palsy Alliance Research Institute, Sydney, NSW, Australia
| | - Karen Walker
- Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, The Sydney Children's Hospital Network, Hawkesbury Rd, Westmead, Wentworthville, NSW, 2145, Australia.,The University of Sydney, Sydney, NSW, Australia.,Cerebral Palsy Alliance Research Institute, Sydney, NSW, Australia
| | - Soundappan S V Soundappan
- Department of Paediatric Surgery, The Children's Hospital at Westmead, The Sydney Children's Hospital Network, Hawkesbury Rd, Westmead, NSW, 2145, Australia.,The University of Sydney, Sydney, NSW, Australia
| | - Thushari I Alahakoon
- Westmead Institute for Maternal and Fetal Medicine, Women's and Newborn Health, Westmead Hospital, Research & Education Network Building, Hawkesbury Rd, PO Box 533, Westmead, NSW, 2145, Australia.,The University of Sydney, Sydney, NSW, Australia
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23
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Amin R, Domack A, Bartoletti J, Peterson E, Rink B, Bruggink J, Christensen M, Johnson A, Polzin W, Wagner AJ. National Practice Patterns for Prenatal Monitoring in Gastroschisis: Gastroschisis Outcomes of Delivery (GOOD) Provider Survey. Fetal Diagn Ther 2018; 45:125-130. [PMID: 29791899 DOI: 10.1159/000487541] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 02/06/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Gastroschisis is an abdominal wall defect with increasing incidence. Given the lack of surveillance guidelines among maternal-fetal medicine (MFM) specialists, this study describes current practices in gastroschisis management. MATERIALS AND METHODS An online survey was administered to MFM specialists from institutions affiliated with the North American Fetal Therapy Network (NAFTNet). Questions focused on surveillance timing, testing, findings that changed clinical management, and delivery plan. RESULTS Responses were obtained from 29/29 (100%) NAFTNet centers, comprising 143/371 (39%) providers. The majority had a regimen for antenatal surveillance in patients with stable gastroschisis (94%; 134/141). Antenatal testing began at 32 weeks for 68% (89/131) of MFM specialists. The nonstress test (55%; 72/129), biophysical profile (50%; 63/126), and amniotic fluid index (64%; 84/131) were used weekly. Estimated fetal weight (EFW) was performed monthly by 79% (103/131) of providers. At 28 weeks, abnormal EFW (77%; 97/126) and Doppler ultrasound (78%; 99/127) most frequently altered management. In stable gastroschisis, 43% (60/140) of providers delivered at 37 weeks, and 29% (40/ 140) at 39 weeks. DISCUSSION Gastroschisis management differs among NAFTNet centers, although the majority initiate surveillance at 32 weeks. Timing of delivery still requires consensus. Prospective studies are necessary to further optimize practice guidelines and patient care.
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Affiliation(s)
- Ruchi Amin
- Pediatric Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin,
| | - Aaron Domack
- Pediatric Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Joseph Bartoletti
- Pediatric Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Erika Peterson
- Maternal Fetal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Britton Rink
- Maternal and Fetal Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Jennifer Bruggink
- Pediatric Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Anthony Johnson
- Maternal and Fetal Medicine, University of Texas Health Sciences Center, Houston, Texas, USA
| | - William Polzin
- Maternal and Fetal Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Amy J Wagner
- Pediatric Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Haddock C, Al Maawali AG, Ting J, Bedford J, Afshar K, Skarsgard ED. Impact of Multidisciplinary Standardization of Care for Gastroschisis: Treatment, Outcomes, and Cost. J Pediatr Surg 2018; 53:892-897. [PMID: 29499843 DOI: 10.1016/j.jpedsurg.2018.02.013] [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: 01/23/2018] [Accepted: 02/01/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND/PURPOSE Elimination of unnecessary practice variation through standardization creates opportunities for improved outcomes and cost-effectiveness. A quality improvement (QI) initiative at our institution used evidence and consensus to standardize management of gastroschisis (GS) from birth to discharge. METHODS An interdisciplinary team utilized best practice evidence and expert opinion to standardize GS care. Following stakeholder engagement and education, care standardization was implemented in September 2014. A comparative cohort study was conducted on consecutive patients treated before (n=33) and after (n=24) standardization. Demographic, treatment, and outcome measures were collected from a prospective GS registry. Direct costs were estimated, and protocol compliance was audited. RESULTS BW, GA, and bowel injury severity were comparable between groups. Key practice changes were: closure technique (pre-88% primary fascial, post-83% umbilical cord flap; p<0.001), closure location (pre-97% OR, post-67% NICU; p<0.001), and GA avoidance (pre-0%, post-48%; p<0.001). Median post-closure ventilation days were shorter (pre-4, post-1; p<0.001), and SSI rates trended lower (pre-21%, post-8%; p=0.3) in the post-implementation group with no differences in TPN days or LOS. No significant difference was seen in average per-patient costs: pre-$85,725 ($29,974-221,061), post-$76,329 ($14,205-176,856). CONCLUSION Care standardization for GS enables practice transformation, cost-effective outcome improvement, and supports an organizational culture dedicated to continuous improvement. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Candace Haddock
- Division of Pediatric Surgery, Department of Surgery, British Columbia Children's Hospital, University of British Columbia. Vancouver, BC, Canada
| | - Al Ghalgya Al Maawali
- Division of Pediatric Surgery, Department of Surgery, British Columbia Children's Hospital, University of British Columbia. Vancouver, BC, Canada
| | - Joseph Ting
- Division of Neonatology, Department of Pediatrics, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Julie Bedford
- Department of Quality and Safety, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Kourosh Afshar
- Division of Pediatric Urology, Department of Surgery, British Columbia Children's Hospital; Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Erik D Skarsgard
- Division of Pediatric Surgery, Department of Surgery, British Columbia Children's Hospital, University of British Columbia. Vancouver, BC, Canada.
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Passaro RC, Savoie KB, Huang EY. Use of a Gastroschisis Feeding Guideline to Improve Standardization of Care and Patient Outcomes at an Urban Children's Hospital. Nutr Clin Pract 2018; 33:545-552. [DOI: 10.1002/ncp.10083] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- R. Colby Passaro
- College of Medicine; University of Tennessee Health Science Center; Memphis Tennessee USA
| | - Kate B. Savoie
- College of Medicine; University of Tennessee Health Science Center; Memphis Tennessee USA
- Division of Pediatric Surgery; Le Bonheur Children's Hospital; Memphis Tennessee USA
- Department of General Surgery; University of Tennessee Health Science Center; Memphis Tennessee USA
| | - Eunice Y. Huang
- College of Medicine; University of Tennessee Health Science Center; Memphis Tennessee USA
- Division of Pediatric Surgery; Le Bonheur Children's Hospital; Memphis Tennessee USA
- Department of General Surgery; University of Tennessee Health Science Center; Memphis Tennessee USA
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Burnett AC, Gunn JK, Hutchinson EA, Moran MM, Kelly LM, Sevil UC, Anderson PJ, Hunt RW. Cognition and behaviour in children with congenital abdominal wall defects. Early Hum Dev 2018; 116:47-52. [PMID: 29136542 DOI: 10.1016/j.earlhumdev.2017.11.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 11/03/2017] [Accepted: 11/08/2017] [Indexed: 01/31/2023]
Abstract
AIM To characterise neurodevelopment at age two years and cognition and behaviour at age five years in children born with abdominal wall defects (gastroschisis or exomphalos). STUDY DESIGN Participants were treated as neonates for gastroschisis or exomphalos and invited for routine clinical follow-up at ages two and five years. Thirty-nine two year-olds and 20 five year-olds with gastroschisis and 20 two year-olds and 10 five year-olds with exomphalos returned for age-appropriate assessments of development (two years) and intellectual functioning (IQ), executive function, and behavioural problems. Results were compared with normative data from the tests and published data from local term-born children. RESULTS For both gastroschisis and exomphalos two year-olds, neurodevelopment was in line with the test normative data, but below the level of local normative data for all domains (effect sizes from -0.4 to -1.4 standard deviations). At five years, children with gastroschisis performed similarly to the normative mean for IQ but had high rates of various executive functioning problems on parent report (18-41% compared with 7% expected from norms). There was also a tendency for increased frequency of internalising problems (33% compared with normative expectation of 16%). Five year-olds with exomphalos also performed similarly to the normative mean for IQ and had low rates of executive and behavioural problems. CONCLUSIONS Survivors of gastroschisis and exomphalos may be at risk of poor neurodevelopment in toddlerhood, depending on the reference group, and children with gastroschisis may be particularly at risk for executive functioning difficulties despite an IQ within normal limits.
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Affiliation(s)
- Alice C Burnett
- Department of Neonatal Medicine, The Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia; Premature Infant Follow-Up Programme, Royal Women's Hospital, Melbourne, Australia.
| | - Julia K Gunn
- Department of Neonatal Medicine, The Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Neonatal Research, Murdoch Childrens Research Institute, Melbourne, Australia
| | - Esther A Hutchinson
- Department of Neonatal Medicine, The Royal Children's Hospital, Melbourne, Australia; Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia
| | - Margaret M Moran
- Department of Neonatal Medicine, The Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Lisa M Kelly
- Little Peeps Paediatric Occupational Therapy, Melbourne, Australia; Developmental Disability and Rehabilitation Research, Murdoch Children's Research Institute, Melbourne, Australia
| | - Ursula C Sevil
- Department of Speech Pathology, The Royal Children's Hospital, Melbourne, Australia
| | - Peter J Anderson
- Department of Paediatrics, University of Melbourne, Melbourne, Australia; Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia; Premature Infant Follow-Up Programme, Royal Women's Hospital, Melbourne, Australia
| | - Rod W Hunt
- Department of Neonatal Medicine, The Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Neonatal Research, Murdoch Childrens Research Institute, Melbourne, Australia
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Koehler SM, Szabo A, Loichinger M, Peterson E, Christensen M, Wagner AJ. The significance of organ prolapse in gastroschisis. J Pediatr Surg 2017; 52:1972-1976. [PMID: 28951014 DOI: 10.1016/j.jpedsurg.2017.08.066] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 08/28/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of this study was to evaluate the incidence and importance of organ prolapse (stomach, bladder, reproductive organs) in gastroschisis. METHODS This is a retrospective review of gastroschisis patients from 2000 to 2014 at a single tertiary institution. Statistical analysis was performed using a chi-square test, Student's t test, log-rank test, or Cox regression analysis models. All tests were conducted as two-tailed tests, and p-values <0.05 were considered statistically significant. RESULTS One hundred seventy-one gastroschisis patients were identified. Sixty-nine (40.6%) had at least one prolapsed organ besides bowel. The most commonly prolapsed organs were stomach (n=45, 26.3%), reproductive organs (n=34, 19.9%), and bladder (n=15, 8.8%). Patients with prolapsed organs were more likely to have simple gastroschisis with significant decreases in the rate of atresia and necrosis/perforation. They progressed to earlier enteral feeds, discontinuation of parenteral nutrition, and discharge. Likewise, these patients were less likely to have complications such as central line infections, sepsis, and short gut syndrome. CONCLUSIONS Gastroschisis is typically described as isolated bowel herniation, but a large portion have prolapse of other organs. Prolapsed organs are associated with simple gastroschisis, and improved outcomes most likely due to a larger fascial defect. This may be useful for prenatal and postnatal counseling of families. TYPE OF STUDY Case Control/Retrospective Comparative Study. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | | | - Matt Loichinger
- Maternal Fetal Medicine, Medical College of Wisconsin & Froedtert Hospital
| | - Erika Peterson
- Maternal Fetal Medicine, Medical College of Wisconsin & Froedtert Hospital
| | | | - Amy J Wagner
- Pediatric Surgery, Children's Hospital of Wisconsin
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Understanding the relationship between hospital volume and patient outcomes for infants with gastroschisis. J Pediatr Surg 2017; 52:1977-1980. [PMID: 28947327 DOI: 10.1016/j.jpedsurg.2017.08.065] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 08/28/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND For many surgical operations, there is a well-established relationship between surgical volume and outcome. We investigated whether this relationship exists for infants with gastroschisis. METHODS Using the Kids' Inpatient Database for years 2003, 2006, 2009, and 2012, we identified all patients undergoing gastroschisis repair. Controlling for patient characteristics and complexity of disease (comorbid intestinal atresia/perforation, necrotizing enterocolitis, and respiratory distress syndrome), we compared surgical outcomes (mortality, length of stay, and incidence of TPN cholestasis) by hospital volume based on quartile for gastroschisis cases treated per year. RESULTS We identified 7769 patients treated at 743 hospitals. The majority of hospitals were low-volume (n=445), while only 49 were high-volume. The overall mortality rate was 4.3%, and the median length of stay was 34days. Adjusting for clinical and demographic characteristics, patients treated at high-volume hospitals had similar rates of TPN cholestasis and similar mortality rates, but a higher chance for a prolonged length of stay compared to those treated at low-volume hospitals. CONCLUSIONS Using national data, we found that gastroschisis patients treated at high-volume hospitals did not have improved outcomes. The benefits of high-volume hospitals, which seem to be important for complex pediatric surgery, may not apply to treatment of gastroschisis. LEVEL OF EVIDENCE Level III Retrospective Study.
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Machuca Vaca A, Ramíres OG, Fernández Carrocera L, Cordero González G, Yllescas Medrano E, Carrera Muiños S, Corral Kassian E. Gastrosquisis: resultados en una institución de tercer nivel. PERINATOLOGÍA Y REPRODUCCIÓN HUMANA 2017. [DOI: 10.1016/j.rprh.2017.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Goodwin RD, Cheslack-Postava K, Nelson DB, Smith PH, Hasin DS, Janevic T, Bakoyiannis N, Wall MM. Serious Psychological Distress and Smoking During Pregnancy in the United States: 2008-2014. Nicotine Tob Res 2017; 19:605-614. [PMID: 28403468 PMCID: PMC5441894 DOI: 10.1093/ntr/ntw323] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 12/14/2016] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The current study examined the relationship between acute (past 30 day) and recent (past year but not past 30 day) serious psychological distress (SPD) and smoking during pregnancy among women in the United States overall, stratified by demographic characteristics, and described the change in the prevalence of prenatal smoking among women with and without SPD, from 2008 to 2014. METHODS Data were drawn from the National Survey on Drug Use and Health (NSDUH), an annual cross-sectional study of US persons aged 12 and over. SPD and smoking in the past 30 days among pregnant women, aged 18 and older, were examined using logistic regression models. Heterogeneity in this association by demographic characteristics, trends over time, and level of cigarette consumption was also examined. RESULTS Prenatal smoking was common. Almost 40% of pregnant women with acute SPD reported smoking, 23% of pregnant women with recent SPD smoked, and 11.7% of pregnant women without recent SPD smoked. No significant change was found in the prevalence of prenatal smoking from 2008 to 2014 in any of these groups. Robust relationships were found between acute (OR = 5.05 [3.64-6.99]) and recent SPD (OR = 2.37 [1.74-3.24]) and smoking; these findings remained after adjusting for demographics. CONCLUSIONS SPD and smoking during pregnancy are strongly associated; this relationship is present across all sociodemographic groups and the prevalence of smoking in pregnancy has remained relatively unchanged over the past decade both in the presence and absence of SPD. IMPLICATIONS SPD and smoking in pregnancy are robustly linked; the prevalence of smoking in pregnancy is extremely high in women with SPD. Screening women with mental health problems for prenatal smoking, as well as screening pregnant smokers for mental health problems, seems warranted and may assist more women in seeking and utilizing treatment options. Efforts to reduce the prevalence of smoking during pregnancy might specifically target women with SPD, where the potential for impact is substantial.
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Affiliation(s)
- Renee D Goodwin
- Department of Psychology, Queens College and The Graduate Center, City University of New York (CUNY), Queens, NY
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Keely Cheslack-Postava
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY
- New York State Psychiatric Institute, New York, NY
| | - Deborah B Nelson
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA
- Department of Obstetrics and Gynecology, Temple University School of Medicine, Philadelphia, PA
| | - Philip H Smith
- Department of Community Health and Social Medicine, Sophie Davis School of Biomedical Education/CUNY School of Medicine, New York, NY
| | - Deborah S Hasin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY
- New York State Psychiatric Institute, New York, NY
| | - Teresa Janevic
- Department of Population Health Science and Health Policy, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Epidemiology, Rutgers School of Public Health, Piscataway, NJ
| | - Nina Bakoyiannis
- Department of Psychology, Queens College and The Graduate Center, City University of New York (CUNY), Queens, NY
| | - Melanie M Wall
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY
- New York State Psychiatric Institute, New York, NY
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
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Geslin D, Clermidi P, Gatibelza ME, Boussion F, Saliou AH, Le Manac'h Dove G, Margaryan M, De Vries P, Sentilhes L, Levard G, Lardy H, Arnaud A, Leclair MD, Podevin G, Schmitt F. What prenatal ultrasound features are predictable of complex or vanishing gastroschisis? A retrospective study. Prenat Diagn 2017; 37:168-175. [DOI: 10.1002/pd.4984] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 10/19/2016] [Accepted: 12/09/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Dorothée Geslin
- Paediatric Surgery Department; University Hospital of Angers; Angers France
- Paediatric Surgery Department; University Hospital of Lyon; Lyon France
| | - Pauline Clermidi
- Paediatric Surgery Department; University Hospital of Nantes; Nantes France
- Paediatric Surgery Department; Robert Debré University Hospital; Paris France
| | - Marie-Eve Gatibelza
- Paediatric Surgery Department; University Hospital of Poitiers; Poitiers France
- Paediatric Surgery Department; University Hospital of Rennes; Rennes France
| | - Françoise Boussion
- Department of Obstetrics and Gynecology; Angers University; Angers France
| | - Anne-Hélène Saliou
- Department of Obstetrics and Gynecology; University Hospital of Brest; Brest France
| | | | - Marc Margaryan
- Paediatric Surgery Department; Le Mans Hospital; Le Mans France
| | - Philine De Vries
- Paediatric Surgery Department; University Hospital of Brest; Brest France
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology; University Hospital of Bordeaux; Bordeaux France
| | - Guillaume Levard
- Paediatric Surgery Department; University Hospital of Poitiers; Poitiers France
| | - Hubert Lardy
- Paediatric Surgery Department; University Hospital of Tours; Tours France
| | - Alexis Arnaud
- Paediatric Surgery Department; University Hospital of Rennes; Rennes France
| | - Marc-David Leclair
- Paediatric Surgery Department; University Hospital of Nantes; Nantes France
| | - Guillaume Podevin
- Paediatric Surgery Department; University Hospital of Angers; Angers France
| | - Françoise Schmitt
- Paediatric Surgery Department; University Hospital of Angers; Angers France
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Gastroschisis and Omphalocele. Anesthesiology 2017. [DOI: 10.1007/978-3-319-50141-3_53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Gastroschisis: mortality risks with each additional week of expectant management. Am J Obstet Gynecol 2017; 216:66.e1-66.e7. [PMID: 27596619 DOI: 10.1016/j.ajog.2016.08.036] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 08/16/2016] [Accepted: 08/26/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Prior studies have evaluated the overall risk of stillbirth in pregnancies with fetal gastroschisis. However, the gestational age at which mortality is minimized, balancing the risk of stillbirth against neonatal mortality, remains unclear. OBJECTIVE We sought to evaluate the gestational age at which prenatal and postnatal mortality risk is minimized for fetuses with gastroschisis. STUDY DESIGN This was a retrospective cohort study of singleton pregnancies delivered between 24 0/7 and 39 6/7 weeks, using 2005 through 2006 US national linked birth and death certificate data. Among pregnancies with fetal gastroschisis, prospective risk of stillbirth and risk of infant death were determined for each gestational age week. Risk of infant death with delivery was further compared to composite fetal/infant mortality risk with expectant management for 1 additional week. RESULTS Among 2,119,049 pregnancies, 860 cases (0.04%) of gastroschisis were identified. The overall stillbirth rate among gastroschisis cases was 4.8%, and infant death occurred in 8.3%. Prospective risk of stillbirth became more consistently elevated beginning at 35 weeks, rising to 13.9 per 1000 pregnancies (95% confidence interval, 10.8-17.1) at 39 weeks. Risk of infant death concurrently nadired in the third trimester, ranging between 62.4-66.8 per 1000 live births between 32-39 weeks. Comparing mortality with expectant management vs delivery, relative risk was significantly greater with expectant management between 37-39 weeks, reaching 1.90 (95% confidence interval, 1.73-2.08) at 39 weeks with a number needed to deliver of 17.49 (95% confidence interval, 15.34-20.32) to avoid 1 excess death. CONCLUSION Risk of prenatal and postnatal mortality for fetuses with gastroschisis may be minimized with delivery as early as 37 weeks.
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Robertson JA, Kimble RM, Stockton K, Sekar R. Antenatal ultrasound features in fetuses with gastroschisis and its prediction in neonatal outcome. Aust N Z J Obstet Gynaecol 2016; 57:52-56. [PMID: 27874184 DOI: 10.1111/ajo.12565] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 10/04/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Gastroschisis is the most common major congenital anomaly managed by paediatric surgeons. The significance of certain associated antenatal ultrasound features in determining fetal outcome is under discussion. AIM The study aims to define if associated antenatal ultrasound features of gastroschisis are useful prognostic markers for fetal outcome. By establishing the significance of features, including extra- and intra-abdominal bowel dilatation, stomach herniation, stomach dilatation, bowel matting, growth restriction, abnormal umbilical artery (UA) Doppler ultrasounds, and abnormal amniotic fluid volume, it is hoped clinicians will have enhanced ability to counsel parents about the likely outcomes for their infant. MATERIALS AND METHODS Retrospective analysis of ultrasound images, reports and medical records of 101 pregnancies affected by fetal gastroschisis managed by the Royal Brisbane and Women's Hospital Maternal and Fetal Medicine Department over a 13 and a half year period was performed. The presence of ultrasound features during antenatal surveillance corresponded to fetal outcome measures, including the diagnosis of postnatal complex gastroschisis, the number of operations required, length of parenteral feeding and length of stay in neonatal intensive care. RESULTS The only statistically significant predictor of complex cases of gastroschisis was extra-abdominal bowel dilatation. Although a statistically significant feature, approximately three-quarters (44/59) of all infants with gastroschisis with associated extra-abdominal bowel dilatation had simple gastroschisis. CONCLUSIONS Extra-abdominal bowel dilatation is a statistically significant marker of complex gastroschisis and associated morbidity. Its presence in infants who had uncomplicated outcomes, suggests that clinically, its usefulness in antenatal counselling is still debatable.
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Affiliation(s)
| | - Roy M Kimble
- Department of Paediatric Surgery, Burns and Trauma, Lady Cilento Hospital, Brisbane, Queensland, Australia
| | - Kellie Stockton
- Department of Physiotherapy, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
| | - Renuka Sekar
- Department of Maternal Fetal Medicine Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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Kong JY, Yeo KT, Abdel-Latif ME, Bajuk B, Holland AJA, Adams S, Jiwane A, Heck S, Yeong M, Lui K, Oei JL. Outcomes of infants with abdominal wall defects over 18years. J Pediatr Surg 2016; 51:1644-9. [PMID: 27364305 DOI: 10.1016/j.jpedsurg.2016.06.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 04/20/2016] [Accepted: 06/05/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND/PURPOSE Infants with abdominal wall defects (AWD) are at risk of poor outcomes including prolonged hospitalization, infections and mortality. Our objective was to describe and compare the outcomes of infants admitted with gastroschisis and omphalocele over 18years. METHODS Population-based study of clinical data and outcomes of live-born infants with AWD admitted to all tertiary-level neonatal intensive care units in New South Wales and Australian Capital Territory from 1992 to 2009. RESULT There were 502 infants with AWD - 336 gastroschisis, 166 omphalocele. Infants with gastroschisis required a longer duration of total parenteral nutrition (19 vs 4days, p<0.05), longer hospitalization (28 vs 15days, p<0.05) and had a higher rate of systemic infection [23.5% vs 13.3%, OR 1.77 (1.15-2.74), p<0.05] compared to infants with omphalocele. Overall, omphalocele infants had higher mortality rate compared to gastroschisis infants [OR 2.77 (1.53, 5.04), p<0.05]. Gastroschisis mortality rates increased from epoch 1 to epoch 3 (4.2% to 8.8%). CONCLUSION Compared to infants with omphalocele, infants with gastroschisis required significantly longer hospitalization and parenteral nutrition with higher rates of infection. Infants with omphalocele had higher overall mortality rates. However, there has been an increase in the gastroschisis mortality rates but the cause for this is unclear.
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Affiliation(s)
- Juin Yee Kong
- Department of Newborn Care, Royal Hospital for Women, Randwick, NSW, Australia; Department of Neonatology, KK Women's and Children's Hospital, Singapore.
| | - Kee Thai Yeo
- Department of Newborn Care, Royal Hospital for Women, Randwick, NSW, Australia; Department of Neonatology, KK Women's and Children's Hospital, Singapore
| | - Mohamed E Abdel-Latif
- Department of Neonatology, Centenary Hospital for Women and Children, Garran, ACT, Australia; School of Clinical Medicine, Australian National University, Woden, ACT, Australia
| | - Barbara Bajuk
- Neonatal Intensive Care Units' Data Collection, NSW Pregnancy and Newborn Services Network, Westmead, NSW, Australia
| | - Andrew J A Holland
- The Children's Hospital at Westmead, The University of Sydney, NSW, Australia;; School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia
| | - Susan Adams
- School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia;; Department of Pediatric Surgery, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Ashish Jiwane
- School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia;; Department of Pediatric Surgery, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Sandra Heck
- The Children's Hospital at Westmead, The University of Sydney, NSW, Australia
| | - Michael Yeong
- Department of Newborn Care, Royal Hospital for Women, Randwick, NSW, Australia
| | - Kei Lui
- Department of Newborn Care, Royal Hospital for Women, Randwick, NSW, Australia; School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia
| | - Ju Lee Oei
- Department of Newborn Care, Royal Hospital for Women, Randwick, NSW, Australia; School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia
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Johnston R, Haeri S. Oligohydramnios and growth restriction do not portend worse prognosis in gastroschisis pregnancies. J Matern Fetal Neonatal Med 2016; 29:4055-8. [DOI: 10.3109/14767058.2016.1154939] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | - Sina Haeri
- St. David’s North Austin Medical Center Women’s Center of Texas, Austin Maternal–Fetal Medicine, Austin, TX, USA
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Martillotti G, Boucoiran I, Damphousse A, Grignon A, Dubé E, Moussa A, Bouchard S, Morin L. Predicting Perinatal Outcome from Prenatal Ultrasound Characteristics in Pregnancies Complicated by Gastroschisis. Fetal Diagn Ther 2015; 39:279-86. [DOI: 10.1159/000440699] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 08/25/2015] [Indexed: 11/19/2022]
Abstract
Introduction: The objective of the study was to establish the predictive value of prenatal ultrasound markers for complex gastroschisis (GS) in the first 10 days of life. Material and Methods: In this retrospective cohort study over 11 years (2000-2011) of 117 GS cases, the following prenatal ultrasound signs were analyzed at the last second- and third-trimester ultrasounds: intrauterine growth restriction, intra-abdominal bowel dilatation (IABD) adjusted for gestational age, extra-abdominal bowel dilatation (EABD) ≥25 mm, stomach dilatation, stomach herniation, perturbed mesenteric circulation, absence of bowel lumen and echogenic dilated bowel loops (EDBL). Results: Among 114 live births, 16 newborns had complex GS (14.0%). Death was seen in 16 cases (13.7%): 3 intrauterine fetal deaths, 9 complex GS and 4 simple GS. Second-trimester markers had limited predictive value. Third-trimester IABD, EABD, EDBL, absence of intestinal lumen and perturbed mesenteric circulation were statistically associated with complex GS and death. IABD was able to predict complex GS with a sensitivity of 50%, a specificity of 91%, a positive predictive value of 47% and a negative predictive value of 92%. Discussion: Third-trimester IABD adjusted for gestational age appears to be the prenatal ultrasound marker most strongly associated with adverse outcome in GS.
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Ma T, Zhang H, Liu F, Sun F, Zeng Z. Communication: First results of cases series of one-stage repair of gastroschisis using human acellular dermal matrix in 7 neonates. J Plast Reconstr Aesthet Surg 2015; 69:e55-6. [PMID: 26589449 DOI: 10.1016/j.bjps.2015.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 09/11/2015] [Accepted: 10/21/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Tongsheng Ma
- Department of Pediatric Surgery, Children's Hospital of Xuzhou, Xuzhou 221006, Jiangsu Province, China
| | - Hongwei Zhang
- Department of Pediatric Surgery, Children's Hospital of Xuzhou, Xuzhou 221006, Jiangsu Province, China
| | - Fengli Liu
- Department of Pediatric Surgery, Children's Hospital of Xuzhou, Xuzhou 221006, Jiangsu Province, China.
| | - Fang Sun
- Department of Pediatric Surgery, Children's Hospital of Xuzhou, Xuzhou 221006, Jiangsu Province, China
| | - Zhandong Zeng
- Department of Pediatric Surgery, Children's Hospital of Xuzhou, Xuzhou 221006, Jiangsu Province, China
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Carvalho NS, Helfer TM, Serni PDO, Terasaka OA, Boute T, Araujo Júnior E, Nardozza LMM, Moron AF, Rolo LC. Postnatal outcomes of infants with gastroschisis: a 5-year follow-up in a tertiary referral center in Brazil. J Matern Fetal Neonatal Med 2015; 29:418-22. [PMID: 25747953 DOI: 10.3109/14767058.2014.1002764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate postnatal outcomes in fetuses with gastroschisis. METHODS This is a retrospective study (2009-2013) of patients with gastroschisis at the Hospital São Paulo (Federal University of São Paulo, Brazil). RESULTS A total of 44 infants with gastroschisis were examined. The mean maternal age was 21.1 years and mean gestational age at delivery was 36.1 weeks. Delivery occurred before 34 weeks in 13.6%, between 34 and 36 weeks and 6 d in 40.9%, and after 37 weeks in 45.5%. The mean birth weight was 2349 g, with 37.2% small-for-gestational age infants. The mean umbilical cord blood pH was 7.32. Bowel resection and delayed fascial closure was performed in 14.6% and 19.5%, respectively. The mean hospitalization time in the neonatal intensive care unit was 52.7 d. Neonatal infection was detected in 52.4%, with a positive blood culture; 77.3% of those cases were coagulase negative staphylococci. The overall rate of mortality was 25%; 18.2% before birth, 45.4% during the neonatal period, and 36.4% in infants. The main cause of postnatal death was septicemia (55.5%). CONCLUSIONS Despite advances in perinatal care and surgical techniques, infants with gastroschisis still present high rates of complications and death.
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Affiliation(s)
- Natália Silva Carvalho
- a Department of Obstetrics , Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP) , São Paulo-SP , Brazil
| | - Talita Micheletti Helfer
- a Department of Obstetrics , Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP) , São Paulo-SP , Brazil
| | - Priscila de Oliveira Serni
- a Department of Obstetrics , Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP) , São Paulo-SP , Brazil
| | - Ohanna Ana Terasaka
- a Department of Obstetrics , Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP) , São Paulo-SP , Brazil
| | - Tatiane Boute
- a Department of Obstetrics , Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP) , São Paulo-SP , Brazil
| | - Edward Araujo Júnior
- a Department of Obstetrics , Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP) , São Paulo-SP , Brazil
| | | | - Antonio Fernandes Moron
- a Department of Obstetrics , Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP) , São Paulo-SP , Brazil
| | - Liliam Cristine Rolo
- a Department of Obstetrics , Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP) , São Paulo-SP , Brazil
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Chesley PM, Ledbetter DJ, Meehan JJ, Oron AP, Javid PJ. Contemporary trends in the use of primary repair for gastroschisis in surgical infants. Am J Surg 2015; 209:901-5; discussion 905-6. [PMID: 25776902 DOI: 10.1016/j.amjsurg.2015.01.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 12/31/2014] [Accepted: 01/06/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Gastroschisis is a newborn anomaly requiring emergent surgical intervention. We review our experience with gastroschisis to examine trends in contemporary surgical management. METHODS Infants who underwent initial surgical management of gastroschisis from 1996 to 2014 at a pediatric hospital were reviewed. Closure techniques included primary fascial repair using suture or sutureless umbilical closure, and staged repair using sutured or spring-loaded silo (SLS). Data were separated into 3 clinical eras: pre-SLS (1996 to 2004), SLS (2005 to 2008), and umbilical closure (2009 to 2014). RESULTS In the pre-SLS era, 60% (34/57) of infants with gastroschisis underwent primary repair. With the advent of SLS, there was a decrease in primary repair (15%, 10/68, P < .0001). Following introduction of sutureless umbilical closure, 61% (47/77) of infants have undergone primary repair. On multivariate regression, primary repair was associated with shorter intensive care unit stays (P < .001) and time to initiate enteral nutrition (P < .01). CONCLUSIONS Following introduction of a less invasive technique for gastroschisis repair, most infants with gastroschisis were able to be repaired primarily. Primary repair should be considered in all babies with gastroschisis and favorable anatomy.
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Affiliation(s)
- Patrick M Chesley
- Division of Pediatric General and Thoracic Surgery, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA, USA; Department of General Surgery, Madigan Army Medical Center, Fort Lewis, WA, USA
| | - Daniel J Ledbetter
- Division of Pediatric General and Thoracic Surgery, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA, USA
| | - John J Meehan
- Division of Pediatric General and Thoracic Surgery, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA, USA
| | - Assaf P Oron
- Core for Biostatistics, Seattle Children's Hospital, Seattle, WA, USA
| | - Patrick J Javid
- Division of Pediatric General and Thoracic Surgery, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA, USA.
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Perinatal outcomes and hospital costs in gastroschisis based on gestational age at delivery. Obstet Gynecol 2015; 124:543-550. [PMID: 25162254 DOI: 10.1097/aog.0000000000000427] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the association between gestational age at delivery and perinatal outcomes among gastroschisis-affected pregnancies that result in live birth. METHODS We conducted a retrospective cohort study using a linked maternal-infant database for more than 2.3 million liveborn neonates in Florida from 1998 to 2009. Cases were identified using a combination of International Classification of Diseases, 9th Edition, Clinical Modification, diagnosis and procedure codes indicative of gastroschisis. We restricted our analyses to singleton cases without another major birth defect or medical conditions that would justify early elective delivery. We categorized cases based on gestational age in weeks and compared perinatal outcomes. RESULTS Among 1,005 neonates with gastroschisis, 324 (32.3%) were isolated, singleton cases without an additional indication for early delivery. We observed decreased rates of adverse pregnancy outcomes among those neonates delivered in the early term period (37-38 weeks of gestation) compared with preterm (less than 34 weeks of gestation); specifically, jaundice (18.5% compared with 42.3%, P=.01) and respiratory distress syndrome (5.9% compared with 23.1%, P≤.01). As the gestational age at birth increased, we observed fewer mean number of days spent in the hospital (less than 34 weeks of gestation: 55.9, P<.01; 34-36 weeks of gestation: 51.9, P=.02; 37-38 weeks of gestation: 36.9 [reference]) and lower direct inpatient medical costs (in thousands, U.S. dollars; less than 34 weeks of gestation: 79, P=.01; 34-36 weeks of gestation: 71, P=.04; 37-38 weeks of gestation: 51 [reference]) per infant in the first year of life. CONCLUSION In pregnancies complicated by gastroschisis, and with no other known major indications, birth at early term or later term gestation, when compared with delivery before 37 weeks of gestation, is associated with improved perinatal outcomes and lower medical costs. LEVEL OF EVIDENCE II.
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Abstract
OBJECTIVE To identify perinatal variables associated with adverse outcomes in neonates prenatally diagnosed with gastroschisis. METHODS A retrospective review was conducted of all inborn pregnancies complicated by gastroschisis within the five institutions of the University of California Fetal Consortium from 2007 to 2012. The primary outcome was a composite adverse neonatal outcome comprising death, reoperation, gastrostomy, and necrotizing enterocolitis. Variables collected included antenatal ultrasound findings, maternal smoking or drug use, gestational age at delivery, preterm labor, elective delivery, mode of delivery, and birth weight. Univariate and multivariate analysis was used to assess factors associated with adverse outcomes. We also evaluated the association of preterm delivery with neonatal outcomes such as total parenteral nutrition cholestasis and length of stay. RESULTS There were 191 neonates born with gastroschisis in University of California Fetal Consortium institutions at a mean gestational age of 36 3/7±1.8 weeks. Within the cohort, 27 (14%) had one or more major adverse outcomes, including three deaths (1.6%). Early gestational age at delivery was the only variable identified as a significant predictor of adverse outcomes on both univariate and multivariate analysis (odds ratio 1.4, 95% confidence interval 1.1-1.8 for each earlier week of gestation). Total parenteral nutrition cholestasis was significantly more common in neonates delivered at less than 37 weeks of gestation (38/115 [33%] compared with 11/76 [15%]; P<.001). CONCLUSION In this contemporary cohort, earlier gestational age at delivery is associated with adverse neonatal outcomes in neonates with gastroschisis. Other variables, such as antenatal ultrasound findings and mode of delivery, did not predict adverse neonatal outcomes.
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Wright NJ, Zani A, Ade-Ajayi N. Epidemiology, management and outcome of gastroschisis in Sub-Saharan Africa: Results of an international survey. Afr J Paediatr Surg 2015; 12:1-6. [PMID: 25659541 PMCID: PMC4955493 DOI: 10.4103/0189-6725.150924] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The aim was to compare gastroschisis (GS) epidemiology, management and outcome in low-income countries (LIC) in Sub-Saharan Africa (SSA) with middle- (MIC) and high-income countries (HIC). MATERIALS AND METHODS A 10-question survey was administered at the 2012 Pan-African Paediatric Surgery Association Congress. RESULTS are presented as median (range); differences were analysed using contingency tests. RESULTS A total of 82 delegates (28 countries [66 institutions]) were divided into LIC (n = 11), MIC (n = 6) and HIC (n = 11). In LIC, there were fewer surgeons and more patients. LIC reported 22 cases (1-184) GS/institution/year, compared to 12 cases (3-23)/institution/year in MICs and 15 cases (1-100)/institution/year in HICs. Antenatal screening was less readily available in LIC. Access to parenteral nutrition and neonatal intensive care in LIC was 36% and 19%, compared to 100% in HIC. Primary closure rates were similar in LIC and HIC at 58% and 54%, respectively; however, the majority of staged closure utilised custom silos in LIC and preformed silos in HIC. In LIC, mortality was reported as >75% by 61% delegates and 50-75% by 33%, compared to <25% by 100% of HIC delegates (P < 0.0001). CONCLUSIONS Gastroschisis is a problem encountered by surgeons in SSA. Mortality is high and resources in many centres inadequate. We propose the implementation of a combined epidemiological research, service delivery training and resource provision programme to help improve our understanding of GS in SSA whilst attempting to improve outcome.
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Affiliation(s)
| | | | - Niyi Ade-Ajayi
- Department of Paediatric Surgery, Kings College Hospital, London, United Kingdom
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Savoie KB, Huang EY, Aziz SK, Blakely ML, Dassinger S, Dorale AR, Duggan EM, Harting MT, Markel TA, Moore-Olufemi SD, Shah SR, St Peter SD, Tsao K, Wyrick DL, Williams RF. Improving gastroschisis outcomes: does birth place matter? J Pediatr Surg 2014; 49:1771-5. [PMID: 25487481 DOI: 10.1016/j.jpedsurg.2014.09.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 09/05/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Babies born in the hospital where they obtain definitive surgical care do not require transportation between institutions and may have shorter time to surgical intervention. Whether these differences result in meaningful improvement in outcomes has been debated. A multi-institutional retrospective study was performed comparing outcomes based on birthplace. METHODS Six institutions within the PedSRC reviewed infants born with gastroschisis from 2008 to 2013. Birthplace, perinatal, and postoperative data were collected. Based on the P-NSQIP definition, inborn was defined as birth at the pediatric hospital where repair occurred. The primary outcome was days to full enteral nutrition (FEN; 120kcal/kg/day). RESULTS 528 patients with gastroschisis were identified: 286 inborn, 242 outborn. Days to FEN, time to bowel coverage and abdominal wall closure, primary closure rate, and length of stay significantly favored inborn patients. In multivariable analysis, birthplace was not a significant predictor of time to FEN. Gestational age, presence of atresia or necrosis, primary closure rate, and time to abdominal wall closure were significant predictors. CONCLUSIONS Inborn patients had bowel coverage and definitive closure sooner with fewer days to full feeds and shorter length of stay. Birthplace appears to be important and should be considered in efforts to improve outcomes in patients with gastroschisis.
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Affiliation(s)
- Kate B Savoie
- University of Tennessee Health Science Center, Memphis, Tennessee.
| | - Eunice Y Huang
- University of Tennessee Health Science Center, Memphis, Tennessee.
| | | | | | | | - Amanda R Dorale
- Indiana University School of Medicine, Indianapolis, Indiana.
| | | | | | - Troy A Markel
- Indiana University School of Medicine, Indianapolis, Indiana.
| | | | - Sohail R Shah
- University of Missouri-Kansas City, Kansas City, Missouri.
| | | | - Koujen Tsao
- University of Texas at Houston, Houston, Texas.
| | | | - Regan F Williams
- University of Tennessee Health Science Center, Memphis, Tennessee.
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Caporossi C, Nogueira PLB, Marques JCC, Assis RMD, Aguilar-Nascimento JED. Validation of the gastroschisis experimental model and the influence of the mother's diet enriched with glutamine in the fetal morphology. Acta Cir Bras 2014; 29:158-65. [PMID: 24626727 DOI: 10.1590/s0102-86502014000300003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 02/19/2014] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To validate the gastroschisis experimental model in female rats and the effects on the glutamine fetal morphology during pregnancy. METHODS Twelve pregnant rats Wistar were separated in two groups: Group I (n = 6 rats, 71 fetuses) took glutamine and Group II (n = 6 rats, 75 fetuses) took isocaloric supplementation. At the 18th day of pregnancy, female rats were taken to hysterotomy and the fetuses which were selected for the act of gastroschisis were partially removed from the womb and by the laparotomy technique, the exclusion of the intestine was done. After that, fetuses were put in the womb cavity again and the rats' abdomen sutured. At the 21st day of pregnancy, date before delivery, by C-section ordinary animals and the ones with gastroschisis were removed and studied separately. The morphometrical parameters studied were the body weight (PC); the intestine weight (PI); the intestine length (CI) and its relations (PI/PC, PI/CI e PC-PI). RESULTS The intestine weight (PI) and the intestine length (CI) were different in fetuses with gastroschisis (p<0.05), however no difference between the groups regarding supplementation with glutamine. CONCLUSIONS The gastroschisis experimental model is valid and reproducible. The nutritional therapy with glutamine did not change the morphometrical parameters.
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Affiliation(s)
- Cervantes Caporossi
- Federal University of Mato Grosso, Department of Surgery, CuiabaMT, Brazil, PhD, Associate Professor, Division of Digestive Surgery, Department of Surgery, Federal University of Mato Grosso (UFMT), Cuiaba-MT, Brazil. Conception, design, intellectual and scientific content of the study
| | - Paulo Luiz Batista Nogueira
- UFMT, CuiabaMT, Brazil, Fellow Master degree, Postgraduate Program in Health Sciences, UFMT, Cuiaba-MT, Brazil. Acquisition and interpretation of data, manuscript writing
| | - José Carlos Costa Marques
- University of Cuiaba, School of Medicine, Department of Surgery, CuiabaMT, Brazil, Assistant Professor, Surgical Techniques Division, Department of Surgery, School of Medicine, University of Cuiaba (UNIC), Cuiaba-MT, Brazil. Acquisition of data, statistical analysis
| | - Rafael Moraes de Assis
- UNIC, Faculty of Veterinary Medicine, CuiabaMT, Brazil, Graduate student, Faculty of Veterinary Medicine, UNIC, Cuiaba-MT, Brazil. Surgical procedures, acquisition of data
| | - José Eduardo de Aguilar-Nascimento
- UFMT, Department of Surgery, CuiabaMT, Brazil, PhD, Full Professor, Division of Digestive Surgery, Department of Surgery, UFMT, Cuiaba-MT, Brazil. Critical revision
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Correa C, Mallarino C, Peña R, Rincón LC, Gracia G, Zarante I. Congenital malformations of pediatric surgical interest: prevalence, risk factors, and prenatal diagnosis between 2005 and 2012 in the capital city of a developing country. Bogotá, Colombia. J Pediatr Surg 2014; 49:1099-103. [PMID: 24952796 DOI: 10.1016/j.jpedsurg.2014.03.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 03/01/2014] [Accepted: 03/04/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Congenital anomalies (CAs) cause nearly one third of infant deaths worldwide. Various surveillance systems have been established, such as the Bogota Congenital Malformations Surveillance Program (BCMSP). Some CAs are of special interest to pediatric surgeons: omphalocele, gastroschisis, intestinal and esophageal atresia, anorectal malformations, vascular anomalies, diaphragmatic hernias, hypospadias and cryptorchidism. The aim of this study is to determine the prevalence of such CAs, and identify possible risk factors. METHODS Data from the BCMSP were collected between January 2005 and April 2012. CAs were classified in accordance with the ICD-10 and grouped for analysis purposes. Data on CA frequencies were obtained from the BCMSP. Association analyses were performed using the case-control methodology. RESULTS 282,523 births were registered. 4682 (1.66%) had one or more CAs at birth. The prevalence of CAs requiring pediatric surgery was 1 in 1000. The most frequent CAs were vascular anomalies, hypospadias, and anorectal malformations. Exposure to external factors was significantly associated with selected CAs. 51% of selected birth defects were not diagnosed in prenatal ultrasound. CONCLUSIONS This study highlights the importance of evaluating the local prevalence of congenital malformations. We propose the creation of specialized centers in Bogota to manage patients with CAs.
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Affiliation(s)
| | - Christina Mallarino
- Instituto de Genética Humana, Pontificia Universidad Javeriana, Bogotá Colombia
| | | | | | | | - Ignacio Zarante
- Instituto de Genética Humana, Pontificia Universidad Javeriana, Bogotá Colombia; Secretaría de Salud de Bogotá
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Friedmacher F, Hock A, Castellani C, Avian A, Höllwarth ME. Gastroschisis-related complications requiring further surgical interventions. Pediatr Surg Int 2014; 30:615-20. [PMID: 24736970 DOI: 10.1007/s00383-014-3500-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of this study was to determine the incidence of gastroschisis-related complications (GRCs) after closure of the abdominal wall defect, with a focus on frequency, type and timing of required surgical interventions, and to identify the impact of these on further outcome. METHODS All gastroschisis patients treated from 1975 to 2008 in a tertiary-level center were retrospectively reviewed. Surgical procedures for GRCs following abdominal wall closure of simple gastroschisis [SG (intact continuous bowel)] and complex gastroschisis [CG (additional gastrointestinal malformations)] were compared, and outcomes were determined. RESULTS One hundred and eight patients were identified with a median follow-up of 15.0 years (range 4-37). Ninety-four (87%) had SG, and 14 (13%) CG. Surgical interventions for GRCs were performed in 28 (26%) patients with 16 requiring multiple operations. Overall, 60 surgical procedures were performed. Bowel obstruction (n = 34) was the most common GRC, followed by anastomotic stricture (n = 8) and ischemic bowel (n = 3). The median interval between gastroschisis closure and secondary surgery for GRCs was 62.5 days (range 1 day-15 years). Surgical interventions were significantly more frequent in CG compared with SG [12/14 (86%) vs. 16/94 (17%); P < 0.0001]. The overall survival rate was 90%. Significantly, more patients required parenteral nutrition for more than 28 days [9/28 (32%) vs. 13/80 (16 %); P = 0.0468], longer median time to achieve full enteral feedings (87 vs. 33 days; P < 0.0001) and longer median hospital stay (117 vs. 54 days; P < 0.0001) compared with those not requiring additional surgery. CONCLUSION GRCs requiring surgical interventions were more common in patients with CG, which were associated with delay in achieving full enteral feedings and prolonged hospital stay.
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Affiliation(s)
- Florian Friedmacher
- Department of Pediatric and Adolescent Surgery, Medical University Graz, Auenbruggerplatz 34, 8036, Graz, Austria,
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Stanger J, Mohajerani N, Skarsgard ED. Practice variation in gastroschisis: factors influencing closure technique. J Pediatr Surg 2014; 49:720-3. [PMID: 24851755 DOI: 10.1016/j.jpedsurg.2014.02.066] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 02/13/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Little is known about the factors influencing surgical practice variation in newborns with gastroschisis. The purpose of this study was to correlate prognostic variables with the intended and actual abdominal closure technique and assess related outcomes. METHODS GS cases were abstracted from a national database. Variables evaluated included GA, BW, bowel injury severity (GPS), neonatal illness severity (SNAP-II), inborn status, center volume and training status, and admission time. Evaluated outcomes by closure method included duration of TPN, LOS, and complications. Descriptive, univariate and multivariable regression analyses were conducted. RESULTS The cohort consisted of 679 patients. A total of 372 (55%) underwent attempted PR, of which 300 (81%) were successful, while 307 (45%) had a silo placed intentionally. Patients undergoing attempted PR were more likely to be inborn, have daytime admissions, and higher SNAP-II scores. Successful PR was predicted by low risk GPS and high volume center. With the exception of higher rates of SSI in the planned silo group, outcomes in the successful PR and planned silo groups were comparable. CONCLUSION Practice variation related to type of closure is predicted by situational and institutional factors (outborn, nighttime admission, and center volume), while outcome variation is attributable to patient factors rather than practice variation.
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Affiliation(s)
- Jennifer Stanger
- Division of Pediatric Surgery, Department of Surgery, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Noosheen Mohajerani
- Division of Pediatric Surgery, Department of Surgery, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Erik D Skarsgard
- Division of Pediatric Surgery, Department of Surgery, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada.
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Prenatal determinants of optic nerve hypoplasia: review of suggested correlates and future focus. Surv Ophthalmol 2014; 58:610-9. [PMID: 24160732 DOI: 10.1016/j.survophthal.2013.02.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Revised: 02/06/2013] [Accepted: 02/12/2013] [Indexed: 11/20/2022]
Abstract
Optic nerve hypoplasia (ONH), a congenital malformation characterized by an underdeveloped optic nerve, is a seemingly epidemic cause of childhood blindness and visual impairment with associated lifelong morbidity. Although the prenatal determinants of ONH are unknown, early case reports have led to a longstanding speculation that risky health behaviors (e.g., prenatal use of recreational drugs, alcohol) are a likely culprit. There has yet to be a systematic review of the epidemiology of ONH to assess the common prenatal features that may help focus research efforts in the identification of likely prenatal correlates. A review of the past 50 years of epidemiologic research was conducted to examine the prenatal features linked with ONH and provide direction for future research. There are select prominent prenatal features associated with ONH: young maternal age and primiparity. Commonly implicated prenatal exposures (recreational or pharmaceutical drugs, viral infection, etc.) were rare or uncommon in large cohort studies of ONH and therefore unlikely to be major contributors to ONH. Familial cases and gene mutations are rare. The preponderance of young mothers and primiparity among cases of ONH is striking, although the significance is unclear. Recent research suggests a potential role for prenatal nutrition, weight gain, and factors of deprivation. With the rapidly increasing prevalence of ONH, future research should focus on investigating the relevance of young maternal age and primiparity and exploring the recently suggested etiologic correlates in epidemic clusters of ONH.
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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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