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The association between fluid restriction and hyponatremia in newborns with gastroschisis. Am J Surg 2021; 221:1262-1266. [PMID: 33714519 DOI: 10.1016/j.amjsurg.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/01/2021] [Accepted: 03/01/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Newborns with gastroschisis require appropriate fluid resuscitation but are also at risk for hyponatremia that may lead to adverse outcomes. The etiology of hyponatremia in gastroschisis has not been defined. METHODS Over a 24-month period, all newborns with gastroschisis in a free-standing pediatric hospital had sodium levels measured from serum, urine, gastric output, and the bowel bag around the eviscerated contents for the first 48 h of life. Total fluid intake and output were measured. Maintenance fluids were standardized at 120 mL/kg/day. Hyponatremia was defined as a serum sodium <132 mEq/L. A logistic regression model was created to determine independent predictors of hyponatremia. RESULTS 28 infants were studied, and 14 patients underwent primary closure. While serum sodium was normal in all patients at birth, 9 (32%) infants developed hyponatremia at a median of 17.4 h of life. On univariate analysis, hyponatremic babies had a greater net positive fluid balance (74.9 vs 114.7 mL/kg, p = 0.001) primarily due to a decrease in total fluid output (p = 0.05). On multivariable regression, a 10 mL/kg increase in overall fluid balance was associated with an increased risk of developing hyponatremia (OR 1.84 [1.23, 3.45], p = 0.016). No differences in the sodium content of urine, gastric, or bowel bag fluid were observed, and sodium balance was equivalent between cohorts. DISCUSSION Hyponatremia in babies with gastroschisis in the early postnatal period was associated with positive fluid balance and decreased fluid output. Prospective studies to determine the appropriate fluid resuscitation strategy in this population are warranted.
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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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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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Schulz AC, Stressig R, Ritgen J, Bagci S, Müller A, Gembruch U, Geipel A, Berg C, Bartmann P, Reutter HM. A classic twin study of isolated gastroschisis. Fetal Pediatr Pathol 2012; 31:324-30. [PMID: 22433012 DOI: 10.3109/15513815.2012.659393] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The etiology of gastroschisis remains elusive. A classic twin study was used to assess the relative contribution of environmental and genetic factors in its development. Screening of 4872 twin pregnancies identified three unreported twin pairs comprising two monozygous and one dizygous discordant pair of twins. Review of the literature identified an additional 21 twin pairs. We observed lower pair- and proband-wise concordance rates for monozygotic compared to dizygotic twin pairs, pair- and proband-wise concordance ratios below 1.0. Our results suggest environmental to play a greater role than genetic factors in the development of gastroschisis.
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Tannuri ACA, Silva LM, Leal AJG, Moraes ACFD, Tannuri U. Does administering albumin to postoperative gastroschisis patients improve outcome? Clinics (Sao Paulo) 2012; 67:107-11. [PMID: 22358234 PMCID: PMC3275118 DOI: 10.6061/clinics/2012(02)04] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 09/21/2011] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES Newborns who undergo surgery for gastroschisis correction may present with oliguria, anasarca, prolonged postoperative ileus, and infection. New postoperative therapeutic procedures were tested with the objective of improving postoperative outcome. PATIENTS AND METHODS One hundred thirty-six newborns participated in one of two phases. Newborns in the first phase received infusions of large volumes of crystalloid solution and integral enteral formula, and newborns in the second phase received crystalloid solutions in smaller volumes, with albumin solution infusion when necessary and the late introduction of a semi-elemental diet. The studied variables were serum sodium and albumin levels, the need for albumin solution expansion, the occurrence of anasarca, the length of time on parenteral nutrition, the length of time before initiating an enteral diet and reaching a full enteral diet, orotracheal intubation time, length of hospitalization, and survival rates. RESULTS Serum sodium levels were higher in newborns in the second phase. There was a correlation between low serum sodium levels and orotracheal intubation time; additionally, low serum albumin levels correlated with the length of time before the initiation of an oral diet and the time until a full enteral diet was reached. However, the discharge weights of newborns in the second phase were higher than in the first phase. The other studied variables, including survival rates (83.4% and 92.0%, respectively), were similar for both phases. CONCLUSIONS The administration of an albumin solution to newborns in the early postoperative period following gastroschisis repair increased their low serum sodium levels but did not improve the final outcome. The introduction of a semi-elemental diet promoted an increase in body weight at the time of discharge.
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Affiliation(s)
- Ana Cristina A Tannuri
- Faculdade de Medicina, Universidade de São Paulo, Pediatric Surgery Division, Pediatric Liver Transplantation Unit, Brazil
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Abstract
Gastroschisis (GS) continues to increase in frequency, with several studies now reported an incidence of between 4 and 5 per 10,000 live births. The main risk factor would seem to be young maternal age, and it is in this group that the greatest increase has occurred. Whilst various geographical regions confer a higher risk, the impact of several other putative risk factors, including smoking and illicit drug use, may be less important than when first identified in early epidemiological studies. Over 90% of cases of GS will now be diagnosed on antenatal ultrasound, but its value in determining the need for early delivery remains unclear. There would appear no clear evidence for either routine early delivery or elective caesarean section for infants with antenatally diagnosed GS. Delivery at a centre with paediatric surgical facilities reduces the risk of subsequent morbidity and should represent the standard of care. The relative roles of primary closure, staged closure and ward reduction, with or without general anaesthesia, appear less clear with considerable variation between centres in both the use of these techniques and subsequent surgical outcomes. Survival rates continue to improve, with rates well in excess of 90% now routine. The limited long-term developmental data available would suggest that normal or near-normal outcomes may be expected although there remains a need for further studies.
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Soares H, Silva A, Rocha G, Pissarra S, Correia-Pinto J, Guimarães H. Gastroschisis: preterm or term delivery? Clinics (Sao Paulo) 2010; 65:139-42. [PMID: 20186296 PMCID: PMC2827699 DOI: 10.1590/s1807-59322010000200004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Accepted: 11/03/2009] [Indexed: 11/22/2022] Open
Abstract
AIM The main objective of this study was to evaluate the association between prematurity and the time to achieve full enteral feeding in newborns with gastroschisis. The second objective was to analyze the associations between length of hospital stay and time to achieve full enteral feeding with mode of delivery, birth weight and surgical procedure. METHODS The medical records of newborns with gastroschisis treated between 1997 and 2007 were reviewed. Two groups were considered: those delivered before 37 weeks (group A) and those delivered after 37 weeks (group B). The variables of gestational age, mode of delivery, birth weight, time to achieve full enteral feeding, length of hospital stay and surgical approach were analyzed and compared between groups. RESULTS Forty-one patients were studied. In Group A, there were 14 patients with a mean birth weight (BW) of 2300 g (range=1680-3000) and a mean gestational age (GA) of 36 weeks (range=34-36). In group B, there were 24 patients with a mean BW of 2700 g (range=1500-3550) and a mean GA of 38 weeks (range=37-39). The mean time to achieve full enteral feeding was 30.1+/-6.7 days in group A and 17.0+/-2.5 days in group B (p=0.09) with an OR of 0.82 and a 95% CI of 0.20-3.23 after adjustment for sepsis and BW. No statistical difference was found between low BW (<2500 g), mode of delivery and number of days to achieve full enteral feeding (p=0.34 and p=0.13, respectively). Patients with BW over 2500 g had fewer days in the hospital (22.9+/-3.1 vs. 35.7+/-5.7 days; p=0.06). CONCLUSION The results of this study do not support the idea of anticipating the delivery of fetuses with gastroschisis in order to achieve full enteral feeding earlier.
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Affiliation(s)
- Henrique Soares
- Neonatology Department, São João Hospital and Porto Medical School – Porto/Portugal
| | - Ana Silva
- Pediatrics Surgery Department, São João Hospital – Porto/Portugal,
, Tel.: 35 1 916108761
| | - Gustavo Rocha
- Neonatology Department, São João Hospital and Porto Medical School – Porto/Portugal
| | - Susana Pissarra
- Neonatology Department, São João Hospital and Porto Medical School – Porto/Portugal
| | - Jorge Correia-Pinto
- Pediatrics Surgery Department, São João Hospital – Porto/Portugal,
, Tel.: 35 1 916108761
| | - Hercília Guimarães
- Neonatology Department, São João Hospital and Porto Medical School – Porto/Portugal
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Van Dorp DR, Malleis JM, Sullivan BP, Klein MD. Teratogens inducing congenital abdominal wall defects in animal models. Pediatr Surg Int 2010; 26:127-39. [PMID: 19756655 DOI: 10.1007/s00383-009-2482-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2009] [Indexed: 02/04/2023]
Abstract
Congenital abdominal wall defects are common anomalies which include gastroschisis, omphalocele and umbilical cord hernia. Recent reports indicate that gastroschisis is increasing in prevalence, whereas omphalocele has remained steady, suggesting that environmental factors may play a part in their pathogenesis. The aim of this study is to review animal teratogen studies resulting in abdominal wall defects to investigate their possible causes. Each report was examined not only for the teratogens causing the defects, but also to carefully identify the defect occurring and its correlation with the known clinical anomalies. We found many discrepancies between the nomenclature used by animal teratology investigators and that used by clinicians. We were able to confirm the induction of gastroschisis by 22 teratogens, omphalocele by 9 teratogens and umbilical cord hernia by 8. There is no doubt that environmental factors may be responsible, at least in part, for all three of the clinical abdominal wall defects. Future studies should take care to appreciate the differences between these anomalies and describe them in detail, so that accurate and meaningful conclusions can be obtained.
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Affiliation(s)
- Dennis R Van Dorp
- Departments of Surgery, Wayne State University and Children's Hospital of Michigan, Michigan, USA
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Estrada JJ, Petrosyan M, Hunter CJ, Lee SL, Anselmo DM, Grikscheit TC, Stein JE, Wang KS, Ford HR, Shaul DB. Preservation of extracorporeal tissue in closing gastroschisis augments intestinal length. J Pediatr Surg 2008; 43:2213-5. [PMID: 19040937 DOI: 10.1016/j.jpedsurg.2008.08.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Accepted: 08/29/2008] [Indexed: 11/15/2022]
Abstract
BACKGROUND Prenatal closure of the umbilical ring in gastroschisis may result in an amorphous, nonviable appearing extracorporeal tissue that is resected during the repair. However, it is unclear whether such remnant intestine is truly nonviable. METHODS AND RESULTS We examined the outcomes of patients when this tissue is preserved. We identified 8 patients who presented with a closing gastroschisis and a mass of tissue connected by a vascular pedicle. Four patients underwent abdominal exploration with resection of the mass and gastroschisis closure. Histologic examination revealed normal intestinal wall architecture. All patients in this group developed short bowel syndrome, requiring long-term parenteral nutrition. Conversely, 4 patients underwent abdominal exploration with internalization of the remnant tissue, a maneuver referred to as "parking," along with either silo placement, or primary closure of the gastroschisis. At re-exploration, 3 of 4 patients were found to have viable intestine, and bowel continuity was reestablished. The mean parenteral nutrition requirement for this group was significantly shorter than the resected group. CONCLUSION In this series, we show that this amorphous tissue, when preserved, may exhibit normal intestinal architecture and absorptive function. Therefore, such remnant tissue should be preserved as it may significantly increase bowel length and minimize parenteral nutrition requirement.
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Affiliation(s)
- Joaquin J Estrada
- Division of Pediatric Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Childrens Hospital Los Angeles, CA 90027, USA
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Abstract
In the last two decades, advancement in neonatal surgery, anesthesia, and intensive care have improved the outcome not only for neonates with complex surgical conditions but also for those preterm infants with combined medical and surgical issues. Infants with surgical problems may remain in the neonatal care setting for weeks or months, and providing ongoing nursing care can be challenging but rewarding. In this article, the authors outline the immediate preoperative management, stabilization, and subsequent postoperative nursing care of the surgical neonate.
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Affiliation(s)
- Andrena Kelly
- The Dan Young Surgical Neonatal Intensive Care Unit, Royal Hospital for Sick Children, Glasgow, Scotland.
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David AL, Tan A, Curry J. Gastroschisis: sonographic diagnosis, associations, management and outcome. Prenat Diagn 2008; 28:633-44. [DOI: 10.1002/pd.1999] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Santiago-Munoz PC, McIntire DD, Barber RG, Megison SM, Twickler DM, Dashe JS. Outcomes of Pregnancies With Fetal Gastroschisis. Obstet Gynecol 2007; 110:663-8. [PMID: 17766615 DOI: 10.1097/01.aog.0000277264.63736.7e] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe pregnancy outcomes with fetal gastroschisis, including the associations of prenatal ultrasound findings with neonatal surgical complications and other morbidities. METHODS This was a review of pregnancies complicated by fetal gastroschisis and delivered from January 1998 through June 2006. The last ultrasonogram before delivery was reviewed to determine stomach dilatation, bowel dilatation, or abnormalities of amniotic fluid volume. Neonatal records were reviewed to determine type of closure and any bowel complications. RESULTS There were 66 pregnancies with gastroschisis, 1 per 2,000 deliveries. There were three stillbirths and three neonatal deaths. Delayed closure was necessary in 49% who underwent surgery. Birth weight below the third percentile, which occurred in 38%, was associated with need for delayed closure, 64% compared with 25% without growth restriction, P<.001, but was not associated with longer hospital stay or neonatal death. Fetal gastroschisis was diagnosed by prenatal ultrasonography in 58 cases. Bowel complications requiring surgery were more frequent when ultrasonography had demonstrated stomach dilatation (five cases), 60% compared with 10%, P=.002. Fetuses with defects so large that no normal ventral wall could be visualized ultrasonographically (three cases) were at increased risk for neonatal death, 100% compared with 0%, P<.001. CONCLUSION Ultrasound findings associated with adverse outcome in fetal gastroschisis included stomach dilatation and a defect so large that no normal ventral wall could be visualized. Fetal growth restriction was common, and such infants were more likely to require delayed gastroschisis closure. Despite more than 90% survival, morbidity with gastroschisis remains high. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Patricia C Santiago-Munoz
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390-9032, USA.
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