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Calado AM, Seixas F, Pires MDA. Updating an Overview of Teratology. Methods Mol Biol 2024; 2753:1-38. [PMID: 38285332 DOI: 10.1007/978-1-0716-3625-1_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
In this chapter, the authors aim to update an overview of the principles of teratology, beginning with the definition of teratology, the critical point at which this process occurs, and some of the most common etiological agents that improve our understanding of teratology.Modern teratology has greatly improved in recent years with advances in new methods in molecular biology, toxicology, animal laboratory science, and genetics, increasing our knowledge of ambient influences. Nevertheless, there is a lot to do to reduce the influence of hazardous intervening agents, whether they target our genetics or not, that can negatively affect pregnancy and induce congenital development disorders, including morphological, biochemical, or behavioral defects.Certain agents might indeed be related to certain defects, but we have not been able to identify the cause of most congenital defects, which highlights the importance of finding and testing out new genetics techniques and conducting laboratory animal science to unravel the etiology and pathogenicity of each congenital defect.
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Affiliation(s)
- Ana Margarida Calado
- Animal and Veterinary Research Centre (CECAV), UTAD, and Associate Laboratory for Animal and Veterinary Science (AL4Animals), Department of Veterinary Sciences, School of Agrarian and Veterinary Sciences (ECAV), University of Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal
| | - Fernanda Seixas
- Animal and Veterinary Research Centre (CECAV), UTAD, and Associate Laboratory for Animal and Veterinary Science (AL4Animals), Department of Veterinary Sciences, School of Agrarian and Veterinary Sciences (ECAV), University of Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal
| | - Maria Dos Anjos Pires
- Animal and Veterinary Research Centre (CECAV), UTAD, and Associate Laboratory for Animal and Veterinary Science (AL4Animals), Department of Veterinary Sciences, School of Agrarian and Veterinary Sciences (ECAV), University of Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal.
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Asemota O, Derraugh G, Levesque M, Iqbal S, Balshaw R, Lum Min SA, Keijzer R. Respiratory outcomes in the first 10 years of life in children with gastroschisis: A retrospective cohort study. Pediatr Pulmonol 2021; 56:2302-2311. [PMID: 33818925 DOI: 10.1002/ppul.25404] [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: 10/24/2020] [Revised: 02/04/2021] [Accepted: 03/05/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Little attention has been given to the long-term respiratory outcomes of children with gastroschisis. The purpose of this study was to determine if gastroschisis survivors have more respiratory illnesses in their first 10 years of life compared with age-matched controls. METHODS We performed a retrospective cohort study of all gastroschisis children born in Manitoba between 1991 and 2017. Gastroschisis cases were identified from a clinical database, and a date of birth-matched control cohort was constructed from a population-based data repository. International Classification of Disease codes were used to compare the risk and frequency of respiratory diagnoses for children with gastroschisis to date of birth-matched controls from 0-5 years of age and 5-10 years of age. RESULTS The 0-5 years of age analysis included 117 gastroschisis cases and 1205 date of birth-matched controls; children with gastroschisis had a higher risk of asthma (relative risk [RR] = 1.46; 95% confidence interval [CI]: 1.03, 2.55; p = .029), acute bronchitis/bronchiolitis (RR = 1.61; 95% CI: 1.27, 2.03; p < .001), pneumonia (RR = 1.99; 95% CI: 1.45, 2.72; p < .001), viral pneumonia (RR = 5.15; 95% CI: 1.79, 14.81; p = .007), and pneumonia due to unspecified organism (RR = 2.06; 95% CI: 1.45, 2.92; p < .001). Gastroschisis children 0-5 years of age were also diagnosed more frequently with bronchitis/bronchiolitis (RR = 2.14; 95% CI: 1.79, 2.57; p < .001) and viral pneumonia (RR = 8.10; 95% CI: 3.79, 17.31; p < .001). The 5-10 years of age analysis included 73 cases and 738 controls; no difference in the risk of respiratory illness was found for gastroschisis cases and controls in this age group. However, gastroschisis cases were more frequently diagnosed with bacterial pneumonia (RR = 3.03; 95% CI: 1.67, 5.51; p < .001) and influenza (RR = 3.03; 95% CI: 1.67, 5.51; p < .001). CONCLUSION Our study shows that children with gastroschisis have an increased risk of asthma and respiratory infections compared with children without gastroschisis, most noticeably in the first 5 years of life.
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Affiliation(s)
- Osamuyi Asemota
- Department of Surgery, Division of Pediatric Surgery, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gabrielle Derraugh
- Department of Surgery, Division of Pediatric Surgery, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Matthew Levesque
- Department of Surgery, Division of Pediatric Surgery, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Shaikh Iqbal
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Robert Balshaw
- Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Suyin A Lum Min
- Department of Surgery, Division of Pediatric Surgery, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Richard Keijzer
- Department of Surgery, Division of Pediatric Surgery, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
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Ferreira RG, Mendonça CR, Gonçalves Ramos LL, de Abreu Tacon FS, Naves do Amaral W, Ruano R. Gastroschisis: a systematic review of diagnosis, prognosis and treatment. J Matern Fetal Neonatal Med 2021; 35:6199-6212. [PMID: 33899664 DOI: 10.1080/14767058.2021.1909563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The present systematic review aims to investigate the diagnosis, prognosis, delivery assistance, pregnancy results and postnatal management in gastroschisis. STUDY DESIGN The following data sources were evaluated: The CINAHL, Embase and MEDLINE/PubMed databases were searched, observational and intervention studies published over the past 20 years. The quality of the studies was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). RESULTS A total of 3770 infants diagnosed with gastroschisis were included (44 studies); 1534 fetuses were classified as simple gastroschisis and 288 as complex gastroschisis. Intrauterine fetal demise occurred in 0.47% and elective termination occurred in 0.13%. Preterm delivery occurred in 23.23% and intrauterine growth restriction in 4.43%. Cesarean section delivery was performed in 54.6%. Neonatal survival was 91.29%. The main neonatal complications were: sepsis (11.78%), necrotizing enterocolitis (2.33%), short bowel syndrome (1.37%), bowel obstruction (0.79%), and volvulus (0.23%). Immediate surgical repair was performed in 80.1% with primary closure in 69%. The average to oral feeding was 33 (range: 11-124.5) days. Average hospital duration was 38 days and 89 days in neonates with simple and complex grastroschisis, respectively. CONCLUSIONS The present systematic review provides scientific data for counseling families with fetal gastroschisis.
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Affiliation(s)
- Rui Gilberto Ferreira
- Postgraduate program in Health Sciences, Universidade Federal de Goiás, Goiania, Brazil.,Department of Obstetrics and Gynaecology, Hospital das Clínicas, Universidade Federal de Goiás, Goiania, Brazil
| | | | | | | | - Waldemar Naves do Amaral
- Postgraduate program in Health Sciences, Universidade Federal de Goiás, Goiania, Brazil.,Department of Obstetrics and Gynaecology, Hospital das Clínicas, Universidade Federal de Goiás, Goiania, Brazil
| | - Rodrigo Ruano
- Department of Obstetrics and Gynecology, Pediatrics and Physiology, Division of Maternal-Fetal Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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Baldacci S, Santoro M, Coi A, Mezzasalma L, Bianchi F, Pierini A. Lifestyle and sociodemographic risk factors for gastroschisis: a systematic review and meta-analysis. Arch Dis Child 2020; 105:756-764. [PMID: 32051127 DOI: 10.1136/archdischild-2019-318412] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 01/24/2020] [Accepted: 01/24/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Gastroschisis is strongly associated with young maternal age. This association suggests the need for further investigations on non-genetic risk factors. Identifying these risk factors is a public health priority in order to develop prevention strategies aimed at reducing the prevalence and health consequences in offspring. OBJECTIVE To systematically assess and quantitatively synthesise the available epidemiological studies to evaluate the association between non-genetic risk factors and gastroschisis. METHODS Literature from PubMed, EMBASE and Scopus was searched for the period 1990-2018. Epidemiological studies reporting risk estimates between lifestyle and sociodemographic risk factors and gastroschisis were included. Two pairs of reviewers independently extracted information on study characteristics following Preferred Reporting Items for Systematic Reviews and Meta-Analyses and MOOSE (Meta-analysis Of Oservational Studies in Epidemiology) guidelines. Relative risk (RR) estimates were calculated across the studies and meta-analysis was performed using random-effects model. RESULTS We identified 58 studies. Meta-analyses were conducted on 29 studies. Maternal smoking (RR 1.56, 95% CI 1.40 to 1.74), illicit drug use (RR 2.14, 95% CI 1.48 to 3.07) and alcohol consumption (RR 1.40, 95% CI 1.13 to 1.70) were associated with an increased risk of gastroschisis. A decreased risk among black mothers compared with non-Hispanic white mothers (RR 0.49, 95% CI 0.38 to 0.63) was found. For Hispanic mothers no association was observed. CONCLUSIONS Exposure to smoking, illicit drugs and alcohol during pregnancy is associated with an increased risk of gastroschisis. A significantly decreased risk for black mothers was observed. Further epidemiological studies to assess the potential role of other environmental factors are strongly recommended. PROSPERO REGISTRATION NUMBER CRD42018104284.
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Affiliation(s)
- Silvia Baldacci
- Institute of Clinical Physiology National Research Council, Pisa, Italy
| | - Michele Santoro
- Institute of Clinical Physiology National Research Council, Pisa, Italy
| | - Alessio Coi
- Institute of Clinical Physiology National Research Council, Pisa, Italy
| | - Lorena Mezzasalma
- Institute of Clinical Physiology National Research Council, Pisa, Italy
| | - Fabrizio Bianchi
- Institute of Clinical Physiology National Research Council, Pisa, Italy.,Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Anna Pierini
- Institute of Clinical Physiology National Research Council, Pisa, Italy.,Fondazione Toscana Gabriele Monasterio, Pisa, Italy
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Kapapa M, Rieg T, Henne-Bruns D, Serra A. Risk factors for abdominal wall defects. Congenit Anom (Kyoto) 2020; 60:54-61. [PMID: 30932237 DOI: 10.1111/cga.12336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 01/24/2023]
Abstract
In the last decades, the prevalence of gastroschisis (GS) has increased worldwide. The purpose of this study was to identify maternal risk factors explaining the described gain and to identify differences between GS and omphalocele (OC). A case-control design was used to compare GS (n = 36) and OC (n = 18) mothers to control group (CG; n = 30) matched for maternal age. Specialized questionnaires and mothers' prenatal records were used, and participants completed a structured interview. Focus was on medical history, changing nutrition, drug consumption, and external risk factors. The local ethics committee approved this study. GS mothers were significantly younger (mean 23.00; median 24; SD ±5) than OC (P = 0.007; mean 28.61; median 28, 19-41; SD ±5.1) and CG (P = 0.001; mean 30.77; median 31, SD ±6.2). Mothers with abdominal wall defects (AWD) ingested antibiotics more often (P = 0.008) than CG. Socioeconomic characteristics, for example, level of profession, of GS mothers was significantly lower than OC (P = 0.039) and CG (P = 0.05) mothers, and their cohabitation time was shorter (P < 0.05; mean 35 month/median 24 month, SD ±35.8). Incidence of OC significantly increased after hormonal treatment (P = 0.022) and invasive prenatal diagnostics (P < 0.05) compared to GS. GS mothers took folic acid prophylaxis less often than OC (P = 0.02). Smoking, illicit drugs, and external risks like herbicides showed no influence, but GS mothers drink significantly more often alcohol (P = 0.05). We confirmed an increased risk for GS if several factors such as young maternal age, short cohabitation time, and usage of antibiotics coincide with alcohol consumption and associated immune diseases. OC increased after hormonal treatment and invasive prenatal diagnostics.
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Affiliation(s)
- Melanie Kapapa
- Department of Surgery (Paediatric Surgery Section), University of Ulm, Ulm, Germany
| | - Teresa Rieg
- Department of Surgery (Paediatric Surgery Section), University of Ulm, Ulm, Germany
| | - Doris Henne-Bruns
- Department of Surgery (Paediatric Surgery Section), University of Ulm, Ulm, Germany
| | - Alexandre Serra
- Department of Surgery (Paediatric Surgery Section), University of Ulm, Ulm, Germany
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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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Vanishing Gastroschisis with a Favorable Outcome after a 3-Year Follow-Up: A Case Report and Literature Review. Case Rep Obstet Gynecol 2020; 2020:8542087. [PMID: 31970004 PMCID: PMC6969982 DOI: 10.1155/2020/8542087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 12/23/2019] [Indexed: 01/14/2023] Open
Abstract
Vanishing gastroschisis (VG) is a severe complication of gastroschisis with a high mortality rate. We report here a case of VG with a favorable outcome after a 3-year follow-up. A 26-year-old primigravida woman was referred to Strasbourg University Hospital because her fetus was diagnosed with an isolated gastroschisis at 13-week gestation. The ultrasound evolution was marked by a progressive closure of the abdominal wall defect from 19-week gestation and the appearance of dilated intra-abdominal loops. The child was born with a closed abdominal wall except a small remnant at the level of the former gastroschisis orifice. Explorative laparotomy revealed extensive midgut atresia with only 50 cm of remaining midgut. A jejunocolic anastomosis was performed. The child is now 3 years old and has a favorable outcome with only 2 nights a week of parenteral nutrition. A total of 39 cases of VG type D from Perrone et al. classification are described in the literature from 1991 to 2019, among which 19 (48.7%) are alive at the time of publication but only 4 cases are described with a long-term follow-up of 3 years or more. This is the fifth case described with a favorable evolution after 3-year follow-up.
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Stallings EB, Isenburg JL, Short TD, Heinke D, Kirby RS, Romitti PA, Canfield MA, O'Leary LA, Liberman RF, Forestieri NE, Nembhard WN, Sandidge T, Nestoridi E, Salemi JL, Nance AE, Duckett K, Ramirez GM, Shan X, Shi J, Lupo PJ. Population-based birth defects data in the United States, 2012-2016: A focus on abdominal wall defects. Birth Defects Res 2019; 111:1436-1447. [PMID: 31642616 DOI: 10.1002/bdr2.1607] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/03/2019] [Accepted: 10/04/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND/OBJECTIVES In this report, the National Birth Defects Prevention Network (NBDPN) examines and compares gastroschisis and omphalocele for a recent 5-year birth cohort using data from 30 population-based birth defect surveillance programs in the United States. METHODS As a special call for data for the 2019 NBDPN Annual Report, state programs reported expanded data on gastroschisis and omphalocele for birth years 2012-2016. We estimated the overall prevalence (per 10,000 live births) and 95% confidence intervals (CI) for each defect as well as by maternal race/ethnicity, maternal age, infant sex, and case ascertainment methodology utilized by the program (active vs. passive). We also compared distribution of cases by maternal and infant factors and presence/absence of other birth defects. RESULTS The overall prevalence estimates (per 10,000 live births) were 4.3 (95% CI: 4.1-4.4) for gastroschisis and 2.1 (95% CI: 2.0-2.2) for omphalocele. Gastroschisis was more frequent among young mothers (<25 years) and omphalocele more common among older mothers (>40 years). Mothers of infants with gastroschisis were more likely to be underweight/normal weight prior to pregnancy and mothers of infants with omphalocele more likely to be overweight/obese. Omphalocele was twice as likely as gastroschisis to co-occur with other birth defects. CONCLUSIONS This report highlights important differences between gastroschisis and omphalocele. These differences indicate the importance of distinguishing between these defects in epidemiologic assessments. The report also provides additional data on co-occurrence of gastroschisis and omphalocele with other birth defects. This information can provide a basis for future research to better understand these defects.
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Affiliation(s)
- Erin B Stallings
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, Georgia.,Carter Consulting, Incorporated, Atlanta, Georgia
| | - Jennifer L Isenburg
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, Georgia
| | - Tyiesha D Short
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, Georgia.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Dominique Heinke
- Massachusetts Department of Public Health, Center for Birth Defects Research and Prevention, Boston, Massachusetts
| | - Russell S Kirby
- College of Public Health, University of South Florida, Tampa, Florida
| | - Paul A Romitti
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Mark A Canfield
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas
| | - Leslie A O'Leary
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, Georgia
| | - Rebecca F Liberman
- Massachusetts Department of Public Health, Center for Birth Defects Research and Prevention, Boston, Massachusetts
| | - Nina E Forestieri
- Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina
| | - Wendy N Nembhard
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Arkansas Center for Birth Defects Research and Prevention, Little Rock, Arkansas
| | | | - Eirini Nestoridi
- Massachusetts Department of Public Health, Center for Birth Defects Research and Prevention, Boston, Massachusetts
| | - Jason L Salemi
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Amy E Nance
- Utah Birth Defect Network, Division of Family Health and Preparedness, Utah Department of Health, Salt Lake City, Utah
| | | | - Glenda M Ramirez
- Arizona Birth Defects Monitoring Program, Arizona Department of Health Services, Phoenix, Arizona
| | - Xiaoyi Shan
- Arkansas Reproductive Health Monitoring System, Arkansas Children's Research Institute, Little Rock, Arkansas
| | - Jing Shi
- Special Child Health and Early Intervention Services, New Jersey Department of Health, Trenton, New Jersey
| | - Philip J Lupo
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, Texas
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Goodman JR, Peck JD, Landmann A, Williams M, Elimian A. An evaluation of nutritional and vasoactive stimulants as risk factors for gastroschisis: a pilot study. J Matern Fetal Neonatal Med 2019; 32:2346-2353. [PMID: 29415587 PMCID: PMC6310664 DOI: 10.1080/14767058.2018.1433657] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 01/08/2018] [Accepted: 01/23/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The objective of this study is to evaluate poor maternal nutrition, environmental exposures and vasoactive stimulants as potential risk factors for gastroschisis. METHODS A case-control study was conducted among singleton pregnancies diagnosed in a tertiary teaching hospital in a 22-month period. Cases of gastroschisis were matched to controls at the time of diagnosis by race and maternal age. Demographics, periconceptual exposures, nutritional biomarkers, and illicit drug hair analysis were evaluated. Analyses were performed using conditional logistic regression. RESULTS Thirty gastroschisis cases and 76 controls were studied with no associations observed for illicit drug use or serum levels of ferritin, iron, B6, B12, folate, or zinc. Neither prescription medication nor over the counter mediation use differed between cases and controls. Following adjustment for insurance, education, low BMI, and nulliparity, mothers of gastroschisis cases had an increased odds of alcohol use 1 month prior and/or during early pregnancy compared with controls, with adjusted odds ratio (OR) 3.19 (95% CI 1.01-11.61). CONCLUSIONS Our findings suggest that further investigation of vasoactive stimulants such as alcohol is warranted in the search to identify risk factors for gastroschisis.
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Affiliation(s)
- Jean R Goodman
- a Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology , Loyola University Medical Center , Maywood , IL , USA
| | - Jennifer D Peck
- b University of Oklahoma Health Sciences Center , Oklahoma City , OK , USA
| | | | - Marvin Williams
- b University of Oklahoma Health Sciences Center , Oklahoma City , OK , USA
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10
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Salinas-Torres VM, Salinas-Torres RA, Cerda-Flores RM, Martínez-de-Villarreal LE. Prevalence, Mortality, and Spatial Distribution of Gastroschisis in Mexico. J Pediatr Adolesc Gynecol 2018; 31:232-237. [PMID: 29317257 DOI: 10.1016/j.jpag.2017.12.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 11/21/2017] [Accepted: 12/31/2017] [Indexed: 10/18/2022]
Abstract
STUDY OBJECTIVE To explore the prevalence, mortality, and spatial distribution of gastroschisis using a large population-based sample with cases identified according to birth and death certificates (ICD-10 diagnosis code Q79.3, gastroschisis) through the General Directorate of Health Information of the Secretary Health of Mexico, over the course of a 15-year period. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: A descriptive study examining 10,287 cases of gastroschisis was performed from 2000-2014 using public natality data for denominators (more than 25 million live births). Gastroschisis prevalence and mortality was calculated for each of year, state, maternal, and newborn characteristics. Spatial distribution was analyzed according to gastroschisis prevalence in the 32 states of Mexico. RESULTS Gastroschisis prevalence was 4.01 per 10,000 live births (annual trend 2.09-6.85). Mortality associated with gastroschisis was 1.28 per 10,000 live births. Women younger than 20 years old, primiparae, and preterm infants had the highest gastroschisis-related prevalence (13.12, 5.83, and 7.51 per 10,000 live births, respectively). Gastroschisis prevalence and mortality did not differ according to newborn sex. A negative binomial distribution, variance (82,391.87) greater than the mean (321.47) was identified. CONCLUSION Our findings show an increasing temporal trend for gastroschisis since 2000 in Mexico. Additionally, gastroschisis might follow in future instances a positive binomial or Poisson distribution. Therefore, improving surveillance of risk factors and supporting research for gastroschisis is warranted among maternal age younger than 25, particularly, younger than 20 years of age.
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Affiliation(s)
- Victor M Salinas-Torres
- Universidad Autónoma de Nuevo León, Departamento de Genética, Facultad de Medicina y Hospital Universitario José Eleuterio González, Monterrey, Nuevo León, México; Instituto de Servicios de Salud Pública en el Estado de Baja California, Departamento de Genética, Hospital General Tijuana, Tijuana, Baja California, México.
| | - Rafael A Salinas-Torres
- Instituto de Servicios de Salud Pública en el Estado de Baja California, Departamento de Genética, Hospital General Tijuana, Tijuana, Baja California, México; Instituto Tecnológico de Tijuana, Departamento de Sistemas y Computación, Tijuana, Baja California, México
| | - Ricardo M Cerda-Flores
- Universidad Autónoma de Nuevo León, Facultad de Enfermería, Monterrey, Nuevo León, México
| | - Laura E Martínez-de-Villarreal
- Universidad Autónoma de Nuevo León, Departamento de Genética, Facultad de Medicina y Hospital Universitario José Eleuterio González, Monterrey, Nuevo León, México
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11
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Williams SL, Leonard M, Hall ES, Perez J, Wessel J, Kingma PS. Evaluation of Early Onset Sepsis, Complete Blood Count, and Antibiotic Use in Gastroschisis. Am J Perinatol 2018; 35:385-389. [PMID: 29084414 PMCID: PMC5842123 DOI: 10.1055/s-0037-1607420] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Gastroschisis is a congenital defect in which the abdominal viscera herniate through the abdominal wall. In this population, antibiotics are often initiated immediately following delivery; however, this may be unnecessary as infections typically develop as a consequence of chronic issues in gastroschisis. The objective of this study was to evaluate the incidence of culture positive early onset sepsis, the reliability of the immature to mature neutrophil count (I:T) ratio as an infectious biomarker, and antibiotic use in infants with gastroschisis. STUDY DESIGN This retrospective chart review analyzed clinical data from 103 infants with gastroschisis and 103 weight-matched controls that were evaluated for early onset infection. RESULTS Compared with the control group, there was a significantly increased percentage of infants with an I:T ratio > 0.2 in the gastroschisis group (43% vs. 12%, p < 0.001) and an increased percentage of infants exposed to greater than 5 days of antibiotics regardless of their I:T ratio (75% vs. 6%, p < 0.001). There were no episodes of culture positive early onset sepsis in either group. CONCLUSION Our results indicate that I:T ratio is not a reliable marker of infection in gastroschisis, and suggest that empiric septic evaluation and antibiotic use, immediately following delivery in gastroschisis infants, may be unnecessary.
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Affiliation(s)
- Sadie L Williams
- The Perinatal Institute, Section of Neonatology, Perinatal and Pulmonary Biology Cincinnati Children’s, Hospital Medical Center, Cincinnati, Ohio
| | - Matthew Leonard
- The Perinatal Institute, Section of Neonatology, Perinatal and Pulmonary Biology Cincinnati Children’s, Hospital Medical Center, Cincinnati, Ohio
| | - Eric S Hall
- The Perinatal Institute, Section of Neonatology, Perinatal and Pulmonary Biology Cincinnati Children’s, Hospital Medical Center, Cincinnati, Ohio
| | - Jose Perez
- Winnie Palmer Hospital, Mednax Health Partner Solutions, Orlando, Florida
| | - Jacqueline Wessel
- Division of Nutrition Therapy, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Paul S Kingma
- The Perinatal Institute, Section of Neonatology, Perinatal and Pulmonary Biology Cincinnati Children’s, Hospital Medical Center, Cincinnati, Ohio,Cincinnati Fetal Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
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Abstract
In this chapter, we provide an overview of the basic principles of teratology, beginning with its definition, the critical point for teratogenesis to occur and the most evident etiological agents to improve the understanding of this science.Teratology is a recent science that began in the early twentieth century, and has greatly improved over the recent years with the advancements in molecular biology, toxicology, animal laboratory science, and genetics, as well as the improvement on the knowledge of the environmental influences.Nevertheless, more work is required to reduce the influence of hazardous products that could be deleterious during pregnancy, thus reducing teratogenic defects in the newborn. While some teratogenic defects are attributed to their agents with certainty, the same for a lot of other such defects is lacking, necessitating consistent studies to decipher the influence of various teratogenic agents on their corresponding teratogenic defects. It is here that the laboratory animal science is of great importance both in the present and in the future.
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Affiliation(s)
- Ana M Calado
- Departamento de Ciências Veterinárias, Universidade de Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal.,Centro de Ciência Animal e Veterinária (CECAV), Universidade de Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal
| | - Maria Dos Anjos Pires
- Departamento de Ciências Veterinárias, Universidade de Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal. .,Centro de Ciência Animal e Veterinária (CECAV), Universidade de Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal.
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13
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Wesonga AS, Fitzgerald TN, Kabuye R, Kirunda S, Langer M, Kakembo N, Ozgediz D, Sekabira J. Gastroschisis in Uganda: Opportunities for improved survival. J Pediatr Surg 2016; 51:1772-1777. [PMID: 27516176 DOI: 10.1016/j.jpedsurg.2016.07.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 06/09/2016] [Accepted: 07/15/2016] [Indexed: 11/15/2022]
Abstract
PURPOSE Neonatal mortality from gastroschisis in sub-Saharan Africa is high, while in high-income countries, mortality is less than 5%. The purpose of this study was to describe the maternal and neonatal characteristics of gastroschisis in Uganda, estimate the mortality and elucidate opportunities for intervention. METHODS An ethics-approved, prospective cohort study was conducted over a one-year period. All babies presenting with gastroschisis in Mulago Hospital in Kampala, Uganda were enrolled and followed up to 30days. Univariate and descriptive statistical analyses were performed on demographic, maternal, perinatal, and clinical outcome data. RESULTS 42 babies with gastroschisis presented during the study period. Mortality was 98% (n=41). Maternal characteristics demonstrate a mean maternal age of 21.8 (±3.9) years, 40% (n=15) were primiparous, and fewer than 10% (n=4) of mothers reported a history of alcohol use, and all denied cigarette smoking and NSAID use. Despite 93% (n=39) of mothers receiving prenatal care and 24% (n=10) a prenatal ultrasound, correct prenatal diagnosis was 2% (n=1). Perinatal data show that 81% of deliveries occurred in a health facility. The majority of babies (58%) arrived at Mulago Hospital within 12h of birth, however 52% were breastfeeding, 53% did not have intravenous access and only 19% had adequate bowel protection in place. Four patients (9%) arrived with gangrenous bowel. One patient, the only survivor, had primary closure. Average time to death was 4.8days [range<1 to 14days]. CONCLUSION The mortality of gastroschisis in Uganda is alarmingly high. Improving prenatal diagnosis and postnatal care of babies in a tertiary center may improve outcome.
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Affiliation(s)
| | - Tamara N Fitzgerald
- Paul L. Foster School of Medicine, Texas Tech University, EI Paso, TX, United States.
| | - Ronald Kabuye
- Makerere University School of Medicine, Kampala, Uganda
| | | | - Monica Langer
- Tufts University School of Medicine and Maine Medical Center, Portland, ME, United States
| | | | - Doruk Ozgediz
- Yale University School of Medicine, New Haven, CT, United States
| | - John Sekabira
- Makerere University School of Medicine, Kampala, Uganda
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14
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The epidemiology, prevalence and hospital outcomes of infants with gastroschisis. J Perinatol 2016; 36:901-5. [PMID: 27388940 DOI: 10.1038/jp.2016.99] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/20/2016] [Accepted: 06/03/2016] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The purpose of this study is to evaluate recent trends in prevalence of gastroschisis among infants admitted for neonatal intensive care in the United States. STUDY DESIGN Retrospective review of a de-identified patient data. The current study extends our observations through the end of 2007 to 2015. RESULTS During the study period (1 January 1997 to 12 December 2015), there were 1 158 755 total discharges; 6023 (5.2/1000) had gastroschisis and 1885 (1.6/1000) had an omphalocele. Between 1997 and 2008, the reported rate of gastroschisis increased from 2.9 to 6.4/1000 discharges. From 2008 to 2011, the values have slowly decreased from 6.4 to 4.7/1000 discharges and since 2011 have been stable. The largest drop in the prevalence was in mothers who were <20 years old. In contrast, the reported rate of omphalocele was stable at 1 to 2/1000 discharges. CONCLUSION The prevalence of gastroschisis increased from 1997 to 2008, and then declined thereafter.
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Nazer Herrera J, Karachon Essedin L, Cifuentes Ovalle L, Assar Cuevas R. [Gastroschisis: A pandemic with increasing rates? ECLAMC experience in Chile 1982-2015]. ACTA ACUST UNITED AC 2016; 87:380-386. [PMID: 27476074 DOI: 10.1016/j.rchipe.2016.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/31/2016] [Accepted: 06/13/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Several communications have reported a significant increase in the prevalence of gastroschisis at birth in the last three decades. In many Countries it is referred to as "a pandemic strongly associated to low maternal age". OBJECTIVE To verify if there has been a significant increase in the prevalence of gastroschisis at birth in Chile, and if this rate is associated with a low maternal age. PATIENTS AND METHODS The study was performed using the ECLAMC data base from 26 Chilean Hospitals. Comparison between prevalence rates and maternal age categories were made using the X2 test or Fisher exact Test. The time series was studied comparing average tendencies using the Student t test and Wilcoxon-test. RESULTS There were 721,901 newborns in the period 1982-2014, among which 107 were diagnosed with gastroschisis (1.48/10,000). Around three-quarters (75.7%) of them were born from mothers younger than 25. The mean maternal age was 21.6 years in mothers of children with gastroschisis, while the mean maternal age of all mothers from Chile was almost 28 years old. The gastroschisis prevalence at birth rate was constant at around 1/10,000 until 1994. From 1995 this rate has a significant increasing tendency of 0.1591 by year (P=.00714). This increase is about a 300% on average for the 1995-2014 period, compared with the previous one (P<.00001). CONCLUSION There has been a significant increase in the gastroschisis prevalence at birth in Chile from 1995, and this anomaly is associated with a low maternal age.
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Affiliation(s)
- Julio Nazer Herrera
- Unidad de Neonatología, Hospital Clínico Universidad de Chile, Santiago, Chile.
| | | | - Lucía Cifuentes Ovalle
- Programa de Genética Humana, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Rodrigo Assar Cuevas
- Programa de Genética Humana, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
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Dennison FA. Closed gastroschisis, vanishing midgut and extreme short bowel syndrome: Case report and review of the literature. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2016; 24:170-174. [PMID: 27867410 DOI: 10.1177/1742271x16648360] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 03/19/2016] [Indexed: 11/17/2022]
Abstract
Gastroschisis alone has excellent survival rates. Occasionally reported is closed gastroschisis, leading to vanishing small bowel and extreme short bowel syndrome. It is believed that the abdominal wall defect can contract or close in utero, which leads to strangulation of the eviscerated bowel and the rare "vanishing gut syndrome." This has a very poor prognosis with mortality as high as 70%. An 18-year-old primigravid patient's 13 week scan diagnosed a large gastroschisis affecting the fetus. After counselling, she decided to continue with the pregnancy. Between 20 and 22 weeks, the gastroschisis disappeared, and the bowel within the abdomen became markedly dilated. Spontaneous labour occurred at 33 + 3 weeks gestation. There was no abdominal wall defect seen at delivery. Imaging and an exploratory laparotomy demonstrated absence of most of the midgut. Because available options for treatment would be very aggressive and risky, palliative care was thought to be the most feasible and practical option. He died at home on day 29 after birth. Extreme short gut syndrome (less than 25 cm of remaining small bowel) is rare. There are 13 reported cases in the literature from year 2000 to 2013. Treatment is aggressive and involves a bowel lengthening procedure or small bowel transplant. All require total parenteral nutrition and liver failure, and liver transplant is a common complication. Of these cases, 12 were born alive and 7 had aggressive treatment. Only two cases were confirmed to still be alive in infancy. If gastroschisis is seen to be reducing and "disappearing" antenatally, parents should be made aware of this rare complication so that they might be prepared if a poor outcome is anticipated.
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Affiliation(s)
- F A Dennison
- Obstetrics Department, Aberdeen Maternity Hospital, Aberdeen, UK
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17
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Nicoletti D, Appel LD, Siedersberger Neto P, Guimarães GW, Zhang L. Maternal smoking during pregnancy and birth defects in children: a systematic review with meta-analysis. CAD SAUDE PUBLICA 2016; 30:2491-529. [PMID: 26247979 DOI: 10.1590/0102-311x00115813] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Accepted: 08/18/2014] [Indexed: 11/22/2022] Open
Abstract
This systematic review aimed to investigate the association between maternal smoking during pregnancy and birth defects in children. We performed an electronic search of observational studies in the databases ovid MEDLINE (1950 to April 2010), LILACS and SciELO. We included 188 studies with a total of 13,564,914 participants (192,655 cases). Significant positive associations were found between maternal smoking and birth defects in the following body systems: cardiovascular (OR: 1.11; 95%CI: 1.03-1.19), digestive (OR: 1.18; 95%CI: 1.07-1.30), musculoskeletal (OR: 1.27; 95%CI: 1.16-1.39) and face and neck (OR: 1.28; 95%CI: 1.19-1.37). The strength of association between maternal smoking and birth defects measured by the OR (95%CI) is significantly related to the amount of cigarettes smoked daily (χ2 = 12.1; df = 2; p = 0.002). In conclusion, maternal smoking during pregnancy is associated with congenital malformations in children and this association is dose-dependent.
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Affiliation(s)
- Dilvania Nicoletti
- Faculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande, Brazil
| | | | | | | | - Linjie Zhang
- Faculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande, Brazil
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18
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The long-term neurodevelopmental and psychological outcomes of gastroschisis: A cohort study. J Pediatr Surg 2016; 51:549-53. [PMID: 26490011 DOI: 10.1016/j.jpedsurg.2015.08.062] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 08/26/2015] [Accepted: 08/30/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Previous gastroschisis specific neurodevelopmental studies have focused on the first 3years of life. The aim of this study was to assess the intellectual, behavioral and neurological outcomes of older children and adolescents born with gastroschisis. STUDY DESIGN Of 99 gastroschisis survivors born in Western Australia, 1992 to 2005, and who were at least 5years old, 42 agreed to take part in this study. The study assessed: intellectual ability, with age appropriate Wechsler intelligence scales; neurological status; hearing; vision; behavioral status with the Strengths and Difficulties Questionnaire (SDQ); and parenting style with the Parenting Relationship Questionnaire (PRQ). All results were compared to normative means. RESULTS Median age at follow-up was 10years (range 5-17). No child had evidence of cerebral palsy or hearing loss; 1 child had amblyopia. Psychometric tests were completed in 39 children: mean full scale IQ was 98.2 (standard deviation [SD] 10.7); the working memory index was the only subscale to show a significant decrease from the normative mean (mean 95.5, SD 12.4, p=0.038). The mean SDQ behavioral scores were significantly lower for 3 of 5 domains and the Total Difficulties score. PRQ scores were significantly abnormal for 4 of 7 domains: Communication, Discipline, Satisfaction with School and Relational Frustration. CONCLUSIONS Overall intellectual abilities were within a normal range. The decrease in working memory index and the behavioral and parenting relationship impairments could be an effect of perinatal factors, gastroschisis management and complications or the complexity of the socio-economic environment.
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Chlamydia trachomatis IgG3 seropositivity is associated with gastroschisis. J Perinatol 2015; 35:930-4. [PMID: 26378912 PMCID: PMC4626386 DOI: 10.1038/jp.2015.115] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 08/09/2015] [Accepted: 08/10/2015] [Indexed: 12/05/2022]
Abstract
OBJECTIVE To investigate the association between Chlamydia trachomatis (CT) infection seropositivity and gastroschisis. STUDY DESIGN In this case-control study we enrolled pregnant women either prenatally diagnosed with gastroschisis (cases, n=33) or with a normal ultrasound (controls, n=66). Both groups attended the University of Utah's Maternal Fetal Medicine Diagnostic Center for their diagnostic ultrasound or because of a community obstetrician referral. Participants completed a structured interview on potential risk factors. Anti-CT immunoglobulin (IgG)1 and IgG3 were measured by a CT elementary body enzyme-linked immunosorbent assay. RESULT Median age at sexual debut was lower and reported sexual partner number higher in cases compared with controls. Risk factors for gastroschisis included having ⩾ 3 sexual partners (odds ratio (OR)=3.3, 95% CI 1.2, 9.4), change in partner from the previous pregnancy (OR=3.6, 95% CI 0.9, 13.9) and anti-CT IgG3 seropositivity (age-adjusted OR=3.9, 95% CI: 1.1, 13.2). CONCLUSION Anti-CT IgG3 seropositivity was associated with greater than a threefold risk for gastroschisis.
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20
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Vo LUT, Langlois PH. Time trends in prevalence of gastroschisis in Texas, 1999 to 2011: Subgroup analyses by maternal and infant characteristics. ACTA ACUST UNITED AC 2015; 103:928-40. [PMID: 26408207 DOI: 10.1002/bdra.23438] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 08/03/2015] [Accepted: 08/04/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND The prevalence of gastroschisis, a birth defect of the abdominal wall, has been increasing in several areas around the world. Suggested risk factors for gastroschisis include maternal age, race/ethnicity, nativity, body mass index, and socioeconomic status. METHODS Data for cases of gastroschisis and live births were taken from the Texas Birth Defects Registry and Texas vital records for deliveries between 1999 and 2011. Prevalence by subgroups over time was calculated for: infant sex, maternal age, race/ethnicity, nativity, education, parity, plurality, body mass index, and payer type. Stratified, adjusted, and interaction analyses of the trends were conducted using Poisson regression. A joinpoint trend analysis was also conducted for each subgroup. RESULTS A total of 2,549 gastroschisis cases and 4,970,979 live births were delivered in 1999 to 2011, for an overall prevalence of 5.13 cases per 10,000 live births (95% confidence interval = 4.93-5.33). On average, the prevalence increased 4.8% each year; this overall time trend was statistically significant (p-value < 0.0001). The time trend remained significant after adjusting for all variables, except payer type. The stratified analysis showed the increasing time trend was significant in many of the subgroups. However, there were no significant differences in the magnitude of the time trends between subgroups according to the interaction analysis. CONCLUSION This study confirms the increasing prevalence of gastroschisis over the time period 1999 to 2011 in Texas. The results suggest that no population subgroups are experiencing a significantly different increase in gastroschisis prevalence over time than others.
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Affiliation(s)
- Loc-Uyen T Vo
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas.,University Health Science Center Houston School of Public Health, Austin Regional Campus, Austin, Texas
| | - Peter H Langlois
- University Health Science Center Houston School of Public Health, Austin Regional Campus, Austin, Texas
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21
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Yazdy MM, Werler MM, Feldkamp ML, Shaw GM, Mosley BS, Vieira VM. Spatial analysis of gastroschisis in the National Birth Defects Prevention Study. BIRTH DEFECTS RESEARCH. PART A, CLINICAL AND MOLECULAR TERATOLOGY 2015; 103:544-53. [PMID: 25850424 PMCID: PMC4478213 DOI: 10.1002/bdra.23375] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Gastroschisis is a birth defect where loops of bowel are protruding from the abdominal wall at birth. Previous research has suggested that gastroschisis cases can occur in clusters. The objective of this study was to identify if there were areas of elevated gastroschisis risk using data from the National Birth Defects Prevention Study (NBDPS), 1997 through 2007. METHODS We obtained data on cases (n = 371) through population-based birth defects surveillance systems in Arkansas, California, and Utah; controls (n = 2359) were selected from the same geographic areas as cases. Mothers were interviewed on demographic information and exposures during pregnancy, including residential history. We used first trimester maternal addresses and generalized additive models to create a continuous map surface of odds ratios (OR) by smoothing over latitude and longitude. Permutation tests were used to assess whether location of maternal residence was important and identify locations with statistically significant ORs. RESULTS In Arkansas, adjusted ORs in the southwest corner were 2.0 and the global deviance was not statistically significant (p-value: 0.57). Adjusted ORs for California indicated areas of increased risk with ORs 1.3 (p-value: 0.34). In Utah, the adjusted ORs were elevated (OR: 2.4) in the south-eastern corner of the study area (p-value: 0.34). CONCLUSION The results of this study, while not statistically significant, suggest there were spatial variations in gastroschisis births. We cannot rule out that these variations were due to edge effects or residual confounding.
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Affiliation(s)
- Mahsa M Yazdy
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
| | - Martha M Werler
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
| | - Marcia L Feldkamp
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | | | - Bridget S Mosley
- Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Arkansas Children's Hospital Research Institute, Little Rock, Arkansas
| | - Veronica M Vieira
- Program in Public Health, University of California, Irvine, California
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22
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Rittler M, Campaña H, Ermini ML, Gili JA, Poletta FA, Pawluk MS, Giménez LG, Cosentino VR, Castilla EE, López-Camelo JS. Gastroschisis and young mothers: What makes them different from other mothers of the same age? ACTA ACUST UNITED AC 2015; 103:536-43. [DOI: 10.1002/bdra.23374] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Monica Rittler
- Latin American Collaborative Study of Congenital Malformations (ECLAMC) at Hospital Materno Infantil Ramón Sardá; Buenos Aires Argentina
| | - Hebe Campaña
- ECLAMC at Department of Research; CEMIC (Center for Medical Education and Clinical Research); Buenos Aires Argentina
- Commission of Scientific Research (CIC); La Plata Buenos Aires Argentina
| | - Monica L. Ermini
- Department of Obstetrics; Hospital Italiano; La Plata Buenos Aires Argentina
| | - Juan A. Gili
- ECLAMC at Department of Research; CEMIC (Center for Medical Education and Clinical Research); Buenos Aires Argentina
| | - Fernando A. Poletta
- ECLAMC at Department of Research; CEMIC (Center for Medical Education and Clinical Research); Buenos Aires Argentina
- National Institute of Population Medical Genetics (INAGEMP) at Laboratório de Epidemiologia de Malformações Congênitas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz; Rio de Janeiro Brazil
| | - Mariela S. Pawluk
- ECLAMC at Department of Research; CEMIC (Center for Medical Education and Clinical Research); Buenos Aires Argentina
| | - Lucas G. Giménez
- ECLAMC at Department of Research; CEMIC (Center for Medical Education and Clinical Research); Buenos Aires Argentina
| | - Viviana R. Cosentino
- ECLAMC at Department of Research; CEMIC (Center for Medical Education and Clinical Research); Buenos Aires Argentina
| | - Eduardo E. Castilla
- ECLAMC at Department of Research; CEMIC (Center for Medical Education and Clinical Research); Buenos Aires Argentina
- National Institute of Population Medical Genetics (INAGEMP) at Laboratório de Epidemiologia de Malformações Congênitas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz; Rio de Janeiro Brazil
| | - Jorge S López-Camelo
- ECLAMC at Department of Research; CEMIC (Center for Medical Education and Clinical Research); Buenos Aires Argentina
- National Institute of Population Medical Genetics (INAGEMP) at Laboratório de Epidemiologia de Malformações Congênitas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz; Rio de Janeiro Brazil
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Surgical Treatment Results In Gastroschisis Based On Preterm Delivery Within The 34th Week Of Gestation By Caesarean Section. POLISH JOURNAL OF SURGERY 2015; 87:346-56. [DOI: 10.1515/pjs-2015-0068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Indexed: 11/15/2022]
Abstract
Abstractwas to assess the value of the today’s appropriate approach, preterm delivery in the 34th week of gestation by Caesarean section and subsequent surgical intervention at the perinatal center, in daily practice of pediatric surgery with regard to early postoperative and mid-term outcome.Over the time period of 9 years, all consecutive cases diagnosed with gastroschisis at the perinatal center, University Hospital of Magdeburg, were born by Caesarean section within the 34th week of gestation followed by surgical intervention. The registered data were compared with those published by other groups.Overall, there were 19 cases through the investigation period from 01/01/2006 to 12/31/2014. The mean duration of gestation was 237.9 days. The mean birth weight was 2,276 g. In all individuals, a primary closure with no artificial material was achieved. The duration of postoperative artificial respiration was 2.3 days. Oral uptake could be initiated on the 10The data indicate that in case of gastroschisis, primary closure can be more frequently achieved by section within the 34
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Kim K, Wang Y, Kirby RS, Druschel CM. Prevalence and trends of selected congenital malformations in New York state, 1983 to 2007. ACTA ACUST UNITED AC 2013; 97:619-27. [DOI: 10.1002/bdra.23160] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 05/17/2013] [Accepted: 05/24/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Keewan Kim
- School of Public Health, University at Albany, State University of New York, One University Place; Rensselaer; New York
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25
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Khodr ZG, Lupo PJ, Canfield MA, Chan W, Cai Y, Mitchell LE. Hispanic ethnicity and acculturation, maternal age and the risk of gastroschisis in the national birth defects prevention study. ACTA ACUST UNITED AC 2013; 97:538-45. [DOI: 10.1002/bdra.23140] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 03/20/2013] [Accepted: 03/22/2013] [Indexed: 11/05/2022]
Affiliation(s)
- Zeina G. Khodr
- Division of Epidemiology; Human Genetics and Environmental Sciences, University of Texas School of Public Health; Houston; Texas
| | | | - Mark A. Canfield
- Birth Defects Epidemiology and Surveillance Branch; Texas Department of State Health Services; Austin; Texas
| | - Wenyaw Chan
- Division of Biostatistics; University of Texas school of Public Health; Houston; Texas
| | - Yi Cai
- Division of Biostatistics; University of Texas school of Public Health; Houston; Texas
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Mohamed MA, Aly H. Birth region, race and sex may affect the prevalence of congenital diaphragmatic hernia, abdominal wall and neural tube defects among US newborns. J Perinatol 2012; 32:861-8. [PMID: 22282130 DOI: 10.1038/jp.2011.184] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Birth defects are number one cause of death among infants below 1 year of age. The objective is to examine the interaction of sex, race/ethnicity and place of birth on the prevalence of major congenital birth anomalies. STUDY DESIGN We analyzed the data sets produced by the Healthcare Cost and Utilization Project (HCUP) for the years 1997-2004. We identified the malformations: congenital diaphragmatic hernia (CDH), abdominal wall defects (AWD) and neural tube defects (NTD) using their respective International Classification of Disease 9 diagnostic codes. Newborns were classified according to their birth region into four groups; Northeast, South, Midwest and West. We calculated prevalence of each disease for the overall sample then for every sex, race and birth region. Using stratified analysis and χ(2) test, we calculated the odds ratio (OR) risk for each disease comparing females with males, different races/ethnicity to Caucasians and different US regions to Northeast. RESULT There were 1291 newborns with CDH representing 0.031% of the sample. (AWD: 2184 (0.052%) and NTD: 979 (0.024%)). West region had the highest prevalence of CDH (OR=1.62 (confidence intervals (CI): 1.4-1.9, P<0.001)). Female-to-male risk disparities were most observed among Caucasians in the South (OR=1.44 (CI: 1.1-1.8, P=0.003)). African Americans had the least prevalence of CDH but only in the South (OR=0.67 (CI: 0.5-0.8, P=0.001)). Native Americans had higher risk for AWD in the Midwest and West regions compared with Caucasians. CONCLUSION This study links the birth region as a detrimental factor like sex and race in the prevalence of CDH, AWD and NTD. These findings implicate a possible role for environmental factors in the pathogenesis of these diseases.
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Affiliation(s)
- M A Mohamed
- The George Washington University Medical Center, Washington, DC, USA.
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Paranjothy S, Broughton H, Evans A, Huddart S, Drayton M, Jefferson R, Rankin J, Draper E, Cameron A, Palmer SR. The role of maternal nutrition in the aetiology of gastroschisis: an incident case-control study. Int J Epidemiol 2012; 41:1141-52. [PMID: 22798661 DOI: 10.1093/ije/dys092] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Gastroschisis, a congenital anomaly involving a defect in the fetal abdominal wall, has increased in prevalence in many countries, but the aetiology is uncertain. We tested the hypothesis that high maternal alcohol consumption and poor diet in the first trimester are risk factors in a case-control study in the UK (1 July 2007 to 28 February 2010). METHODS Gastroschisis cases and three controls per case (matched for maternal age) were identified at 18- to 20-week routine anomaly screening ultrasound scan (USS). Interviews were carried out during the antenatal period (median 24 weeks' gestation) using a piloted questionnaire. Conditional logistic regression was used to describe the associations between exposure variables and gastroschisis, adjusted for known confounding variables. RESULTS The response rate was 73% for cases (n = 91) and 70% for controls (n = 217). High consumption of fruits and vegetables during the first trimester (aOR 0.2; 95% CI 0.04-0.6), taking folic acid for at least 6 weeks during the first trimester (aOR 0.3; 95% CI 0.1-0.7) and increasing body fat percentage of total maternal body weight (aOR 0.9; 95% CI 0.8-0.9 per 1% increase) were independently associated with reduced risk. Cigarette smoking (aOR 2.7; 95% CI 1.1-6.8) was an independent risk factor. CONCLUSION We report for the first time that higher intake of fruits and vegetables during the first trimester, longer duration of folic acid supplementation and higher body fat percentage are associated with reduced risk of fetal gastroschisis, independent of cigarette smoking. The increased risk of cigarette smoking is greatest in older women and in high socio-economic groups.
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Affiliation(s)
- Shantini Paranjothy
- Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK.
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Langlois PH, Marengo LK, Canfield MA. Time trends in the prevalence of birth defects in Texas 1999-2007: Real or artifactual? ACTA ACUST UNITED AC 2011; 91:902-17. [DOI: 10.1002/bdra.22847] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 06/09/2011] [Accepted: 06/15/2011] [Indexed: 11/06/2022]
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Hackshaw A, Rodeck C, Boniface S. Maternal smoking in pregnancy and birth defects: a systematic review based on 173 687 malformed cases and 11.7 million controls. Hum Reprod Update 2011; 17:589-604. [PMID: 21747128 PMCID: PMC3156888 DOI: 10.1093/humupd/dmr022] [Citation(s) in RCA: 419] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND There is uncertainty over whether maternal smoking is associated with birth defects. We conducted the first ever comprehensive systematic review to establish which specific malformations are associated with smoking. METHODS Observational studies published 1959–2010 were identified (Medline), and included if they reported the odds ratio (OR) for having a non-chromosomal birth defect among women who smoked during pregnancy compared with non-smokers. ORs adjusted for potential confounders were extracted (e.g. maternal age and alcohol), otherwise unadjusted estimates were used. One hundred and seventy-two articles were used in the meta-analyses: a total of 173 687 malformed cases and 11 674 332 unaffected controls. RESULTS Significant positive associations with maternal smoking were found for: cardiovascular/heart defects [OR 1.09, 95% confidence interval (CI) 1.02–1.17]; musculoskeletal defects (OR 1.16, 95% CI 1.05–1.27); limb reduction defects (OR 1.26, 95% CI 1.15–1.39); missing/extra digits (OR 1.18, 95% CI 0.99–1.41); clubfoot (OR 1.28, 95% CI 1.10–1.47); craniosynostosis (OR 1.33, 95% CI 1.03–1.73); facial defects (OR 1.19, 95% CI 1.06–1.35); eye defects (OR 1.25, 95% CI 1.11–1.40); orofacial clefts (OR 1.28, 95% CI 1.20–1.36); gastrointestinal defects (OR 1.27, 95% CI 1.18–1.36); gastroschisis (OR 1.50, 95% CI 1.28–1.76); anal atresia (OR 1.20, 95% CI 1.06–1.36); hernia (OR 1.40, 95% CI 1.23–1.59); and undescended testes (OR 1.13, 95% CI 1.02–1.25). There was a reduced risk for hypospadias (OR 0.90, 95% CI 0.85–0.95) and skin defects (OR 0.82, 0.75–0.89). For all defects combined the OR was 1.01 (0.96–1.07), due to including defects with a reduced risk and those with no association (including chromosomal defects). CONCLUSIONS Birth defects that are positively associated with maternal smoking should now be included in public health educational materials to encourage more women to quit before or during pregnancy.
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Affiliation(s)
- Allan Hackshaw
- CRUK & UCL Trials Centre, University College London, , 90 Tottenham Court Road, London, UK.
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Case AP, Colpitts LR, Langlois PH, Scheuerle AE. Prenatal diagnosis and cesarean section in a large, population-based birth defects registry. J Matern Fetal Neonatal Med 2011; 25:395-402. [DOI: 10.3109/14767058.2011.580801] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Xu L, Li X, Dai L, Yuan X, Liang J, Zhou G, Li Q, He C, Miao L, Wang Y, Zhu J. Assessing the trend of gastroschisis prevalence in China from 1996 to 2007 using two analytical methods. ACTA ACUST UNITED AC 2011; 91:177-84. [PMID: 21308975 DOI: 10.1002/bdra.20753] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Revised: 10/01/2010] [Accepted: 10/05/2010] [Indexed: 01/02/2023]
Abstract
BACKGROUND In recent years, the prevalence of gastroschisis has increased remarkably in some areas and remained unchanged in other areas; however, in general, there is a recent increasing trend compared to the 1970s and 1980s. In this study, we explored the time trend of gastroschisis prevalence in China during 1996 to 2007. METHODS Data were retrieved from the hospital-based national monitoring database maintained by the Chinese Birth Defects Monitoring Network (CBDMN). The monitored subjects were infants born on the 28th gestational week or later, including live births and stillbirths. The maximal time for the diagnosis of a congenital malformation was the seventh day after birth. The secular trends on the overall prevalence and the different feature-specific prevalence of gastroschisis in China were analyzed using the linear chi-square test and the Poisson regression model. RESULTS The overall prevalence of gastroschisis in China was 2.54 per 10,000 births during 1996 to 2007. Except for the prevalence of gastroschisis that significantly increased among infants whose mothers were 20 to 24 years old (p=0.0498 for the linear chi-square test, p=0.0032 for the Poisson regression model analysis) and significantly decreased among infants whose mothers were 30 to 34 years old (p=0.0177 for the Poisson regression model analysis), no significant changes were found in the overall and remaining feature-specific prevalences. CONCLUSION The overall prevalence of gastroschisis in China did not change remarkably during 1996 to 2007; but the prevalence of gastroschisis significantly increased among infants whose mothers were 20 to 24 years old and decreased among infants whose mothers were 30 to 34 years old.
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Affiliation(s)
- Lili Xu
- National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
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Root ED, Meyer RE, Emch M. Socioeconomic context and gastroschisis: Exploring associations at various geographic scales. Soc Sci Med 2011; 72:625-33. [DOI: 10.1016/j.socscimed.2010.11.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Revised: 08/16/2010] [Accepted: 11/13/2010] [Indexed: 11/17/2022]
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Chabra S, Gleason CA, Seidel K, Williams MA. Rising prevalence of gastroschisis in Washington State. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2011; 74:336-345. [PMID: 21240733 DOI: 10.1080/15287394.2011.534424] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The aim of this study was to assess gastroschisis prevalence in Washington (WA) State in relation to putative risk factors. Gastroschisis prevalence was calculated from the WA State birth cohort during 1987-2006 using an administrative database with birth certificate data linked with hospital discharge records and the ICD-9 procedure code 54.71, which specifies gastroschisis repair. Poisson regression analysis was used to evaluate time trends while adjusting for risk factors. Birth year was included as a linear term. Maternal age, smoking, race, residence in urban versus rural area, geographic region (eastern versus western Washington), paternal age, and infant gender were included as categorical factors. Prevalence ratios were adjusted for birth year and all of the preceding factors. Two hundred and eighty-two infants with gastroschisis were identified. In the adjusted analysis, the prevalence ratio for gastroschisis was 1.1 per year (95% CI 1.08-1.13), indicating an average 10% increase per birth year. Teen mothers were at a higher risk compared to mothers≥25 yr old (adjusted rate ratio [aRR] 8.02; 95% CI 5.30-12.13), as were teen fathers (aRR 2.35; 95% CI 1.48-3.74) compared to fathers≥25 years old. Maternal smoking was associated with a higher risk compared to those who were nonsmokers (aRR 1.58; 95% CI 1.19-2.09). Black mothers had a lower risk compared with white mothers. There was no association with geographic classification of mother's residence. Gastroschisis prevalence has increased in WA, particularly in teen mothers and in smokers. This is not explained by a rise in teenage pregnancies or maternal smoking. Further investigation of factors specific to teenage lifestyle is warranted.
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Affiliation(s)
- Shilpi Chabra
- Department of Pediatrics, University of Washington, Seattle, Washington 98195, USA.
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Frolov P, Alali J, Klein MD. Clinical risk factors for gastroschisis and omphalocele in humans: a review of the literature. Pediatr Surg Int 2010; 26:1135-48. [PMID: 20809116 DOI: 10.1007/s00383-010-2701-7] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2010] [Indexed: 10/19/2022]
Abstract
Gastroschisis and omphalocele are usually considered together since they are both congenital abdominal wall defects, and yet their anatomy, embryogenesis, and clinical presentation and problems are quite different. In addition, it appears that the risk factors for their occurrence differ. Etiologic factors contributing to the development of these defects are unknown. To investigate this we have reviewed reports of risk factors for each anomaly and report them here. We conducted a literature search using PubMed (http://www.ncbi.nlm.nih.gov/pubmed/) for risk factors implicated in the development of gastroschisis and omphalocele. The data reviewed here from clinical studies in the literature, closely parallels the data in animal studies which we reported earlier. There is little evidence for a genetic cause in the development of gastroschisis and much evidence supporting the possibility that environmental teratogens are important contributors to the development of this defect. On the other hand, in the case of omphalocele, there was little evidence for environmental factors and substantial data indicating that genetic or familial factors may play an important role.
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Affiliation(s)
- Polina Frolov
- Department of Surgery, Children's Hospital of Michigan, Wayne State University, 3901 Beaubien Street, Detroit, MI 48201-2119, USA
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Burns KH, Casey PH, Lyle RE, Bird TM, Fussell JJ, Robbins JM. Increasing prevalence of medically complex children in US hospitals. Pediatrics 2010; 126:638-46. [PMID: 20855383 DOI: 10.1542/peds.2009-1658] [Citation(s) in RCA: 296] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE In this study we used national data to determine changes in the prevalence of hospital admissions for medically complex children over a 15-year period. PATIENTS AND METHODS Data from the Nationwide Inpatient Sample, a component of the Healthcare Cost and Utilization Project, was analyzed in 3-year increments from 1991 to 2005 to determine national trends in rates of hospitalization of children aged 8 days to 4 years with chronic conditions. Discharge diagnoses from the Nationwide Inpatient Sample were grouped into 9 categories of complex chronic conditions (CCCs). Hospitalization rates for each of the 9 CCC categories were studied both individually and in combination. Trends of children hospitalized with 2 specific disorders, cerebral palsy (CP) and bronchopulmonary dysplasia, with additional diagnoses in more than 1 CCC category were also examined. RESULTS Hospitalization rates of children with diagnoses in more than 1 CCC category increased from 83.7 per 100,000 (1991-1993) to 166 per 100 000 (2003-2005) (P[r]<.001). The hospitalization rate of children with CP plus more than 1 CCC diagnosis increased from 7.1 to 10.4 per 100 000 (P=.002), whereas the hospitalization rates of children with bronchopulmonary dysplasia plus more than 1 CCC diagnosis increased from 9.8 to 23.9 per 100,000 (P<.001). CONCLUSIONS Consistent increases in hospitalization rates were noted among children with diagnoses in multiple CCC categories, whereas hospitalization rates of children with CP alone have remained stable. The relative medical complexity of hospitalized pediatric patients has increased over the past 15 years.
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Affiliation(s)
- Katherine H Burns
- Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, 1 Children's Way, Slot 512-41, Little Rock, AR 72202, USA.
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Parker SE, Mai CT, Canfield MA, Rickard R, Wang Y, Meyer RE, Anderson P, Mason CA, Collins JS, Kirby RS, Correa A. Updated national birth prevalence estimates for selected birth defects in the United States, 2004-2006. ACTA ACUST UNITED AC 2010; 88:1008-16. [DOI: 10.1002/bdra.20735] [Citation(s) in RCA: 1320] [Impact Index Per Article: 94.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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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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Abstract
Ventral body wall defects include ectopia cordis, bladder exstrophy, and the abdominal wall malformations gastroschisis and omphalocele. The etiology of ectopia cordis, gastroschisis, and bladder exstrophy is not known, but they may be linked to abnormalities in the lateral body wall folds responsible for closing the thoracic, abdominal, and pelvic portions of the ventral body wall. These folds form in the fourth week (postfertilization) of development as a combination of the parietal layer of lateral plate mesoderm and overlying ectoderm and must move ventrally to meet in the midline. There are differential rates of cell proliferation in the folds and asymmetries in their movement that may be involved in teratogenic effects of toxic factors. Also, the fusion process between the folds is complex, involving cell-to-cell adhesion, cell migration, and cell reorganization and all of these phenomena may be targets for disruption, leading to malformations. In this regard, closure of the ventral body wall is likened to neural tube closure and involves similar processes. It also encompasses a similar time frame during development, such that most neural tube and ventral body wall defects have their origins during the fourth week of development. Omphalocele is a separate entity whose etiology is known. This defect is attributed to a failure of gut loops to return to the body cavity after their normal physiological herniation into the umbilical cord from the 6th to 10th week of development. Thus, the origin of this defect is completely different from that of the ventral body wall malformations.
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Affiliation(s)
- Thomas W Sadler
- Department of Pediatrics, Division of Medical Genetics, University of Utah Health Sciences Center, Salt Lake City, Utah, USA.
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Benjamin BG, Ethen MK, Van Hook CL, Myers CA, Canfield MA. Gastroschisis prevalence in Texas 1999-2003. BIRTH DEFECTS RESEARCH. PART A, CLINICAL AND MOLECULAR TERATOLOGY 2010; 88:178-85. [PMID: 19950387 DOI: 10.1002/bdra.20642] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The worldwide prevalence of gastroschisis is increasing. Maternal age, race/ethnicity, and place of residence have been associated with increased risk. METHODS We obtained descriptive characteristics of mothers of infants with gastroschisis and mothers of all live births from the Texas Birth Defects Registry and Texas vital records for 1999-2003. We calculated prevalence, crude prevalence ratios, and prevalence ratios adjusted for maternal age, parity, education, race/ethnicity, and geographic entity (Mexican border proximity, urban/rural residence, health service region, and county). RESULTS We observed 764 cases of gastroschisis among 1,827,317 live births, for a prevalence of 4.18 per 10,000 births (95% confidence interval 3.88-4.48). Prevalence increased during 1999-2003 (p for trend <0.02). Infants of young and nulliparous mothers were at greatest risk in crude analyses. Other characteristics associated with increased risk were 12 or fewer years of education, border residence, and Hispanic ethnicity. Black mothers were at lower risk. When adjusted for maternal age, race/ethnicity, education, parity, and residence, we found that border residence, educational level, and Hispanic race/ethnicity were no longer significant, but young mothers and nulliparous mothers remained at higher risk, and blacks at reduced risk. Differences in prevalence observed between regions and counties largely disappeared when adjusted for maternal factors. No significant difference between urban and rural residence was found. CONCLUSION The prevalence of gastroschisis increased in Texas during 1999-2003. Black mothers were at lower risk, and Hispanic mothers were at no greater risk than whites. No differences were found between urban/rural or border/nonborder residents.
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Affiliation(s)
- Bonna G Benjamin
- Department of Pediatrics, Texas Tech University Health Sciences Center, Amarillo, Texas 79106, USA.
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Lao OB, Larison C, Garrison MM, Waldhausen JH, Goldin AB. Outcomes in neonates with gastroschisis in U.S. children's hospitals. Am J Perinatol 2010; 27:97-101. [PMID: 19866404 PMCID: PMC2854024 DOI: 10.1055/s-0029-1241729] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Our objectives are to report patient characteristics, comorbidities, and outcomes for gastroschisis patients and analyze factors associated with mortality and sepsis. Using Pediatric Health Information System data, we examined neonates with both an International Classification of Diseases, 9th Revision diagnosis (756.79) and procedure (54.71) code for gastroschisis (2003 to 2008). We examined descriptive characteristics and conducted multivariate regression models examining risk factors for mortality, during the birth hospitalization, and sepsis. Analysis of 2490 neonates with gastroschisis found 90 deaths (3.6%) and sepsis in 766 (31%). Critical comorbidities and procedures are cardiovascular defects (15%), pulmonary conditions (5%), intestinal atresia (11%), intestinal resection (12.5%), and ostomy formation (8.3%). Factors associated with mortality were large bowel resection (odds ratio [OR] 8.26, 95% confidence interval [CI] 1.17 to 58.17), congenital circulatory (OR 5.62, 95% CI 2.11 to 14.91), and pulmonary (OR 8.22, 95% CI 2.75 to 24.58) disease, and sepsis (OR 3.87, 95% CI 1.51 to 9.91). Factors associated with sepsis include intestinal ostomy (OR 2.94, 95% CI 1.71 to 5.05), respiratory failure (OR 2.48, 95% CI 1.85 to 3.34), congenital circulatory anomalies (OR 1.58, 95% CI 1.10 to 2.28), and necrotizing enterocolitis (OR 4.38, 95% CI 2.51 to 7.67). Further investigation into modifiable factors such as small bowel ostomy and prevention of sepsis and necrotizing enterocolitis is warranted to guide surgical decision making and postoperative management.
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Affiliation(s)
- Oliver B. Lao
- Department of Surgery, Seattle Children’s Hospital, Seattle, Washington
| | - Cindy Larison
- Seattle Children’s Hospital Research Institute, Seattle Children’s Hospital, Seattle, Washington
| | - Michelle M. Garrison
- Seattle Children’s Hospital Research Institute, Seattle Children’s Hospital, Seattle, Washington
| | | | - Adam B. Goldin
- General & Thoracic Surgery, Seattle Children’s Hospital, Seattle, Washington
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Salemi JL, Pierre M, Tanner JP, Kornosky JL, Hauser KW, Kirby RS, Carver JD. Maternal nativity as a risk factor for gastroschisis: A population-based study. ACTA ACUST UNITED AC 2009; 85:890-6. [DOI: 10.1002/bdra.20612] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Maramreddy H, Fisher J, Slim M, Lagamma EF, Parvez B. Delivery of gastroschisis patients before 37 weeks of gestation is associated with increased morbidities. J Pediatr Surg 2009; 44:1360-6. [PMID: 19573662 DOI: 10.1016/j.jpedsurg.2009.02.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Revised: 02/01/2009] [Accepted: 02/02/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Despite advances in the care of neonates with gastroschisis, patients present with significant morbidities. Preterm delivery of neonates with gastroschisis is often advocated to avoid the intestinal damage that may be sustained with prolonged exposure to amniotic fluid. However, preterm delivery may impose additional morbidities to this disease process. METHODS We conducted a retrospective review of patients with gastroschisis born from 1989 to 2007. Demographic and clinical data were collected. Preterm healthy neonates, with gestational age from 26 to 36 weeks, were used as controls. RESULTS Preterm infants with gastroschisis had a 14 times higher risk for any of the recorded morbidities. As compared to term neonates with gastroschisis, preterm neonates with gastroschisis had a higher rate of sepsis, longer duration to reach full enteral feedings, and longer length of stay. Although the preterm infants with gastroschisis were less likely to be small for gestational age at birth, they were as likely as the term infants with gastroschisis to have failure to thrive at discharge and had a greater drop in weight percentile during hospitalization. CONCLUSIONS Preterm delivery should be avoided because there is no clear benefit to the gut in avoiding derivative injuries. Meticulous attention should be given to the nutritional needs of patients with gastroschisis.
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Affiliation(s)
- Hima Maramreddy
- Department of Pediatrics, Division of Neonatology, Brenner Children's Hospital at Wake Forest University Baptist Medical Center, Winston-Salem, NC 27157, USA.
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Clark RH, Walker MW, Gauderer MWL. Prevalence of gastroschisis and associated hospital time continue to rise in neonates who are admitted for intensive care. J Pediatr Surg 2009; 44:1108-12. [PMID: 19524725 DOI: 10.1016/j.jpedsurg.2009.02.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2009] [Accepted: 02/17/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study was to evaluate recent trends in the prevalence of gastroschisis. METHODS The study used a retrospective review of a deidentified neonatal intensive care patient data set. To control for ascertainment bias, the prevalence of omphalocele was calculated to provide an internal comparison to another anomaly requiring surgical intervention. RESULTS During the study period (1997-2007), there were 473,366 discharges from the neonatal intensive care unit in the data set. There were 2057 (5.3/1000 discharges) neonates who had a gastroschisis and 853 (1.8/1000 discharges) who had an omphalocele. Between 1997 and 2004, the reported rate of gastroschisis increased from 2.9 to 6.1/1000 discharges, a relative increase of 210% (P < .001). Since 2004, the values have remained relatively stable at between 5.5 and 6.2/1000 discharges. Between 1997 and 2007, the hospital days for patients with gastroschisis/total hospital days increased from 0.6% to 1.3%, a relative increase of 220% (P < .001). In contrast, the reported rate of neonates with and the number of hospital days attributed to neonates with omphalocele has not changed significantly. CONCLUSION The prevalence and the number of hospital days needed to care for neonates with gastroschisis have continued to increase since 2001.
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Affiliation(s)
- Reese H Clark
- The Pediatrix-Obstetrix Center for Research and Education, Sunrise, FL 33323-2825, USA.
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Evidence of localized clustering of gastroschisis births in North Carolina, 1999–2004. Soc Sci Med 2009; 68:1361-7. [DOI: 10.1016/j.socscimed.2009.01.034] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Indexed: 11/22/2022]
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Feldkamp ML, Alder SC, Carey JC. A case control population-based study investigating smoking as a risk factor for gastroschisis in Utah, 1997-2005. ACTA ACUST UNITED AC 2009; 82:768-75. [PMID: 18985693 DOI: 10.1002/bdra.20519] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Smoking in pregnancy increases the risk for many different adverse pregnancy outcomes, including birth defects. Gastroschisis, a birth defect most commonly associated with young maternal age has been associated with smoking, but findings are inconsistent. We assessed whether smoking increases the risk for gastroschisis using population-based data from Utah. METHODS Gastroschisis cases (n = 189) were identified from the Utah Birth Defect Network and all live births without birth defects (n = 423,499) occurring in Utah from January 1, 1997 through December 31, 2005 served as controls. Exposure data were derived from birth certificates and fetal death certificates and, for terminated pregnancies, the Utah Birth Defect Network. RESULTS Women who smoked during the first trimester of pregnancy had an increased risk of gastroschisis (OR 1.6; 95% CI: 1.1, 2.3) after adjusting for maternal age and preconception BMI. Discordance between birth certificate data and data from structured interviews increased exposure prevalence from 16.9 to 22.2% for case mothers and 7.4 to 13.2% for control mothers. Accounting for this misclassification, the crude OR decreased by 24%, 1.9 (1.3, 2.7). CONCLUSIONS Though first trimester cigarette smoking was reported on birth certificates by more mothers of gastroschisis cases than controls, adjustment for confounders (maternal age and preconception BMI) and smoking misclassification suggests the association is weak. Despite a decrease in smoking prevalence among all women of childbearing years in Utah between 1997 and 2005, the prevalence of gastroschisis has not followed a similar trend.
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Affiliation(s)
- Marcia L Feldkamp
- Department of Medical Genetics, University of Utah Health Sciences Center, Salt Lake City, Utah 84132, USA.
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Chabra S. Is the prevalence of gastroschisis increasing in selected US states? J Pediatr Surg 2009; 44:476-7. [PMID: 19231563 DOI: 10.1016/j.jpedsurg.2008.10.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Accepted: 10/22/2008] [Indexed: 12/01/2022]
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Fillingham A, Rankin J. Prevalence, prenatal diagnosis and survival of gastroschisis. Prenat Diagn 2008; 28:1232-7. [DOI: 10.1002/pd.2153] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Routine use of a SILASTIC spring-loaded silo for infants with gastroschisis: a multicenter randomized controlled trial. J Pediatr Surg 2008; 43:1807-12. [PMID: 18926212 DOI: 10.1016/j.jpedsurg.2008.04.003] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2007] [Revised: 04/02/2008] [Accepted: 04/02/2008] [Indexed: 11/22/2022]
Abstract
BACKGROUND Retrospective studies have suggested that routine use of a preformed silo for infants with gastroschisis may be associated with improved outcomes. We performed a prospective multicenter randomized controlled trial to test this hypothesis. METHODS Eligible infants were randomized to (1) routine bedside placement of a preformed Silastic spring-loaded silo, with gradual reduction and elective abdominal wall closure, or (2) primary closure. RESULTS There were 27 infants in each group. There was no significant difference between groups with respect to age, weight, sex, Apgar scores, prenatal diagnosis, or mode of delivery. The total number of days on the ventilator was lower in the spring-loaded silo group, although it did not reach statistical significance (3.2 vs 5.3, P = .07). There was no significant difference between groups with respect to length of time on total parenteral nutrition, length of stay, or incidence of sepsis and necrotizing enterocolitis. CONCLUSION Routine use of a preformed silo was associated with similar outcomes to primary closure for infants with gastroschisis but with a strong trend toward fewer days on the ventilator. Use of a preformed silo has the advantage of permitting definitive abdominal wall closure in a more elective setting.
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Guerra FAR, Llerena JC, Gama SGND, Cunha CBD, Theme Filha MM. [Birth defects in Rio de Janeiro, Brazil: an evaluation through birth certificates (2000-2004)]. CAD SAUDE PUBLICA 2008; 24:140-9. [PMID: 18209842 DOI: 10.1590/s0102-311x2008000100014] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2006] [Accepted: 07/13/2007] [Indexed: 11/21/2022] Open
Abstract
To evaluate the occurrence of birth defects in the city of Rio de Janeiro, Brazil, using the Live Birth Information System (SINASC), we performed a cross-sectional study on all live newborns with birth defects from January 1, 2000, to December 31, 2004. The variables referred to birth defects (presence and system affected), type of health service, mothers, gestations, live births, and deliveries. Prevalence of birth defects was 83/10,000 live births. The most frequent birth defects involved the musculoskeletal system, central nervous system, cleft lip and palate, and chromosomal anomalies. The majority of cases were born in public (municipal) and private maternity hospitals, with the highest prevalence in the Fernandes Figueira Insitute, Oswaldo Cruz Foundation. Older women and those with less schooling had more live born infants with birth defects. The proportion of reports with missing information was high, reaching 21% in some institutions. Wider dissemination of SINASC data on birth defects should be encouraged. Reliability studies are recommended for better use of these reports.
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Rasmussen SA, Frías JL. Non-genetic risk factors for gastroschisis. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2008; 148C:199-212. [DOI: 10.1002/ajmg.c.30175] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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