1
|
Wu D, Van Oerle R, Martinez A, Piper HG. Risk Factors for Infection in Neonates With Intestinal Failure. J Pediatr Surg 2024; 59:854-857. [PMID: 38365474 DOI: 10.1016/j.jpedsurg.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 01/18/2024] [Indexed: 02/18/2024]
Abstract
PURPOSE Neonates with intestinal failure (IF) are at risk for infection due to central venous access, and intestinal surgery. Infection can cause systemic inflammation and sepsis, potentially affecting growth. The purpose of this study was to identify risk factors for, and the potential impact of infection to help with preventative strategies. METHODS A retrospective review of infants with IF, at a single centre from 2018 to 2022 was conducted. Clinical characteristics, intestinal pathology, nutritional intake, and growth were compared among infants with bloodstream infection (BSI), other infection (OI) (urinary, respiratory, or wound), or no infection (NI) within 2 months of diagnosis. Mann-Whitney and Kruskal-Wallis tests were used for comparisons with p-values <0.05 considered significant. RESULTS Eighty-six infants were included, with gastroschisis (41%) and necrotizing enterocolitis (26%) the most common diagnoses. Fifty-nine % of infants developed infection (22% BSI and 37% OI). Those with BSI or OI had a lower gestational age and birthweight, and were more likely to have a stoma. All infants with complex gastroschisis developed infection compared to 38% of infants with simple gastroschisis. Median daily weight gain was suboptimal across all groups and did not differ over 6 weeks following infection. CONCLUSION Most infants with IF develop infection shortly after diagnosis. Risk factors include prematurity, complex gastroschisis, and the presence of a stoma. Growth was suboptimal but did not differ among infants with or without infection. TYPE OF STUDY Retrospective Review. LEVEL OF EVIDENCE Level III Retrospective Comparative Study.
Collapse
Affiliation(s)
- Dana Wu
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Rhonda Van Oerle
- Division of Neonatology, University of British Columbia/BC Women's Hospital and Health Center, Vancouver, BC, Canada
| | - Andrea Martinez
- Division of Gastroenterology, University of British Columbia/BC Children's Hospital, Vancouver, BC, Canada
| | - Hannah G Piper
- Division of Pediatric Surgery, University of British Columbia/BC Children's Hospital, Vancouver, BC, Canada.
| |
Collapse
|
2
|
Tauriainen A, Harju S, Raitio A, Hyvärinen A, Tauriainen T, Helenius I, Vanamo K, Saari A, Sankilampi U. Longitudinal growth of children born with gastroschisis or omphalocele. Eur J Pediatr 2023; 182:5615-5623. [PMID: 37819418 PMCID: PMC10746581 DOI: 10.1007/s00431-023-05217-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/10/2023] [Accepted: 09/15/2023] [Indexed: 10/13/2023]
Abstract
Normal childhood growth is an indicator of good health, but data addressing the growth of children born with abdominal wall defects (AWDs) are limited. The detailed growth phenotypes of children born with gastroschisis or omphalocele are described and compared to peers without AWDs from birth to adolescence. Data from 183 gastroschisis and 144 omphalocele patients born between 1993 and 2017 were gathered from Finnish nationwide registers and electronic health records. Weight (n = 3033), length/height (n = 2034), weight-for-length (0-24 months, n = 909), and body mass index measures (2-15 years, n = 423) were converted into sex- and age-specific Z-scores. Linear mixed models were used for comparisons. Intrauterine growth failure was common in infants with gastroschisis. Birth weight Z-scores in girls and boys were - 1.2 (0.2) and - 1.3 (0.2) and length Z-scores - 0.7 (0.2) and - 1.0 (0.2), respectively (p < 0.001 for all comparisons to infants without AWDs). During early infancy, growth failure increased in infants with gastroschisis, and thereafter, catch-up growth was prominent and faster in girls than in boys. Gastroschisis children gained weight and reached their peers' weights permanently at 5 to 10 years. By 15 years or older, 30% of gastroschisis patients were overweight. Infants with omphalocele were born with a normal birth size but grew shorter and weighing less than the reference population until the teen-age years. CONCLUSION Children with gastroschisis and omphalocele have distinct growth patterns from fetal life onwards. These growth trajectories may also provide some opportunities to modulate adult health. WHAT IS KNOWN • Intrauterine and postnatal growth failure can be seen frequently in gastroschisis and they often show significant catch-up growth later in infancy. It is assumed that part of the children with gastroschisis will become overweight during later childhood. WHAT IS NEW • The longitudinal growth of girls and boys with gastroschisis or omphalocele is described separately until the teenage years. The risk of gaining excessive weight in puberty was confirmed in girls with gastroschisis.
Collapse
Affiliation(s)
- Asta Tauriainen
- Department of Pediatric Surgery, University of Eastern Finland and Kuopio University Hospital, Puijonlaaksontie 2, 70210, Kuopio, Finland.
- Department of Pediatric Surgery, University of Turku and Turku University Hospital, Turku, Finland.
| | - Samuli Harju
- Department of Pediatrics, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Arimatias Raitio
- Department of Pediatric Surgery, University of Turku and Turku University Hospital, Turku, Finland
| | - Anna Hyvärinen
- Faculty of Medicine and Health Technology, University of Tampere and Tampere University Hospital, Tampere, Finland
- Department of Surgery, Mehiläinen Länsi-Pohja Oy, Kemi, Finland
- Department of Pediatric Surgery, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Tuomas Tauriainen
- Department of Cardiac Surgery, University of Turku and Turku University Hospital, Turku, Finland
| | - Ilkka Helenius
- Department of Orthopedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kari Vanamo
- Department of Pediatric Surgery, University of Eastern Finland and Kuopio University Hospital, Puijonlaaksontie 2, 70210, Kuopio, Finland
| | - Antti Saari
- Department of Pediatrics, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Ulla Sankilampi
- Department of Pediatrics, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| |
Collapse
|
3
|
Bigio JZD, Tannuri ACA, Falcão MC, Matsushita FY, de Carvalho WB. Factors associated with cholestasis in newborns with gastroschisis. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2023; 42:e2022152. [PMID: 37436246 DOI: 10.1590/1984-0462/2024/42/2022152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 02/14/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVE To describe the incidence and to analyze risk factors associated with cholestasis in neonates with gastroschisis. METHODS This is a retrospective cohort study in a tertiary single center analyzing 181 newborns with gastroschisis between 2009 and 2020. The following risk factors associated with cholestasis were analyzed: gestational age, birth weight, type of gastroschisis, silo closure or immediate closure, days of parenteral nutrition, type of lipid emulsion, days of fasting, days to reach a full diet, days with central venous catheter, presence of infections, and outcomes. RESULTS Among the 176 patients evaluated, 41 (23.3%) evolved with cholestasis. In the univariate analysis, low birth weight (p=0.023), prematurity (p<0.001), lipid emulsion with medium-chain triglycerides and long-chain triglycerides (p=0.001) and death (p<0.001) were associated with cholestasis. In the multivariate analysis, patients who received lipid emulsion with fish oil instead of medium chain triglycerides/long chain triglycerides (MCT/LCT) emulsion had a lower risk of cholestasis. CONCLUSIONS Our study shows that lipid emulsion with fish oil is associated with a lower risk of cholestasis in neonates with gastroschisis. However, this is a retrospective study and a prospective study should be performed to confirm the results.
Collapse
|
4
|
Outcome and management in neonates with gastroschisis in the third millennium-a single-centre observational study. Eur J Pediatr 2022; 181:2291-2298. [PMID: 35226141 PMCID: PMC9110488 DOI: 10.1007/s00431-022-04416-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 02/02/2023]
Abstract
UNLABELLED Gastroschisis is one of the most common congenital malformations in paediatric surgery. However, there is no consensus regarding the optimal management. The aims of this study were to investigate the management and outcome and to identify predictors of outcome in gastroschisis. A retrospective observational study of neonates with gastroschisis born between 1999 and 2020 was undertaken. Data was extracted from the medical records and Cox regression analysis was used to identify predictors of outcome measured by length of hospital stay (LOS) and duration of parenteral nutrition (PN). In total, 114 patients were included. Caesarean section was performed in 105 (92.1%) at a median gestational age (GA) of 36 weeks (range 29-38) whereof (46) 43.8% were urgent. Primary closure was achieved in 82% of the neonates. Overall survival was 98.2%. One of the deaths was caused by abdominal compartment syndrome and one patient with intestinal failure-associated liver disease died from sepsis. None of the deceased patients was born after 2005. Median time on mechanical ventilation was 22 h. Low GA, staged closure, intestinal atresia, and sepsis were independent predictors of longer LOS and duration on PN. In addition, male sex was an independent predictor of longer LOS. CONCLUSION Management of gastroschisis according to our protocol was successful with a high survival rate, no deaths in neonates born after 2005, and favourable results in LOS, duration on PN, and time on mechanical ventilation compared to other reports. Multicentre registry with long-term follow-up is required to establish the best management of gastroschisis. WHAT IS KNOWN • Gastroschisis is one of the most common congenital malformations in paediatric surgery with increasing incidence. • There is no consensus among clinicians regarding the optimal management of gastroschisis. WHAT IS NEW • Although primary closure was achieved in 82% of the patients, mortality rate was very low (1.8%) with no deaths in neonates born after 2005 following the introduction of measurement of intraabdominal pressure at closure. • Low gestational age, staged closure, intestinal atresia, sepsis, and male sex were independent predictors of longer length of hospital stay.
Collapse
|
5
|
Bigio JZD, Falcão MC, Tannuri ACA. GROWTH ANALYSIS OF PRETERM NEWBORNS WITH GASTROSCHISIS DURING HOSPITALIZATION IN A NEONATAL INTENSIVE CARE UNIT. ARQUIVOS DE GASTROENTEROLOGIA 2021; 58:504-508. [PMID: 34909857 DOI: 10.1590/s0004-2803.202100000-90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/18/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Gastroschisis, especially complex type, prematurity and low birth weight are associated with a worse clinical outcome with higher mortality, higher incidence of sepsis and catheter-related infection, cholestasis, short bowel syndrome, greater number of days to achieve full diet, longer time of parenteral nutrition and longer hospitalization time. OBJECTIVE To evaluate the growth of preterm newborns with gastroschisis during their hospitalization in the neonatal intensive care unit. METHODS Descriptive study, based on a retrospective cohort (January 2012 to December 2018), including preterm newborns (gestational age less than 37 weeks) with simple and complex gastroschisis admitted in a tertiary neonatal intensive care unit. The following parameters were analyzed: maternal age, parity, type of delivery, birth weight, gender, gestational age, nutritional adequacy, type of gastroschisis, fasting time, parenteral nutrition time, time until achieving full enteral nutrition, hospitalization time, weight gain and outcome. The results were expressed in percentage, average, and median. RESULTS A total of 101 newborns with gastroschisis were admitted, of which 59.4% were premature (80.7% of late preterm infants). From the maternal data, the mean age was 21.2 years and 68.3% were primiparous. Regarding childbirth: 80% were cesarean sections. From newborns: the average birth weight was 2137 g, 56.6% were female, the average gestational age was 34.8 weeks, the average weight gain was 20.8 g/day during hospitalization and 83.3% were discharged from the hospital. CONCLUSION The growth analysis by weight gain (grams/day) during hospitalization in the intensive care unit showed that more than 90% of the sample presented acceptable or adequate weight gain.
Collapse
Affiliation(s)
- Juliana Zoboli Del Bigio
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Instituto da Criança, São Paulo, SP, Brasil
| | - Mário Cícero Falcão
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Instituto da Criança, São Paulo, SP, Brasil
| | - Ana Cristina Aoun Tannuri
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Instituto da Criança, São Paulo, SP, Brasil
| |
Collapse
|
6
|
Behram M, Oğlak SC, Özaydın S, Çaypınar SS, Gönen İ, Tunç Ş, Başkıran Y, Özdemir İ. What is the main factor in predicting the morbidity and mortality in patients with gastroschisis: delivery time, delivery mode, closure method, or the type of gastroschisis (simple or complex)? Turk J Med Sci 2021; 51:1587-1595. [PMID: 33550767 PMCID: PMC8283496 DOI: 10.3906/sag-2011-166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 02/06/2021] [Indexed: 11/06/2022] Open
Abstract
Background/aim There are numerous debates in the management of gastroschisis (GS). The current study aimed to evaluate perinatal outcomes and surgical and clinical characteristics among GS patients based on their type of GS, abdominal wall closure method, and delivery timing. Materials and methods This study was a retrospective analysis of prospectively collected data of 29 fetuses with GS that were prenatally diagnosed, delivered, and managed between June 2015 and December 2019 at the Obstetrics and Pediatric Surgery Clinics of Kanuni Sultan Süleyman Training and Research Hospital. Results Twenty-three of the patients had simple GS, and six of them had complex GS. The reoperation requirement, number of operations, duration of mechanical ventilation, time to initiate feeding, time to full enteral feeding, total parenteral nutrition (TPN) duration, TPN-associated cholestasis, wound infection, sepsis, and necrotizing enterocolitis were significantly lower in the simple GS group than in the complex GS group. The mean hospital length of stay was 3.5 times longer in the complex GS group (121.50 ± 24.42 days) than in the simple GS group (33.91 ± 4.13 days, p = 0.009). There were no cases of death in the simple GS group. However, two deaths occurred in the complex GS group. Conclusion This study indicated that simple GS, compared with complex GS, was associated with improved neonatal outcomes. We suggest that the main factor affecting the patients’ outcomes is whether the patient is a simple or complex GS rather than the abdominal wall closure method.
Collapse
Affiliation(s)
- Mustafa Behram
- Department of Perinatology, Health Sciences University, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey
| | - Süleyman Cemil Oğlak
- Department of Obstetrics and Gynecology, Health Sciences University, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Seyithan Özaydın
- Department of Pediatric Surgery, Health Sciences University, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey
| | - Sema Süzen Çaypınar
- Department of Perinatology, Health Sciences University, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey
| | - İlker Gönen
- Department of Neonatology, Health Sciences University, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey
| | - Şeyhmus Tunç
- Department of Obstetrics and Gynecology, Health Sciences University, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Yusuf Başkıran
- Department of Perinatology, Health Sciences University, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey
| | - İsmail Özdemir
- Department of Perinatology, Health Sciences University, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey
| |
Collapse
|
7
|
Martins BMR, Abreu I, Méio MDB, Moreira MEL. Gastroschisis in the neonatal period: A prospective case-series in a Brazilian referral center. J Pediatr Surg 2020; 55:1546-1551. [PMID: 32467036 DOI: 10.1016/j.jpedsurg.2020.04.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 04/19/2020] [Accepted: 04/20/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND/PURPOSE Gastroschisis is increasing in incidence and has low mortality and high morbidity. We describe the clinical and surgical characteristics of gastroschisis patients in a Brazilian referral center. METHODS Single-center prospective case series of gastroschisis patients. The following two groups were formed depending on the intestinal characteristics: simple and complex patients. RESULTS In total, 79 patients were enrolled, 89% of whom were classified as simple and 11% as complex. The baseline characteristics were similar between the groups, with the exception of the illness severity score. The complex group had a significantly smaller defect size, more reoperations and worse clinical outcomes than the simple group, with the initiation of feeding taking 1.5 times longer, the duration of total parenteral nutrition taking twice as long, and the length of hospitalization being 2.5 times longer; the complex group also included all the deaths that occurred. Overall, the survival rate was 96%. Patients who underwent the sutureless technique had significantly fewer wound infections and a decreased duration of mechanical ventilation than sutured patients. CONCLUSIONS This study provides a comprehensive picture of gastroschisis during the neonatal period in a Brazilian referral center, emphasizing the significantly higher risk for morbidity and mortality among complex patients than among simple patients and the few advantages of the sutureless technique over the sutured technique in terms of closing the defect. TYPE OF STUDY Prognostic. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Bianca M R Martins
- Department of Surgery, Surgical NICU, Instituto Fernandes Figueira - Fundação Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil.
| | - Isabel Abreu
- Department of Surgery, Surgical NICU, Instituto Fernandes Figueira - Fundação Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil
| | - Maria Dalva B Méio
- Clinical Research Unit, Instituto Fernandes Figueira - Fundação Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil
| | - Maria Elisabeth L Moreira
- Clinical Research Unit, Instituto Fernandes Figueira - Fundação Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil
| |
Collapse
|
8
|
Abstract
BACKGROUND Patients with gastroschisis and prolonged total (or partial) parenteral nutrition (PN) commonly develop direct hyperbilirubinemia (DH). OBJECTIVE To quantify the prevalence and severity of DH in newborns with gastroschisis and characterize the diagnostic work-up for DH in this patient population. DESIGN/METHODS Retrospective chart review of patients born with gastroschisis between 2005 and 2015 for the first 6 months of life. RESULTS 29 patients were identified with gastroschisis. Mean gestational age and birthweight were 36.4 (± 1.8) weeks and 2.5 (± 0.6) kg. 41% were treated with primary reduction versus staged closure. Peak total and direct bilirubin (DB) levels were 10.17 ± 6.21 mg/dL and 5.58 ± 3.94 mg/dL, respectively. 23 patients (79.3%) were diagnosed with DH and 78.2% underwent additional work-up for hyperbilirubinemia consisting of imaging and laboratory studies, none of which revealed a cause for DH other than the presumed PN-associated cholestasis. In all patients, DB began to decline within 1-10 days of initiation of enteral feeds. CONCLUSION(S) DH is common in patients with gastroschisis and is unlikely to be associated with pathology aside from PN. Additional work-up may lead to unnecessary resource utilization. LEVELS OF EVIDENCE Case series with no comparison group, Level IV.
Collapse
|
9
|
Passaro RC, Savoie KB, Huang EY. Use of a Gastroschisis Feeding Guideline to Improve Standardization of Care and Patient Outcomes at an Urban Children's Hospital. Nutr Clin Pract 2018; 33:545-552. [DOI: 10.1002/ncp.10083] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- R. Colby Passaro
- College of Medicine; University of Tennessee Health Science Center; Memphis Tennessee USA
| | - Kate B. Savoie
- College of Medicine; University of Tennessee Health Science Center; Memphis Tennessee USA
- Division of Pediatric Surgery; Le Bonheur Children's Hospital; Memphis Tennessee USA
- Department of General Surgery; University of Tennessee Health Science Center; Memphis Tennessee USA
| | - Eunice Y. Huang
- College of Medicine; University of Tennessee Health Science Center; Memphis Tennessee USA
- Division of Pediatric Surgery; Le Bonheur Children's Hospital; Memphis Tennessee USA
- Department of General Surgery; University of Tennessee Health Science Center; Memphis Tennessee USA
| |
Collapse
|
10
|
Hong CR, Zurakowski D, Fullerton BS, Ariagno K, Jaksic T, Mehta NM. Nutrition Delivery and Growth Outcomes in Infants With Gastroschisis. JPEN J Parenter Enteral Nutr 2018; 42:913-919. [DOI: 10.1002/jpen.1022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 09/20/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Charles R. Hong
- Department of Surgery; Boston Children's Hospital and Harvard Medical School; Boston Massachusetts USA
| | - David Zurakowski
- Department of Surgery; Boston Children's Hospital and Harvard Medical School; Boston Massachusetts USA
- Department of Anesthesia; Boston Children's Hospital; Harvard Medical School; Boston Massachusetts USA
| | - Brenna S. Fullerton
- Department of Surgery; Boston Children's Hospital and Harvard Medical School; Boston Massachusetts USA
| | - Katelyn Ariagno
- Center for Nutrition; Division of Gastroenterology; Hepatology and Nutrition; Boston Children's Hospital; Boston Massachusetts USA
| | - Tom Jaksic
- Department of Surgery; Boston Children's Hospital and Harvard Medical School; Boston Massachusetts USA
| | - Nilesh M. Mehta
- Center for Nutrition; Division of Gastroenterology; Hepatology and Nutrition; Boston Children's Hospital; Boston Massachusetts USA
- Division of Critical Care Medicine; Department of Anesthesiology Perioperative and Pain Medicine; Boston Children's Hospital; Boston Massachusetts USA
- Center for Nutrition Boston Children's Hospital; Harvard Medical School Boston; Boston Massachusetts USA
| |
Collapse
|
11
|
Landisch RM, Yin Z, Christensen M, Szabo A, Wagner AJ. Outcomes of gastroschisis early delivery: A systematic review and meta-analysis. J Pediatr Surg 2017; 52:1962-1971. [PMID: 28947324 DOI: 10.1016/j.jpedsurg.2017.08.068] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 08/28/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND/PURPOSE Elective preterm delivery (EPD) of a fetus with gastroschisis may prevent demise and ameliorate intestinal injury. While the literature on optimal timing of delivery varies, we hypothesize that a potential benefit may be found with EPD. METHODS A meta-analysis of publications describing timing of delivery in gastroschisis from 1/1990 to 8/2016 was performed, including studies where either elective preterm delivery (group 1, G1) or preterm gestational age (GA) (group 2, G2) were evaluated against respective comparators. The following outcomes were analyzed: total parenteral nutrition (TPN), first enteral feeding (FF), length of stay, ventilator days, fetal demise, complex gastroschisis, sepsis, and death. RESULTS Eighteen studies describing 1430 gastroschisis patients were identified. G1 studies found less sepsis (p<0.01), fewer days to FF (p=0.03), and 11days less of TPN (p=0.07) in the preterm cohort. Comparatively, G2 studies showed less days to FF in term GA (p=0.02).Whereas G1 BWs were similar, G2 preterm had a significantly lower BW compared to controls (p=0.001). CONCLUSIONS Elective preterm delivery appears favorable with respect to feeding and sepsis. However, benefits are lost when age is used as a surrogate of EPD. A randomized, prospective, multi-institutional trial is necessary to delineate whether EPD is advantageous to neonates with gastroschisis. TYPE OF STUDY Treatment study. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Rachel M Landisch
- Division of Pediatric Surgery, Department of Surgery, The Children's Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Ziyan Yin
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Melissa Christensen
- Division of Pediatric Surgery, Department of Surgery, The Children's Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, WI, USA
| | - Aniko Szabo
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Amy J Wagner
- Division of Pediatric Surgery, Department of Surgery, The Children's Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, WI, USA
| |
Collapse
|
12
|
Calkins KL, Havranek T, Kelley-Quon LI, Cerny L, Flores M, Grogan T, Shew SB. Low-Dose Parenteral Soybean Oil for the Prevention of Parenteral Nutrition-Associated Liver Disease in Neonates With Gastrointestinal Disorders. JPEN J Parenter Enteral Nutr 2016; 41:404-411. [PMID: 26024828 DOI: 10.1177/0148607115588334] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Neonates with gastrointestinal disorders (GDs) are at high risk for parenteral nutrition-associated liver disease (PNALD). Soybean-based intravenous lipid emulsions (S-ILE) have been associated with PNALD. This study's objective was to determine if a lower dose compared with a higher dose of S-ILE prevents cholestasis without compromising growth. MATERIALS AND METHODS This multicenter randomized controlled pilot study enrolled patients with GDs who were ≤5 days of age to a low dose (~1 g/kg/d) (LOW) or control dose of S-ILE (~3 g/kg/d) (CON). The primary outcome was cholestasis (direct bilirubin [DB] >2 mg/dL) after the first 7 days of age. Secondary outcomes included growth, PN duration, and late-onset sepsis. RESULTS Baseline characteristics were similar between the LOW (n = 20) and CON groups (n = 16). When the LOW group was compared with the CON group, there was no difference in cholestasis (30% vs 38%, P = .7) or secondary outcomes. However, mean ± SE DB rate of change over the first 8 weeks (0.07 ± 0.04 vs 0.3 ± 0.09 mg/dL/wk, P = .01) and entire study (0.008 ± 0.03 vs 0.2 ± 0.07 mg/dL/wk, P = .02) was lower in the LOW group compared with the CON group. CONCLUSION In neonates with GDs who received a lower dose of S-ILE, DB increased at a slower rate in comparison to neonates who received a higher dose of S-ILE. Growth was comparable between the groups. This study demonstrates a need for a larger, randomized controlled trial comparing 2 different S-ILE doses for cholestasis prevention in neonates at risk for PNALD.
Collapse
Affiliation(s)
- Kara L Calkins
- 1 David Geffen School of Medicine, University of California, Los Angeles, and Mattel Children's Hospital at UCLA, Department of Pediatrics, Division of Neonatology and Developmental Biology, Neonatal Research Center of the UCLA Children's Discovery and Innovation Institute, Los Angeles, California, USA
| | - Thomas Havranek
- 2 Department of Pediatrics, Division of Neonatology, St Louis University School of Medicine, Cardinal Glennon Children's Hospital, St Louis, Missouri, USA.,3 Department of Pediatrics, Division of Neonatology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Lorraine I Kelley-Quon
- 4 Department of Surgery, Division of General Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Laura Cerny
- 2 Department of Pediatrics, Division of Neonatology, St Louis University School of Medicine, Cardinal Glennon Children's Hospital, St Louis, Missouri, USA
| | - Martiniano Flores
- 5 Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, California, USA
| | - Tristan Grogan
- 6 Department of Medicine, Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Stephen B Shew
- 7 Department of Surgery, Division of Pediatric Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| |
Collapse
|
13
|
Youssef F, Laberge JM, Baird RJ. The correlation between the time spent in utero and the severity of bowel matting in newborns with gastroschisis. J Pediatr Surg 2015; 50:755-9. [PMID: 25783374 DOI: 10.1016/j.jpedsurg.2015.02.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 02/13/2015] [Indexed: 01/26/2023]
Abstract
BACKGROUND Optimal timing of delivery in fetuses with gastroschisis (GS) is unknown. Some favor early induced delivery to prevent bowel injury. This study evaluates the correlation between bowel injury and the gestational age at birth using the Gastroschisis Prognostic Score (GPS). METHODS A national database was analyzed from 2005 to 2013. Patients were pooled based on their gestational age at birth. The mean GPS and % of patients with severe bowel matting were tabulated for each week in utero. Regression modeling was used to evaluate the relationship between the dependent (severe matting and GPS) and independent (gestational age) variables and the R(2) coefficient of determination was derived to evaluate model strength. Additional factors influencing the timing of delivery were evaluated. RESULTS Of 780 cases, 88 were excluded because of missing data. A linear relationship is seen between increasing gestational age and decreasing bowel matting (R(2)=0.66) and GPS (R(2)=0.72). For every week in utero, the % of patients with severe matting decreases by 3.6%. CONCLUSION Early induced delivery simply to protect the bowel from ongoing in utero damage appears unfounded and should be reserved for evidence of closing gastroschisis or traditional obstetrical/fetal indications.
Collapse
Affiliation(s)
- Fouad Youssef
- The Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Jean Martin Laberge
- The Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Robert J Baird
- The Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital of the McGill University Health Centre, Montreal, Quebec, Canada.
| |
Collapse
|