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Claiborne A, Wisseman B, Kern K, Steen D, Jevtovic F, Mcdonald S, Strom C, Newton E, Isler C, Devente J, Mouro S, Collier D, Kuehn D, Kelley GA, May LE. Exercise during pregnancy Dose: Influence on preterm birth outcomes. Eur J Obstet Gynecol Reprod Biol 2024; 300:190-195. [PMID: 39025039 DOI: 10.1016/j.ejogrb.2024.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 05/03/2024] [Accepted: 07/08/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Preterm delivery typically increases health risk for neonates and is associated with longer infant hospital stay and financial burden. Prenatal exercise dose (frequency, intensity, type, time, volume) have been shown to influence birth outcomes. Increased prenatal exercise dose could therefore provide a critical reduction in health risk and financial burden in preterm neonates. OBJECTIVE It was our aim to explore the effects of prenatal exercise dose from a supervised exercise intervention in pregnant women on the occurrence of preterm (<37 weeks gestation) births, and the impact on health outcomes in preterm neonates. STUDY DESIGN This study is a retrospective, secondary analysis of pooled data from three blinded, prospective, randomized controlled trials. Prenatal exercise dose were assessed in supervised aerobic, resistance, and combination sessions throughout pregnancy. In addition to gestational age, birth weight, resting heart rate, neonatal morphometrics (body circumferences, ponderal index), and health status (Apgar-1 and -5) metrics were obtained for 21 women at birth. One-way analysis of variance tests were used to assess the differences between dose grouped as tertiles, while Pearson correlations determined the association between dose and birth outcomes. RESULTS Women exercised for an average of 19.6 wks (range: 6 - 21 wks) during pregnancy. Exercise during pregnancy tended to result in later preterm deliveries (p = 0.08). Greater prenatal exercise volume and duration were associated with reduced infant hospital stay post-delivery (p = 0.02). Weekly exercise volume was associated with increased Apgar scores (p = 0.01). CONCLUSION Increased prenatal exercise volume and duration is associated with improved birth outcomes in preterm neonates.
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Affiliation(s)
- Alex Claiborne
- Department of Kinesiology, East Carolina University (ECU), Greenville, NC, USA; Human Performance Laboratory, ECU, Greenville, NC, USA; East Carolina Diabetes & Obesity Institute, ECU, Greenville, NC, USA
| | - Breanna Wisseman
- Department of Kinesiology, East Carolina University (ECU), Greenville, NC, USA; Human Performance Laboratory, ECU, Greenville, NC, USA; East Carolina Diabetes & Obesity Institute, ECU, Greenville, NC, USA
| | - Kara Kern
- Department of Kinesiology, East Carolina University (ECU), Greenville, NC, USA; Human Performance Laboratory, ECU, Greenville, NC, USA; East Carolina Diabetes & Obesity Institute, ECU, Greenville, NC, USA
| | - Dylan Steen
- Department of Kinesiology, East Carolina University (ECU), Greenville, NC, USA; Human Performance Laboratory, ECU, Greenville, NC, USA; East Carolina Diabetes & Obesity Institute, ECU, Greenville, NC, USA
| | - Filip Jevtovic
- Department of Kinesiology, East Carolina University (ECU), Greenville, NC, USA; Human Performance Laboratory, ECU, Greenville, NC, USA; East Carolina Diabetes & Obesity Institute, ECU, Greenville, NC, USA
| | - Samantha Mcdonald
- School of Kinesiology and Recreation, Illinois State University, Normal, IL, USA
| | - Cody Strom
- Department of Kinesiology and Sport, University of Southern Indiana, Evansville, IN, USA
| | - Edward Newton
- Department of Obstetrics & Gynecology, East Carolina University, USA
| | - Christy Isler
- Department of Obstetrics & Gynecology, East Carolina University, USA
| | - James Devente
- Department of Obstetrics & Gynecology, East Carolina University, USA
| | - Steven Mouro
- Department of Obstetrics & Gynecology, East Carolina University, USA
| | - David Collier
- Department of Pediatrics, East Carolina University, USA
| | - Devon Kuehn
- Department of Pediatrics, East Carolina University, USA
| | - George A Kelley
- Department of Epidemiology and Biostatistics, West Virginia University, Morgantown, WV, USA; School of Public and Population Health, Boise State University, Boise, ID, USA
| | - Linda E May
- Department of Kinesiology, East Carolina University (ECU), Greenville, NC, USA; Human Performance Laboratory, ECU, Greenville, NC, USA; East Carolina Diabetes & Obesity Institute, ECU, Greenville, NC, USA; Department of Obstetrics & Gynecology, East Carolina University, USA.
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Riddle S, Acharya K, Agarwal N, Ahmad I, Bendel-Stenzel E, Shepherd J, Williams S, Zaniletti I, Jacobson E. Gestational Age at Delivery and Neonatal Outcomes among Infants with Gastroschisis in the Children's Hospitals Neonatal Consortium (CHNC). Am J Perinatol 2024; 41:756-763. [PMID: 35553040 DOI: 10.1055/s-0042-1744510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The effect of gestational age (GA) on gastroschisis outcomes is unclear and delivery timing varies in practice. We aimed to correlate clinical outcomes of infants with gastroschisis and GA at delivery in the Children's Hospitals Neonatal Consortium (CHNC). STUDY DESIGN This was a retrospective multicenter cohort study of infants with gastroschisis admitted to CHNC neonatal intensive care units (NICUs) from 2010 to 2016. Patients were categorized by GA: 32 to 346/7, 35 to 366/7, and ≥37 weeks. Respiratory and feeding interventions, mortality, length of stay, and common complications were compared. RESULTS In 2021 for patients with gastroschisis, median GA at delivery was 36.3 weeks (interquartile range [IQR] 35.1, 37.3) and mean birth weight 2,425 g (IQR 2,100, 2,766). Overall mortality was low and there was no difference across GA groups. Infants <35 weeks' gestation had the greatest need for respiratory and feeding interventions. Complications such as medical necrotizing enterocolitis (NEC), cholestasis, and central line-associated blood stream infection were less common in infants ≥37 weeks. Feeding initiation and full feeds were earliest in term infants, compared with infants between 35 and 366/7 weeks, and longest in infants <35 weeks. Prematurity had a significant negative association with breast milk exposure. Enteral feeding tube support at discharge increased with prematurity. Compared with term, infants born between 35 and 366/7 weeks' gestation had a higher incidence of medical NEC and lower exposure to mother's milk at discharge but the need for respiratory interventions or tube feeding at discharge was similar. CONCLUSION Premature infants with gastroschisis had more neonatal complications including respiratory interventions, longer NICU stay, longer time to full enteral feeds, and higher need for tube feeds at discharge as compared with those delivered at term. Differences were greatest for those <35 weeks GA. While overall mortality remains low, these results provide additional information about GA at birth in gastroschisis, with no evidence of benefit from preterm delivery. KEY POINTS · Respiratory support was greatest for those with <35 weeks gestation.. · NEC and cholestasis increase with prematurity.. · Term infants have better feeding outcomes..
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Affiliation(s)
- Stefanie Riddle
- Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Krishna Acharya
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nidhi Agarwal
- Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Irfan Ahmad
- Department of Neonatology, Children's Hospital Orange County, Orange, California
| | | | - Jennifer Shepherd
- Division of Neonatology, Department of Pediatrics, Fetal and Neonatal Institute, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | | | | | - Elizabeth Jacobson
- Seattle Children's Hospital and University of Washington School of Medicine, Seattle, Washington
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Goldstein MJ, Bailer JM, Gonzalez-Brown VM. Preterm vs term delivery in antenatally diagnosed gastroschisis: a systematic review and meta-analysis. Am J Obstet Gynecol MFM 2022; 4:100651. [PMID: 35462060 DOI: 10.1016/j.ajogmf.2022.100651] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To review the evidence regarding gestational age at birth, length of stay, sepsis incidence, days on mechanical ventilation, and mortality between preterm and term deliveries in pregnancies complicated by gastroschisis. DATA SOURCES We conducted database searches of PubMed, Cochrane Central Register of Controlled Trials, Embase, the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov without language restrictions through August 16, 2021. References of all relevant articles were reviewed. STUDY ELIGIBILITY CRITERIA Randomized controlled trials, nonrandomized controlled trials, and observational studies were evaluated comparing length of stay, sepsis, days on mechanical ventilation, and mortality between either elective preterm delivery and expectant management (Group 1) or preterm gestational age and term gestational age (Group 2). METHODS Two researchers independently selected studies and evaluated risk of bias with the Risk of Bias 2 tool for randomized controlled trials and the Newcastle-Ottawa Scale for cohort studies. Mean differences and odds ratios were calculated using a random-effects model for inclusion and methodological quality. The primary outcome was length of stay. Secondary outcomes were incidence of sepsis, mortality, days on mechanical ventilation, and gestational age. RESULTS Thirty studies with a total of 7409 patients were included in the systematic review, of which 25 were included in the analysis. Group 1 studies found no difference in length of stay or mortality and a trend toward fewer days on mechanical ventilation (mean difference, -0.40; 95% confidence interval, -0.89 to -0.10; P=.12; I2=35%). Subgroup analysis excluding premature delivery demonstrated lower sepsis incidence in elective preterm delivery (odds ratio, 0.46; 95% confidence interval, 0.25-0.84; P=.01; I2=0%). Group 2 studies found increased length of stay (mean difference, 15.44; 95% confidence interval, 8.44-21.83; P<.00001; I2=94%), sepsis (odds ratio, 1.69; 95% confidence interval, 1.15-2.50; P=.008; I2=51%), days on mechanical ventilation (mean difference, 1.38; 95% confidence interval, 0.10-2.66; P=.03; I2=66%), and mortality (odds ratio, 2.97; 95% confidence interval, 1.59-5.55; P=.0007; I2=0%). Gestational age was significantly lower in Group 2 studies than in Group 1 studies. CONCLUSION Data continue to be conflicting, but subgroup analysis suggested a possible reduction in sepsis incidence and mean days on mechanical ventilation with elective early term delivery.
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Affiliation(s)
| | - Jessica Marie Bailer
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Veronica Mayela Gonzalez-Brown
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX
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ElHassan NO, Sharma M, Akmyradov C, Kaiser JR, Goudie A, Nembhard WN. Childhood Educational Outcomes of Children Born with Gastroschisis. J Pediatr 2022; 240:110-116.e3. [PMID: 34499945 DOI: 10.1016/j.jpeds.2021.08.086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/26/2021] [Accepted: 08/31/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare third grade literacy and mathematics test proficiency among children born with gastroschisis vs unaffected controls and identify predictors of academic proficiency among these children. STUDY DESIGN Infants born with gastroschisis (2000-2005) were identified from the Arkansas Reproductive Health Monitoring System. For each case, 2 controls were selected at random from birth certificates and matched for hospital and month of birth, sex, and race/ethnicity. Data on rehospitalization within the first 6 years and payer data were abstracted from the Arkansas Hospital Inpatient Discharge database. Surviving cases and controls were linked to the Arkansas Department of Education database containing achievement test scores. The primary outcome was proficiency, defined as performance at or above grade level, on third grade achievement tests. Cases and controls who did not attend public schools could not be linked to education records. Multivariable logistic regression models evaluated the association between study characteristics and academic proficiency. RESULTS The final study cohort included 47 cases and 63 controls. There was no statistically significant difference in the rate of literacy (68% vs 81%; P = .65) or mathematics proficiency (89% vs 87%; P = .15) between cases and controls. On multivariable analysis, a complex gastroschisis (defined as atresia, volvulus, necrosis, or perforation of the bowel) was associated with lower proficiency in literacy (aOR, 0.1; 95% CI, 0.02-0.58; P = .01). No neonatal or maternal characteristics predictive of lower proficiency in mathematics were identified. CONCLUSIONS Among children born with gastroschisis, the presence of a complex gastroschisis was associated with lower proficiency on third grade literacy achievement tests.
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Affiliation(s)
- Nahed O ElHassan
- Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, AR; Arkansas Center for Birth Defects Research and Prevention, Little Rock, AR.
| | - Megha Sharma
- Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, AR
| | | | - Jeffrey R Kaiser
- Department of Pediatrics, Penn State Children's Hospital, Hershey, PA; Department of Obstetrics and Gynecology, Penn State Children's Hospital, Hershey, PA
| | - Anthony Goudie
- Department of Health Policy and Management, Fay W. Boozman College of Public Heath, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Wendy N Nembhard
- Arkansas Center for Birth Defects Research and Prevention, Little Rock, AR; Department of Epidemiology, Fay W. Boozman College of Public Heath, University of Arkansas for Medical Sciences, Little Rock, AR
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Outcome and management in neonates with gastroschisis in the third millennium-a single-centre observational study. Eur J Pediatr 2022; 181:2291-2298. [PMID: 35226141 PMCID: PMC9110488 DOI: 10.1007/s00431-022-04416-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 02/02/2023]
Abstract
UNLABELLED Gastroschisis is one of the most common congenital malformations in paediatric surgery. However, there is no consensus regarding the optimal management. The aims of this study were to investigate the management and outcome and to identify predictors of outcome in gastroschisis. A retrospective observational study of neonates with gastroschisis born between 1999 and 2020 was undertaken. Data was extracted from the medical records and Cox regression analysis was used to identify predictors of outcome measured by length of hospital stay (LOS) and duration of parenteral nutrition (PN). In total, 114 patients were included. Caesarean section was performed in 105 (92.1%) at a median gestational age (GA) of 36 weeks (range 29-38) whereof (46) 43.8% were urgent. Primary closure was achieved in 82% of the neonates. Overall survival was 98.2%. One of the deaths was caused by abdominal compartment syndrome and one patient with intestinal failure-associated liver disease died from sepsis. None of the deceased patients was born after 2005. Median time on mechanical ventilation was 22 h. Low GA, staged closure, intestinal atresia, and sepsis were independent predictors of longer LOS and duration on PN. In addition, male sex was an independent predictor of longer LOS. CONCLUSION Management of gastroschisis according to our protocol was successful with a high survival rate, no deaths in neonates born after 2005, and favourable results in LOS, duration on PN, and time on mechanical ventilation compared to other reports. Multicentre registry with long-term follow-up is required to establish the best management of gastroschisis. WHAT IS KNOWN • Gastroschisis is one of the most common congenital malformations in paediatric surgery with increasing incidence. • There is no consensus among clinicians regarding the optimal management of gastroschisis. WHAT IS NEW • Although primary closure was achieved in 82% of the patients, mortality rate was very low (1.8%) with no deaths in neonates born after 2005 following the introduction of measurement of intraabdominal pressure at closure. • Low gestational age, staged closure, intestinal atresia, sepsis, and male sex were independent predictors of longer length of hospital stay.
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Diyaolu M, Wood LS, Bruzoni M. Sutureless closure for the management of gastroschisis. Transl Gastroenterol Hepatol 2021; 6:31. [PMID: 34423152 DOI: 10.21037/tgh-20-185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/22/2020] [Indexed: 11/06/2022] Open
Abstract
Gastroschisis is a common congenital anomaly in which the midgut fails to return to the abdominal cavity resulting in exposed intestines, which are not covered by a membrane in a neonate. The incidence of gastroschisis has been increasing worldwide resulting in an evolving medical and surgical management. Gastroschisis can be either simple or complicated. Complicated gastroschisis occurs when gastroschisis is associated with gastrointestinal conditions such as intestinal atresia, volvulus, stenosis or perforation. In this instance, the mortality and morbidity of patients significantly increases. Initial management of gastroschisis requires a multi-modal, interdisciplinary approach in order to successfully care for a neonate. Patients should be managed in a neonatal intensive care unit under the care of intensivists, respiratory therapists and pediatric surgeons. Temperature regulation, hydration and protection of the bowel are of the utmost priorities. Surgical management of gastroschisis focuses on reduction of the bowel and closure of the abdominal wall defect. Initially, the defect was closed primarily with suture, however, more recently, a sutureless closure has become prevalent. This, in conjunction with use of a silo, has led to a shift from the operating room and general anesthesia to the bedside. This article aims to discuss the presentation, diagnosis and management of gastroschisis.
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Affiliation(s)
- Modupeola Diyaolu
- Division of Pediatric Surgery, Lucile Packard Children's Hospital at Stanford University, Stanford, CA, USA
| | - Lauren S Wood
- Division of Pediatric Surgery, Lucile Packard Children's Hospital at Stanford University, Stanford, CA, USA
| | - Matias Bruzoni
- Division of Pediatric Surgery, Lucile Packard Children's Hospital at Stanford University, Stanford, CA, USA
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Regional variation in gastroschisis: a nationwide database review of demographics and outcomes. Pediatr Surg Int 2021; 37:911-917. [PMID: 33787981 DOI: 10.1007/s00383-021-04894-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Gastroschisis is an index neonatal malformation with an increasing incidence from earlier decades. The aim of this study was to investigate regional variations in patient demographics, outcomes, and costs in gastroschisis. MATERIALS AND METHODS The 2016 kid's inpatient database (KID) obtained from the Healthcare Cost and Utilization Project (HCUP) was used to obtain gastroschisis birth, demographic, and outcome data across four U.S. geographical regions: Northeast, Midwest, South, and West. Categorical variables were analyzed with Pearson's Chi-squared test. Odds ratios (OR) with 95% confidence intervals (CI) were reported for variables with significance (p < 0.05). Appropriate logistic regressions were used for comparing categorical, cardinal, and continuous data. RESULTS 2043 gastroschisis cases were obtained from the 2016 KID database with a weighted incidence of 5.1 per 10,000 live births. Incidence of gastroschisis across regions was similar when controlling for a number of hospitals reporting to KID. Prematurity was common, with 59% (1204) of neonates with gastroschisis born at less than 37 weeks. 52% (N = 1067) of gastroschisis infants were male. 46% (955) were White, 9% (178) African American, 22% (450) Hispanic, and 8% (155) other. The overall mortality of gastroschisis in this database was 3.6% (75). The average length of stay was 39 days and average cost of treatment was $357,436. Though without significant differences in mortality, there were significant differences in demographics, costs, and lengths of stay between regions. CONCLUSIONS There has been a significant increase in gastroschisis incidence over the last three decades. This significant increase appears to be related to an increase in socioeconomic inequality and an alteration in the population demographics in the United States. Further study of regional variations will facilitate the development of best practice guidelines that benefit all.
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Chabra S, Peterson SE, Cheng EY. Development of a prenatal clinical care pathway for uncomplicated gastroschisis and literature review. J Neonatal Perinatal Med 2021; 14:75-83. [PMID: 32145003 DOI: 10.3233/npm-190277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Gastroschisis is an abdominal wall defect wherein the bowel is herniated into the amniotic fluid. Controversy exists regarding optimal prenatal surveillance strategies that predict fetal well-being and help guide timing of delivery. Our objective was to develop a clinical care pathway for prenatal management of uncomplicated gastroschisis at our institution. METHODS We performed a review of literature from January 1996 to May 2017 to evaluate prenatal ultrasound (US) markers and surveillance strategies that help determine timing of delivery and optimize outcomes in fetal gastroschisis. RESULTS A total 63 relevant articles were identified. We found that among the US markers, intraabdominal bowel dilatation, polyhydramnios, and gastric dilatation are potentially associated with postnatal complications. Prenatal surveillance strategy with monthly US starting at 28weeks of gestational age (wGA) and twice weekly non-stress testing beginning at 32wGA is recommended to optimize fetal wellbeing. Timing of delivery should be based on obstetric indications and elective preterm delivery prior to 37wGA is not indicated. CONCLUSIONS Close prenatal surveillance of fetal gastroschisis is necessary due to the high risk for adverse outcomes including intrauterine fetal demise in the third trimester. Decisions regarding the timing of delivery should take into consideration the additional prematurity-associated morbidity.
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Affiliation(s)
- Shilpi Chabra
- Department of Pediatrics, Division of Neonatology, Seattle Children's Hospital and University of Washington, Seattle, WA, USA
| | - Suzanne E Peterson
- Department of Obstetrics/Gynecology, Division of Maternal-Fetal Medicine Swedish Medical Center, Seattle, WA, USA
| | - Edith Y Cheng
- Department of Obstetrics/Gynecology, Division of Maternal-Fetal Medicine, Seattle Children's Hospital and University of Washington Medical Center, Seattle, WA, USA
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Nair N, Merhar S, Wessel J, Hall E, Kingma PS. Factors that Influence Longitudinal Growth from Birth to 18 Months of Age in Infants with Gastroschisis. Am J Perinatol 2020; 37:1438-1445. [PMID: 31365930 DOI: 10.1055/s-0039-1693988] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE This study aimed to investigate factors that influence growth in infants with gastroschisis. STUDY DESIGN Growth parameters at birth, discharge, 6, 12, and 18 months of age were collected from 42 infants with gastroschisis. RESULTS The mean z-scores for weight, length, and head circumference were below normal at birth and decreased between birth and discharge. Lower gestational age correlated with a worsening change in weight z-score from birth to discharge (rho 0.38, p = 0.01), but not with the change in weight z-score from discharge to 18 months (rho 0.04, p = 0.81). There was no correlation between the day of life when the enteral feeds were started and the change in weight z-score from birth to discharge (rho 0.12, p = 0.44) or discharge to 18 months (rho -0.15, p = 0.41). CONCLUSION Our study demonstrates that infants with gastroschisis experience a significant decline in weight z-score between birth and discharge, and start to catch up on all growth parameters after discharge. Prematurity in gastroschisis infants is associated with a greater risk for weight loss during this time. This information emphasizes the importance of minimizing weight loss prior to discharge in premature infants with gastroschisis and highlights the need for optimal management strategies for these infants.
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Affiliation(s)
- Nitya Nair
- Division of Neonatology, Perinatal and Pulmonary Biology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Stephanie Merhar
- Division of Neonatology, Perinatal and Pulmonary Biology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jacqueline Wessel
- Division of Nutrition Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Eric Hall
- Division of Neonatology, Perinatal and Pulmonary Biology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Paul S Kingma
- Division of Neonatology, Perinatal and Pulmonary Biology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Cincinnati Fetal Center, Division of Pediatric General Thoracic and Fetal Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Hariharan G, Jones N, Ee M, De Paoli A. Epidemiology and outcomes of gastroschisis in Tasmania. J Paediatr Child Health 2020; 56:1795-1798. [PMID: 32196139 DOI: 10.1111/jpc.14863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 01/21/2020] [Accepted: 03/01/2020] [Indexed: 11/30/2022]
Abstract
AIM To describe the epidemiology and outcomes of gastroschisis in Tasmania. METHODS A retrospective analysis of all pregnancies complicated by gastroschisis in Tasmania from 1996 to 2015 was undertaken (epidemiology cohort), and the presentation, surgical management and outcomes (surgery cohort) were reviewed for the period between September 1990 and July 2015. RESULTS Gastroschisis was detected in 58 pregnancies during the 20-year epidemiology cohort period, giving an incidence of 4.4 per 10 000 live births for the 20-year period. Two of the four stillbirths occurred after 36 weeks' gestation. Of the 65 babies with gastroschisis treated at the Royal Hobart Hospital, 51 had a staged surgical repair (silo in 47, stoma formation in 4), and 14 had a primary closure. Staged repair was associated with a significantly longer duration of ventilation and stay in the neonatal intensive care unit. There were six post-natal deaths, all born in the first epoch. Death was significantly associated with the condition of the intestine at delivery (P = 0.02). There were no deaths in babies with simple gastroschisis. Complex gastroschisis was significantly associated with longer duration of total parenteral nutrition (P = 0.0002) and longer stay in hospital (P = 0.03). CONCLUSIONS The incidence of gastroschisis in Tasmania is similar to that reported in other Australian regions and has not increased over the 20-year period of study. The high risk of stillbirth, and the significant association between mortality and the condition of the intestine at birth necessitates close fetal surveillance. Complex gastroschisis imposes a significant burden on hospital resources.
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Affiliation(s)
- Gopakumar Hariharan
- Department of Neonatal and Paediatric Intensive Care Unit (NPICU), Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Niall Jones
- Department of Paediatric Surgery, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Michael Ee
- Department of Paediatric Surgery, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Antonio De Paoli
- Department of Neonatal and Paediatric Intensive Care Unit (NPICU), Royal Hobart Hospital, Hobart, Tasmania, Australia
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Okoro PE, Ngaikedi C. Outcome of management of gastroschisis: comparison of improvised surgical silo and extended right hemicolectomy. ANNALS OF PEDIATRIC SURGERY 2020. [DOI: 10.1186/s43159-019-0012-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Gastroschisis is onea of the major abdominal wall defects encountered commonly in pediatric surgery. Whereas complete reduction and abdominal closure is achieved easily sometimes, a daunting situation arises when the eviscerated bowel loops and other viscera cannot be returned immediately into the abdominal cavity. This situation is a major contributor to the outcome of the treatment of gastroschisis in our region. In our efforts to improve our outcome, we have adopted the technique of extended right hemicolectomy for cases where complete reduction and primary abdominal wall closure is otherwise not possible. This study compared the management outcome of gastroschisis using our improvised silo, and performing an extended right hemicolectomy.
Results
Thirty-nine cases were analyzed. Simple closure could not be achieved in 28 cases. In the absence of standard silos, improvised ones were constructed from the amniotic membrane (3 cases), urine bag (4 cases), and latex gloves (9 cases) giving a total of 16 cases managed with silos. Extended right hemicolectomy was performed in 12 cases.
Conclusions
Given the peculiarities of circumstances in our region regarding human and material resources in the care of gastroschisis patients, an extended right hemicolectomy, to make it possible to close the abdomen primarily in gastroschisis is a more viable option than the use of improvised silo.
Trial registration
This trial was approved by the Ethical Committee of the University of Port Harcourt Teaching Hospital, Nigeria. Reference Number: UPTH/ADM/90/S.II/VOL XI/835. Registered 3 May 2013.
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Williams SL, Tkach JA, Rattan MS, South AP, Wessel J, Kingma PS. Feeding Tolerance, Intestinal Motility, and Superior Mesenteric Artery Blood Flow in Infants with Gastroschisis. Neonatology 2020; 117:95-101. [PMID: 31851996 DOI: 10.1159/000504226] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 10/17/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to determine the relationship of superior mesenteric artery (SMA) blood flow and intestinal motility with feeding tolerance in infants with gastroschisis. STUDY DESIGN This was a prospective observational cohort study of 23 infants with gastroschisis. Magnetic resonance images were obtained at abdominal wall closure, initiation of feeds, and full feeds. Motility and SMA flow data were correlated with feeding tolerance. RESULT All infants had abnormal motility, and most continued with abnormal motility despite achieving full feeds. Increased SMA flow at the time of abdominal wall closure was found to be significantly related to the earlier achievement of full feeds (ρ = -0.45, p = 0.05) and trended towards earlier initiation of feeds (ρ = -0.36, p = 0.13), shorter parenteral nutrition days (ρ = -0.42, p = 0.07), and earlier discharge (ρ = -0.41, p = 0.08). CONCLUSION Increased SMA blood flow at the time of abdominal wall closure is positively correlated with feeding tolerance, suggesting the importance of initial intestinal perfusion in the pathophysiology for feeding intolerance and intestinal dysmotility in gastroschisis.
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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, USA
| | - Jean A Tkach
- Imaging Research Center and Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Mantosh S Rattan
- Imaging Research Center and Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Andrew P South
- Division of Neonatology, Children's Hospital Medical Center of Akron, Akron, Ohio, USA
| | - Jacqueline Wessel
- Division of Nutrition Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Paul S Kingma
- The Perinatal Institute, Section of Neonatology, Perinatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA, .,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA, .,Cincinnati Fetal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA,
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13
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Dewberry LC, Hilton SA, Zaretsky MV, Behrendt N, Galan HL, Marwan AI, Liechty KW. Examination of Prenatal Sonographic Findings: Intra-Abdominal Bowel Dilation Predicts Poor Gastroschisis Outcomes. Fetal Diagn Ther 2019; 47:245-250. [PMID: 31454815 DOI: 10.1159/000501592] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 06/19/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Gastroschisis is an anterior abdominal wall defect with variable outcomes. There are conflicting data regarding the prognostic value of sonographic findings. OBJECTIVES The aim of this study was to identify prenatal ultrasonographic features associated with poor neonatal outcomes. METHOD A retrospective review of 55 patients with gastroschisis from 2007 to 2017 was completed. Ultrasounds were reviewed for extra-abdominal intestinal diameter (EAID) and intra-abdominal intestinal diameter (IAID), echogenicity, visceral content within the herniation, amniotic fluid index, defect size, and abdominal circumference (AC). Ultrasound variables were correlated with full enteral feeding and the diagnosis of a complex gastroschisis. RESULTS Bivariate analysis demonstrated an increased time to full enteral feeds with increasing number of surgeries, EAID, and IAID. Additionally, there was a significant relationship between IAID and AC percentile with the diagnosis of complex gastroschisis. On multivariate analysis, only IAID was significant and increasing diameter had a 2.82 (95% CI 1.02-7.78) higher odds of a longer time to full enteral feeds and a 1.2 (95% CI 1.05-1.36) greater odds of the diagnosis of a complex gastroschisis. CONCLUSIONS Based on these findings, IAID is associated with a longer time to full enteral feeding and the diagnosis of complex gastroschisis.
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Affiliation(s)
- Lindel C Dewberry
- Department of Surgery, University of Colorado, Aurora, Colorado, USA
| | - Sarah A Hilton
- Department of Surgery, University of Colorado, Aurora, Colorado, USA
| | - Michael V Zaretsky
- Colorado Fetal Care Center, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Nicholas Behrendt
- Colorado Fetal Care Center, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Henry L Galan
- Colorado Fetal Care Center, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Ahmed I Marwan
- Division of Pediatric Surgery, Department of Surgery, University of Colorado, Aurora, Colorado, USA
| | - Kenneth W Liechty
- Division of Pediatric Surgery, Department of Surgery, University of Colorado, Aurora, Colorado, USA,
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14
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Baer RJ, Chambers CD, Ryckman KK, Oltman SP, Rand L, Jelliffe-Pawlowski LL. High risk of spontaneous preterm birth among infants with gastroschisis. Am J Med Genet A 2018; 179:37-42. [PMID: 30549407 DOI: 10.1002/ajmg.a.60675] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/28/2018] [Accepted: 10/10/2018] [Indexed: 11/07/2022]
Abstract
We examined the association between gastroschisis and preterm birth (PTB, <37 weeks) by subtype. The sample was drawn from singleton live births in California from 2007 to 2012 contained in a birth cohort file maintained by the California Office of Statewide Health Planning and Development (n = 2,891,965; 1,421 with gastroschisis). Relative risks (RRs) and 95% confidence intervals (CIs) were calculated for PTB by gestational age (<34, 34-36, and any <37 weeks) and by type (spontaneous labor with intact membranes, preterm premature rupture of the membranes [PPROM], provider initiated) and were adjusted for maternal characteristics. Over 44.5% of infants with gastroschisis were born preterm because of spontaneous etiologies; notably, 8.4% of infants with gastroschisis were born <34 weeks because of spontaneous etiologies (adjusted RRs 9.1-12.2). Overall, 53.7% of infants with gastroschisis were born preterm compared with only 6.9% of infants without gastroschisis (adjusted RR 15.2, 95% CI 13.6-19.5) and are at particularly high risk of spontaneous PTB. Nearly 9% of infants with gastroschisis delivered <34 weeks, regardless of preterm etiology, indicating that these infants are at great risk for PTB morbidities in addition to the complications from gastroschisis.
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Affiliation(s)
- Rebecca J Baer
- Department of Pediatrics, University of California San Diego, La Jolla, California.,California Preterm Birth Initiative, University of California San Francisco, San Francisco, California
| | - Christina D Chambers
- Department of Pediatrics, University of California San Diego, La Jolla, California
| | - Kelli K Ryckman
- Departments of Epidemiology and Pediatrics, University of Iowa, Iowa City, Iowa
| | - Scott P Oltman
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, California.,Departments of Epidemiology and Pediatrics, University of Iowa, Iowa City, Iowa.,Department of Epi and Biostats, University of California San Francisco, San Francisco, California
| | - Larry Rand
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, California.,Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California
| | - Laura L Jelliffe-Pawlowski
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, California.,Departments of Epidemiology and Pediatrics, University of Iowa, Iowa City, Iowa.,Department of Epi and Biostats, University of California San Francisco, San Francisco, California
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15
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Palatnik A, Loichinger M, Wagner A, Peterson E. The association between gestational age at delivery, closure type and perinatal outcomes in neonates with isolated gastroschisis. J Matern Fetal Neonatal Med 2018; 33:1393-1399. [PMID: 30173575 DOI: 10.1080/14767058.2018.1519538] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: The objective of this study was to examine the association between gestational age at delivery and closure type for neonates with gastroschisis. In addition, we compared perinatal outcomes among the cases of gastroschisis based on the following two factors: gestational age at delivery and abdominal wall closure technique.Methods: This was a retrospective cohort study of all fetuses with isolated gastroschisis that were diagnosed prenatally and delivered between September 2000 and January 2017, in a single tertiary care center. Neonates were compared based on the gestational age at the time of delivery: early preterm (less than 350/7 weeks), late preterm (350/7 - 366/7 weeks), and early term (370/6 - 386/7 weeks), using bivariate and multivariate analyses. The primary outcome was the type of abdominal wall closure: primary surgical closure or delayed closure using spring-loaded silo. Secondary outcomes included length of ventilatory support, length of parenteral nutrition, and length of hospital stay.Results: The analysis included 206 pregnancies complicated by gastroschisis. In univariate analysis, no differences were detected in primary closure rates of gastroschisis among the gestational age at delivery groups (67.4%, at <35 weeks, 70.8% at 350/7-366/7 weeks, 73.7% at 370/6-386/7 weeks, p = .865). However, for every additional 100 grams of neonatal live birth weight there was an associated 9% increased odds of primary closure (OR 1.09, 95% CI 1.14-1.19, p = .04). Delivery in the early preterm period compared to the other two groups, was associated with longer duration of ventilation support and longer dependence on the parenteral nutrition. Neonates who underwent primary closure had shorter ventilation support, shorter time to initiation of enteral feeds and to discontinue parenteral nutrition, and shorter length of stay. In multivariate analyses, controlling for gestational age at delivery and presence of bowel atresia, primary closure continued to be associated with the shorter duration of ventilation (by 5 days), earlier initiation of enteral feeds (by 7 days), shorter hospital stay (by 17 days) and lower odds of wound infection (OR = 0.37, 95% CI 0.15-0.97).Conclusions: Our study did not find an association between gestational age at delivery and the rates of primary closure of the abdominal wall defect; however later gestational age at delivery was associated with shorter duration of ventilatory support and parenteral nutrition dependence. In addition, we found that primary closure of gastroschisis, compared with delayed closure technique, was associated with improved neonatal outcomes, including shorter time to initiate enteral feeds and discontinue parenteral nutrition, shorter hospital stay, and lower risk of surgical wound infection. Therefore, postponing delivery of fetuses with gastroschisis until 37 weeks may be considered. Other factors besides the gestational age at delivery should be explored as predictors of primary closure in neonates with gastroschisis.
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Affiliation(s)
- Anna Palatnik
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Amy Wagner
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Erika Peterson
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA
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16
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Oakes MC, Porto M, Chung JH. Advances in prenatal and perinatal diagnosis and management of gastroschisis. Semin Pediatr Surg 2018; 27:289-299. [PMID: 30413259 DOI: 10.1053/j.sempedsurg.2018.08.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Gastroschisis is a congenital, ventral wall defect associated with bowel evisceration. The defect is usually to the right of the umbilical cord insertion and requires postnatal surgical correction. The fetus is at risk for complications such as intrauterine growth restriction, preterm delivery, and intrauterine fetal demise. In addition, complex cases, defined by the presence of intestinal complications such as bowel atresia, stenosis, perforation, or ischemia, occur in up to one third of pregnancies affected by gastroschisis. As complex gastroschisis is associated with increased morbidity and mortality, research has focused on the prenatal detection of this high risk subset of cases. The purpose of this review is to discuss the prenatal, diagnostic approach to the identification of gastroschisis, to describe potential signs of complex gastroschisis on prenatal ultrasound, to review current guidelines for antepartum management and delivery planning, and to summarize results of both past and current intervention trials in fetuses with gastroschisis.
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Affiliation(s)
- Megan C Oakes
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California Irvine Medical Center, Orange, CA, USA
| | - Manuel Porto
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California Irvine Medical Center, Orange, CA, USA
| | - Judith H Chung
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California Irvine Medical Center, Orange, CA, USA.
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17
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Fraga MV, Laje P, Peranteau WH, Hedrick HL, Khalek N, Gebb JS, Moldenhauer JS, Johnson MP, Flake AW, Adzick NS. The influence of gestational age, mode of delivery and abdominal wall closure method on the surgical outcome of neonates with uncomplicated gastroschisis. Pediatr Surg Int 2018; 34:415-419. [PMID: 29417204 DOI: 10.1007/s00383-018-4233-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/25/2018] [Indexed: 11/29/2022]
Abstract
AIM OF THE STUDY To evaluate if gestational age (GA), mode of delivery and abdominal wall closure method influence outcomes in uncomplicated gastroschisis (GTC). METHODS Retrospective review of NICU admissions for gastroschisis, August 2008-July 2016. Primary outcomes were: time to start enteral feeds (on-EF), time to discontinue parenteral nutrition (off-PN), and length of stay (LOS). MAIN RESULTS A total of 200 patients with GTC were admitted to our NICU. Patients initially operated elsewhere (n = 13) were excluded. Patients with medical/surgical complications (n = 62) were analyzed separately. The study included 125 cases of uncomplicated GTC. There were no statistically significant differences in the outcomes of patients born late preterm (34 0/7-36 6/7; n = 70) and term (n = 40): on-EF 19 (5-54) versus 17 (7-34) days (p = 0.29), off-PN 32 (12-101) versus 30 (16-52) days (p = 0.46) and LOS 40 (18-137) versus 37 (21-67) days (p = 0.29), respectively. Patients born before 34 weeks GA (n = 15) had significantly longer on-EF, off-PN and LOS times compared to late preterm patients: 26 (12-50) days (p = 0.01), 41 (20-105) days (p = 0.04) and 62 (34-150) days (p < 0.01), respectively. There were no significant differences in outcomes between patients delivered by C-section (n = 62) and patients delivered vaginally (n = 63): on-EF 20 (5-50) versus 19 (7-54) days (p = 0.72), off-PN 32 (12-78) versus 33 (15-105) days (p = 0.83), LOS 42 (18-150) versus 41 (18-139) days (p = 0.68), respectively. There were significant differences in outcomes between patients who underwent primary reduction (n = 37) and patients who had a silo (88): on-EF 15 (5-37) versus 22 (6-54) days (p < 0.01), off-PN 28 (12-52) versus 34 (15-105) days (p = 0.04), LOS 36 (18-72) versus 44 (21-150) days (p = 0.04), respectively. CONCLUSION In our experience, late preterm delivery did not affect outcomes compared to term delivery in uncomplicated GTC. Outcomes were also not influenced by the mode of delivery. Patients who underwent primary reduction had better outcomes than patients who underwent silo placement.
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Affiliation(s)
- Maria V Fraga
- Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Pablo Laje
- Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA.
| | - William H Peranteau
- Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Holly L Hedrick
- Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Nahla Khalek
- Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Juliana S Gebb
- Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Julie S Moldenhauer
- Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Mark P Johnson
- Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Alan W Flake
- Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - N Scott Adzick
- Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA
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18
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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: 33] [Impact Index Per Article: 4.7] [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.
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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
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19
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Song YK, Nunez Lopez O, Mehta HB, Bohanon FJ, Rojas-Khalil Y, Bowen-Jallow KA, Radhakrishnan RS. Race and outcomes in gastroschisis repair: a nationwide analysis. J Pediatr Surg 2017; 52:1755-1759. [PMID: 28365103 PMCID: PMC7772778 DOI: 10.1016/j.jpedsurg.2017.03.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 03/05/2017] [Accepted: 03/07/2017] [Indexed: 01/27/2023]
Abstract
BACKGROUND The incidence of gastroschisis has increased 30% between the periods 1995-2005 and 2006-2012, with the largest increase in Black neonates born to Black mothers younger than 20years old. OBJECTIVE Racial disparities in peri- and post-operative outcomes have been previously identified in several types of adult and pediatric surgical patients. Is there an association between race and clinical outcomes and healthcare resource utilization in neonates with gastroschisis? METHODS Retrospective study using national administrative data from the Kid's Inpatient Database (KID) from 2006, 2009, and 2012 for neonates (age<28days) with gastroschisis. Multivariable logistic regression was constructed to determine the association of race and socioeconomic characteristics with complications and mortality; linear regression was used for length of stay and hospital charges. RESULTS We identified 3846 neonates with gastroschisis that underwent surgical repair, including 676 patients with complex gastroschisis. When controlling for birth weight, payer status, socioeconomic status, and hospital characteristics, Black neonates had increased odds of having complex gastroschisis and associated atresias. Mortality was higher in patients with complex gastroschisis, patients from the lowest income quartiles, and patients with Medicaid as primary payer (compared to those with private insurance). Length of stay (LOS) was increased in patients with complex gastroschisis, birth weight <2500g, and Medicaid patients. Hospital charges were higher in complex gastroschisis, Black and Hispanic neonates (as compared to Whites), males, birth weight <2500g, and Medicaid patients. CONCLUSIONS There is an association between race and complex gastroschisis, associated intestinal atresias, and total charges in neonates with gastroschisis. In addition, income status is associated with mortality and hospital charges while payer status is associated with complications, mortality, LOS, and hospital charges. Public health and prenatal interventions should target at-risk populations to improve clinical outcomes. PROGNOSIS STUDY Level of Evidence: II.
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Affiliation(s)
- Ye Kyung Song
- Department of Surgery, University of Texas Medical Branch, Galveston, TX
| | - Omar Nunez Lopez
- Department of Surgery, University of Texas Medical Branch, Galveston, TX
| | - Hemalkumar B Mehta
- Department of Surgery, University of Texas Medical Branch, Galveston, TX
| | - Fredrick J Bohanon
- Department of Surgery, University of Texas Medical Branch, Galveston, TX
| | | | | | - Ravi S Radhakrishnan
- Department of Surgery, University of Texas Medical Branch, Galveston, TX; Department of Pediatrics, University of Texas Medical Branch, Galveston, TX.
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20
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Tosello B, Zahed M, Guimond F, Baumstarck K, Faure A, Michel F, Claris O, Gire C, Berakdar I, Massardier J, D’Ercole C, Merrot T. Management and outcome challenges in newborns with gastroschisis: A 6-year retrospective French study. J Matern Fetal Neonatal Med 2016; 30:2864-2870. [DOI: 10.1080/14767058.2016.1265935] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Barthelemy Tosello
- Department of Neonatology, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Meriem Zahed
- Self-Perceived Health Assessment Research Unit, Aix-Marseille University, Marseille, France
| | - Floriane Guimond
- Department of Neonatology, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Karine Baumstarck
- Self-Perceived Health Assessment Research Unit, Aix-Marseille University, Marseille, France
| | - Alice Faure
- Department of Pediatric Surgery, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Fabrice Michel
- Pediatric Intensive Care Unit, Hôpital de la Timone, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Olivier Claris
- Department of Neonatology, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bron, France
| | - Catherine Gire
- Department of Neonatology, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Isabelle Berakdar
- Department of Obstetrics and Gynecology, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bron, France
| | - Jerome Massardier
- Department of Obstetrics and Gynecology, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bron, France
| | - Claude D’Ercole
- Department of Obstetrics and Gynecology, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Thierry Merrot
- Department of Pediatric Surgery, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
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21
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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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