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Martou L, Saxena AK. Morbidity in giant omphaloceles: Predictive factors and management strategies. Acta Paediatr 2024. [PMID: 39115971 DOI: 10.1111/apa.17387] [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: 07/11/2024] [Revised: 07/24/2024] [Accepted: 07/29/2024] [Indexed: 08/10/2024]
Abstract
AIM To identify predictors of morbidity in GO through an analysis of associated anomalies, defect characteristics and management strategies. METHODS PubMed and Ovid EMBASE databases were searched from 2013 to 2023. Primary end points assessed correlation of morbidity with gestational age (GA), birth weight (BW), eviscerated organs, defect size, associated anomalies and management strategy. RESULTS Twenty articles were included for analysis with a total of 1009 GO. Median GA was 37 weeks (27-41), with a median BW of 2700 g (900-6000). 143 cardiovascular anomalies, 238 pulmonary anomalies, 98 musculoskeletal anomalies, 53 urogenital anomalies, 94 gastrointestinal anomalies, 11 neurological anomalies and 43 chromosomal anomalies were identified. 82 had unspecified additional anomalies, of which 20 and 17 were defined as major and minor, respectively. 123 neonates were managed with primary closure, 206 neonates with staged closure and 312 neonates with conservative treatment. Complications included sepsis, respiratory compromise, feeding dysfunction and closure-related adverse events. Long-term morbidity included home ventilation (n = 72), long-term parental nutrition (n = 36), and delayed motor neurodevelopment (n = 21). Main predictors of morbidity were pulmonary hypertension/hypoplasia, major congenital anomalies, greater defect size and liver herniation. CONCLUSION Key predictors of poor outcomes include the presence of additional congenital anomalies, defect size, liver herniation and pulmonary hypertension/hypoplasia.
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Affiliation(s)
- Laura Martou
- Department of Paediatric Surgery, Chelsea Children's Hospital, Chelsea and Westminster NHS Foundation trust, Imperial College London, London, UK
| | - Amulya K Saxena
- Department of Paediatric Surgery, Chelsea Children's Hospital, Chelsea and Westminster NHS Foundation trust, Imperial College London, London, UK
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Malhotra R, Malhotra B, Ramteke H. Enhancing Omphalocele Care: Navigating Complications and Innovative Treatment Approaches. Cureus 2023; 15:e47638. [PMID: 38021990 PMCID: PMC10667945 DOI: 10.7759/cureus.47638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Congenital abdominal wall abnormalities in infants present an interesting and difficult management problem for surgeons. Congenital malformations of the ventral abdominal wall can be diagnosed by their distinctive anatomical presentations. Among them, omphalocele, gastroschisis and umbilical cord hernias are the most frequently observed clinically detected abdominal wall anomalies. Omphalocele refers to the herniation of abdominal contents through a defect in the abdominal wall at the umbilicus with or without the presence of a sac. This article gives an insight into the embryology, risk factors, treatment, investigations and complications of omphalocele, a common congenital abdominal wall defect. There is minimal proof that environmental factors contribute to the development of omphalocele. However, there is a considerable amount of evidence which points to the importance of genetic or familial risk factors. Newborns and infants with prenatal diagnoses are the most frequently presenting patients with omphalocele to paediatric surgeons. This article describes the problems and the steps of management for handling each circumstance, as well as any further complications. Omphalocele and gastroschisis are frequently described together in many research papers. However, it's crucial to consider that they are two different conditions which vary in anatomy, pathology and associated conditions which account for the difference in their treatments and noticeably varied outcomes. Additionally, there is evidence that each has a different set of factors associated with risk for occurrence. There are no known etiologic causes that cause these abnormalities to develop. The size of the baby, the extent of the lesion, and any other disorders all affect how individuals with these congenital abdominal wall anomalies are treated.
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Affiliation(s)
- Ritika Malhotra
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institue of Higher Education and Research, Wardha, IND
| | | | - Harshal Ramteke
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institue of Higher Education and Research, Wardha, IND
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3
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Ruptured omphalocele with ischemic bowels. Pediatr Neonatol 2022; 63:428-429. [PMID: 35396198 DOI: 10.1016/j.pedneo.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/08/2022] [Accepted: 03/02/2022] [Indexed: 11/21/2022] Open
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Marques AT, Estevão-Costa J, Soares H, Fragoso AC. Short and Medium-term Outcomes of Omphalocele and Gastroschisis: A Survey from a Tertiary Center. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:10-18. [PMID: 35092954 PMCID: PMC9948110 DOI: 10.1055/s-0041-1736299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To characterize and compare the outcomes of omphalocele and gastroschisis from birth to 2 years of follow-up in a recent cohort at a tertiary center. METHODS This is a retrospective clinical record review of all patients with gastroschisis and omphalocele admitted to the Neonatal Intensive Care Unit between January 2009 and December 2019. RESULTS There were 38 patients, 13 of whom had omphalocele, and 25 of whom had gastroschisis. Associated anomalies were present in 6 patients (46.2%) with omphalocele and in 10 (41.7%) patients with gastroschisis. Compared with patients with omphalocele, those with gastroschisis had younger mothers (24.7 versus 29.6 years; p = 0.033), were born earlier (36 versus 37 weeks, p = 0.006), had lower birth weight (2365 ± 430.4 versus 2944.2 ± 571.9 g; p = 0.001), and had a longer hospital stay (24 versus 9 days, p = 0.001). The neonatal survival rate was 92.3% for omphalocele and 91.7% for gastroschisis. Thirty-four patients were followed-up over a median of 24 months; 13 patients with gastroschisis (59.1%) and 8 patients with omphalocele (66.7%) had at least one adverse event, mainly umbilical hernia (27.3% vs 41.7%), intestinal obstruction (31.8% vs 8.3%), or additional surgical interventions (27.3% vs 33.3%). CONCLUSION Despite the high proportion of prematurity, low birth weight, and protracted recovery, gastroschisis and omphalocele (without chromosomal abnormalities) may achieve very high survival rates; on the other hand, complications may develop in the first years of life. Thus, a very positive perspective in terms of survival should be transmitted to future parents, but they should also be informed that substantial morbidity may occur in the medium term.
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Affiliation(s)
| | - José Estevão-Costa
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal.,Pediatric Surgery Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Henrique Soares
- Department of Pediatrics, Division of Neonatology, Faculty of Medicine of Porto, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Ana Catarina Fragoso
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal.,Pediatric Surgery Department, Centro Hospitalar Universitário de São João, Porto, Portugal
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Combined Staged Surgery and Negative-Pressure Wound Therapy for Closure of a Giant Omphalocele. Case Rep Pediatr 2021; 2021:5234862. [PMID: 34123450 PMCID: PMC8169269 DOI: 10.1155/2021/5234862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 05/21/2021] [Indexed: 11/18/2022] Open
Abstract
The management of giant omphaloceles had always been a point of interest for the pediatric surgeons. Many surgical techniques were proposed, but none of them succeeded to become the standard procedure in closing the congenital abdominal defect. We present a case of giant omphalocele in which we used staged surgical closure combined with a prosthetic patch, with negative-pressure therapy and, finally, definitive surgical closure. Even though a major complication occurred during the treatment, we were able to close the defect without any prosthetic material left in place.
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6
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Gastroschisis: A State-of-the-Art Review. CHILDREN-BASEL 2020; 7:children7120302. [PMID: 33348575 PMCID: PMC7765881 DOI: 10.3390/children7120302] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/08/2020] [Accepted: 12/14/2020] [Indexed: 01/17/2023]
Abstract
Gastroschisis, the most common type of abdominal wall defect, has seen a steady increase in its prevalence over the past several decades. It is identified, both prenatally and postnatally, by the location of the defect, most often to the right of a normally-inserted umbilical cord. It disproportionately affects young mothers, and appears to be associated with environmental factors. However, the contribution of genetic factors to the overall risk remains unknown. While approximately 10% of infants with gastroschisis have intestinal atresia, extraintestinal anomalies are rare. Prenatal ultrasound scans are useful for early diagnosis and identification of features that predict a high likelihood of associated bowel atresia. The timing and mode of delivery for mothers with fetuses with gastroschisis have been somewhat controversial, but there is no convincing evidence to support routine preterm delivery or elective cesarean section in the absence of obstetric indications. Postnatal surgical management is dictated by the condition of the bowel and the abdominal domain. The surgical options include either primary reduction and closure or staged reduction with placement of a silo followed by delayed closure. The overall prognosis for infants with gastroschisis, in terms of both survival as well as long-term outcomes, is excellent. However, the management and outcomes of a subset of infants with complex gastroschisis, especially those who develop short bowel syndrome (SBS), remains challenging. Future research should be directed towards identification of epidemiological factors contributing to its rising incidence, improvement in the management of SBS, and obstetric/fetal interventions to minimize intestinal damage.
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ELHassan NO, Young SG, Gokun Y, Wan F, Nembhard WN. Trends in prevalence and spatiotemporal distribution of gastroschisis in Arkansas, 1998-2015. Birth Defects Res 2020; 112:1484-1494. [PMID: 33179872 PMCID: PMC8756334 DOI: 10.1002/bdr2.1772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 06/30/2020] [Accepted: 07/02/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Arkansas (AR) had the highest prevalence of gastroschisis in a recent study including 15 U.S. states. Our objective was to evaluate trends in prevalence and the spatiotemporal distribution of gastroschisis in AR. METHODS Infants with gastroschisis, born 1998-2015, were identified from the Arkansas Reproductive Health Monitoring System. Birth record data were used as denominators for calculations. Maternal residence at delivery was geocoded for spatial analyses. Annual prevalence rates (PRs) were calculated. Joinpoint regression analysis was performed to examine trends in gastroschisis and report the annual percent changes (APCs) in PRs. Spatiotemporal analyses identified counties with unusually high PRs of gastroschisis. Poisson regression, including county, year, and county*year indicators, was fit to evaluate the PRs of gastroschisis, while adjusting for county-level maternal variables. RESULTS We identified 401 cases of gastroschisis among 694,459 live births. The overall PR of gastroschisis was 5.8/10,000 live births. The prevalence of gastroschisis had a significant APC of +5.3% (p < .0001) between 1998 and 2012, followed by a nonsignificant yearly average decrease of -17% through 2015 (p = 0.2). The Emerging Hot Spot Analysis and SaTScan identified an overlapping five-county cluster from 2006 to 2013. Poisson regression model, including county (inside vs. outside cluster), time (before vs. after 2006), and county*time indicators, was fit to evaluate the PRs of gastroschisis. The model did not confirm the presence of a spatiotemporal cluster, once it adjusted for county-level maternal characteristics (p = .549). CONCLUSION Close monitoring of rates of gastroschisis is warranted to determine if the PRs of gastroschisis continue to decline in AR.
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Affiliation(s)
- Nahed O ELHassan
- Department of Pediatrics (Neonatology), Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Arkansas Center for Birth Defects Research and Prevention, Little Rock, Arkansas, USA
| | - Sean G Young
- Arkansas Center for Birth Defects Research and Prevention, Little Rock, Arkansas, USA
- Department of Environmental and Occupational Health, Fay W. Boozman College of Public Heath, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Yevgeniya Gokun
- Arkansas Center for Birth Defects Research and Prevention, Little Rock, Arkansas, USA
- Department of Biostatistics, Fay W. Boozman College of Public Heath, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Fei Wan
- Arkansas Center for Birth Defects Research and Prevention, Little Rock, Arkansas, USA
- Department of Biostatistics, Fay W. Boozman College of Public Heath, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Division of Public Health Sciences, Washington University in St. Louis, St Louis, Missouri, USA
| | - Wendy N Nembhard
- Arkansas Center for Birth Defects Research and Prevention, Little Rock, Arkansas, USA
- Department of Epidemiology, Fay W. Boozman College of Public Heath, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Masden T, Moores DC, Radulescu A. A Rare Combination of Left-Sided Gastroschisis and Omphalocele in a Full-Term Neonate: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e923301. [PMID: 32900986 PMCID: PMC7491939 DOI: 10.12659/ajcr.923301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Left-sided gastroschisis is a rare congenital birth defect characterized by herniation of intra-abdominal organs through an abdominal wall defect to the left of the umbilicus. Approximately half of the 31 cases reported in the literature describe other associated anomalies. To the best of our knowledge, it has never been reported in association with an omphalocele. CASE REPORT Here, we present the case of a female newborn, 37 weeks gestational age, born with a 3×6 cm omphalocele and a left-sided gastroschisis with herniation of the small bowel. Both of these anomalies were managed separately, with initial placement of a silo bag on the gastroschisis defect and application of topical agents to the omphalocele until complete epithelialization was achieved. The herniated bowel at the gastroschisis site was reduced with the aid of the silo by 96 hours and the fascia then closed primarily. A gastrostomy tube (G-tube) was placed at 16 weeks of age because of poor oral intake. Definitive closure of the omphalocele and removal of the gastrostomy tube was achieved at 13 months. Her subsequent follow-up visits in the clinic have been uneventful. CONCLUSIONS Our case report highlights the importance of recognizing this combination of rare conditions and directing appropriate surgical care.
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Affiliation(s)
- Tyler Masden
- School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Donald C Moores
- Division of Pediatric Surgery, Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - Andrei Radulescu
- Division of Pediatric Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
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9
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Oluwafemi OO, Benjamin RH, Navarro Sanchez ML, Scheuerle AE, Schaaf CP, Mitchell LE, Langlois PH, Canfield MA, Swartz MD, Scott DA, Northrup H, Ray JW, McLean SD, Ludorf KL, Chen H, Lupo PJ, Agopian AJ. Birth defects that co-occur with non-syndromic gastroschisis and omphalocele. Am J Med Genet A 2020; 182:2581-2593. [PMID: 32885608 DOI: 10.1002/ajmg.a.61830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/22/2020] [Accepted: 07/30/2020] [Indexed: 01/24/2023]
Abstract
Gastroschisis and omphalocele are the two most common abdominal wall birth defects, and epidemiologic characteristics and frequency of occurrence as part of a syndromic condition suggest distinct etiologies between the two defects. We assessed complex patterns of defect co-occurrence with these defects separately using the Texas Birth Defects Registry. We used co-occurring defect analysis (CODA) to compute adjusted observed-to-expected (O/E) ratios for all observed birth defect patterns. There were 2,998 non-syndromic (i.e., no documented syndrome diagnosis identified) cases with gastroschisis and 789 (26%) of these had additional co-occurring defects. There were 720 non-syndromic cases with omphalocele, and 404 (56%) had additional co-occurring defects. Among the top 30 adjusted O/E ratios for gastroschisis, most of the co-occurring defects were related to the gastrointestinal system, though cardiovascular and kidney anomalies were also present. Several of the top 30 combinations co-occurring with omphalocele appeared suggestive of OEIS (omphalocele, exstrophy of cloaca, imperforate anus, spinal defects) complex. After the exclusion of additional cases with features suggestive of OEIS in a post-hoc sensitivity analysis, the top combinations involving defects associated with OEIS (e.g., spina bifida) were no longer present. The remaining top combinations involving omphalocele included cardiovascular, gastrointestinal, and urogenital defects. In summary, we identified complex patterns of defects that co-occurred more frequently than expected with gastroschisis and omphalocele using a novel software platform. Better understanding differences in the patterns between gastroschisis and omphalocele could lead to additional etiologic insights.
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Affiliation(s)
- Omobola O Oluwafemi
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth School of Public Health, Houston, Texas, USA
| | - Renata H Benjamin
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth School of Public Health, Houston, Texas, USA
| | - Maria Luisa Navarro Sanchez
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth School of Public Health, Houston, Texas, USA
| | - Angela E Scheuerle
- Department of Pediatrics, Division of Genetics and Metabolism, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Christian P Schaaf
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA.,Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, Texas, USA.,Heidelberg University, Institute of Human Genetics, Heidelberg, Germany
| | - Laura E Mitchell
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth School of Public Health, Houston, Texas, USA
| | - Peter H Langlois
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas, USA
| | - Mark A Canfield
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas, USA
| | - Michael D Swartz
- Department of Biostatistics and Data Science, UTHealth School of Public Health, Houston, Texas, USA
| | - Daryl A Scott
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA.,Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, Texas, USA
| | - Hope Northrup
- Department of Pediatrics, Division of Medical Genetics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Joseph W Ray
- Department of Pediatrics, Division of Medical Genetics and Metabolism, University of Texas Medical Branch, Galveston, Texas, USA
| | - Scott D McLean
- Clinical Genetics Section, Children's Hospital of San Antonio, San Antonio, Texas, USA
| | - Katherine L Ludorf
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth School of Public Health, Houston, Texas, USA
| | - Han Chen
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth School of Public Health, Houston, Texas, USA.,Center for Precision Health, UTHealth School of Public Health and UTHealth School of Biomedical Informatics, Houston, Texas, USA
| | - Philip J Lupo
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - A J Agopian
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth School of Public Health, Houston, Texas, USA
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Alexander G, Silva J, Curi B, Yancy J, Bogojevic A, Gaither K. Giant Omphalocele Complicated by 9P Minus Syndrome. J Natl Med Assoc 2020; 113:51-53. [PMID: 32747314 DOI: 10.1016/j.jnma.2020.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 07/10/2020] [Indexed: 10/23/2022]
Abstract
Omphalocele is characterized as a ventral wall defect in which there exists a midline herniation of abdominal viscera into the base of the umbilical cord. Fetuses with a diagnosis of this entity are at a significantly increased risk of having an aneuploidy, additional anomalies, or associations with other syndromes such as Beckwith Wiederman. Secondary to these interconnections, there is an elevated risk of fetal loss in affected pregnancies. Detection of concordant abnormalities, appropriate genetic counseling, and involvement of pediatric subspecialties are paramount in affording a prognosis, and providing optimal perinatal management of omphalocele.
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Affiliation(s)
| | - Jessica Silva
- NYC Health+Hospital/Lincoln, Department of Ob/Gyn, Bronx, NY
| | - Berenice Curi
- NYC Health+Hospital/Lincoln, Department of Ob/Gyn, Bronx, NY
| | - Jana Yancy
- NYC Health+Hospital/Lincoln, Department of Ob/Gyn, Bronx, NY
| | | | - Kecia Gaither
- NYC Health+Hospital/Lincoln, Department of Ob/Gyn, Bronx, NY.
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Anyanwu LJC, Ade-Ajayi N, Rolle U. Major abdominal wall defects in the low- and middle-income setting: current status and priorities. Pediatr Surg Int 2020; 36:579-590. [PMID: 32200405 PMCID: PMC7165143 DOI: 10.1007/s00383-020-04638-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/05/2020] [Indexed: 12/28/2022]
Abstract
Major congenital abdominal wall defects (gastroschisis and omphalocele) may account for up to 21% of emergency neonatal interventions in low- and middle-income countries. In many low- and middle-income countries, the reported mortality of these malformations is 30-100%, while in high-income countries, mortality in infants with major abdominal wall reaches less than 5%. This review highlights the challenges faced in the management of newborns with major congenital abdominal wall defects in the resource-limited setting. Current high-income country best practice is assessed and opportunities for appropriate priority setting and collaborations to improve outcomes are discussed.
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Affiliation(s)
| | - Niyi Ade-Ajayi
- Department of Paediatric Surgery, King’s College Hospital, London, UK
| | - Udo Rolle
- Department of Paediatric Surgery and Paediatric Urology, University Hospital Frankfurt/M., Theodor-Stern-Kai 7, 60598 Frankfurt, Germany
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12
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Kumari S, Singh DK, Gowda MT. Gastroschisis—A case report. J ANAT SOC INDIA 2018. [DOI: 10.1016/j.jasi.2018.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Nam MF, Kaneko JS, Intelizano PM, Ferreira RM, Oliveira NM, Mendonça MJ, Goularth AO, Campos LFA, Mastroti RA. Left-sided gastroschisis associated with situs inversus totalis. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2017.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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14
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Abstract
Fetal MRI is a level III diagnostic tool performed subsequently a level II prenatal ultrasound (US), in cases of inconclusive ultrasonographic diagnosis or when a further investigation is required to confirm or improve the diagnosis, to plan an appropriate pregnancy management. Fetal MRI plays an increasingly important role in the prenatal diagnosis of fetal neck, chest and abdominal malformations, even if its role has been amply demonstrated, especially, in the field of fetal CNS anomalies. Due to its multiparametricity and multiplanarity, MRI provides a detailed evaluation of the whole fetal respiratory, gastrointestinal and genitourinary systems, especially on T2-weighted (W) images, with a good tissue contrast resolution. In the evaluation of the digestive tract, T1-W sequences are very important in relation to the typical hyperintensity of the large intestine, due to the presence of meconium. The objective of this review is to focus on the application of fetal MRI in neck, chest and abdominal diseases.
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15
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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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16
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Not gastroschisis or omphalocele or anything in between: a novel congenital abdominal wall defect. Pediatr Surg Int 2017; 33:813-816. [PMID: 28271155 DOI: 10.1007/s00383-017-4076-5] [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: 02/22/2017] [Indexed: 10/20/2022]
Abstract
Congenital abdominal wall defects occur when normal embryonic development is interrupted and most commonly results in gastroschisis or omphalocele. Other entities, such as ruptured omphalocele, vanishing gastroschisis, and patent omphalomesenteric ducts with prolapse, have also been described and can create a confusing picture. This case of a newborn with a midline abdominal defect and a mass that was intestine-like and arose from the bowel cannot be classified, and no similar reports were found. This suggests a previously undescribed abdominal wall defect with an aberrant colonic appendage.
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Singh K, Kumar A. Anterior Abdominal Wall Defects, Diaphragmatic Hernia, and Other Major Congenital Malformations of the Musculoskeletal System in Barbados, 1993-2012. J Pediatr Genet 2017; 6:92-97. [PMID: 28496996 DOI: 10.1055/s-0037-1598186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 12/26/2016] [Indexed: 10/20/2022]
Abstract
This study describes the prevalence and patterns of major congenital malformations of the musculoskeletal system and the resulting morbidity and mortality. It is a retrospective population-based study over the period 1993 to 2012. The overall prevalence of major congenital malformations of the musculoskeletal system was 9.02/10,000 live births. The prevalences of omphalocele, gastroschisis, and diaphragmatic hernia were 2.53, 2.22, and 1.42 per 10,000 live births, respectively. The case fatality ratio for the omphalocele, gastroschisis, and diaphragmatic hernia was 12.5, 28.5, and 67%, respectively. In conclusion, the prevalence rate of the major congenital malformations of the musculoskeletal system was higher than those reported in retrospective studies from other countries and remained static during the study period. These defects were associated with a high mortality rate and contributed significantly to the overall neonatal mortality in this country.
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Affiliation(s)
- Keerti Singh
- Faculty of Medical Sciences, University of the West Indies, Cave Hill, Barbados
| | - Alok Kumar
- Faculty of Medical Sciences, University of the West Indies, Cave Hill, Barbados.,Department of Pediatrics, The Queen Elizabeth Hospital, Bridgetown, Barbados
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de Grijs D, Israelyan N, DeVore GR, Chen SC, Shekherdimian S. An unusual occurrence of isolated thoracoschisis. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2017. [DOI: 10.1016/j.epsc.2016.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Hibbs SD, Bennett A, Castro Y, Rankin KM, Collins JWJ. Abdominal Wall Defects among Mexican American Infants: The Effect of Maternal Nativity. Ethn Dis 2016; 26:165-70. [PMID: 27103766 DOI: 10.18865/ed.26.2.165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND US-born Mexican American women have greater rates of preterm birth and consequent overall infant mortality than their Mexico-born peers. However, the relation of Mexican American women's nativity to rates of congenital anomalies is poorly understood. Hispanic ethnicity and young maternal age are well-known risk factors for gastroschisis. OBJECTIVE To determine the extent to which nativity of Mexican American women is associated with abdominal wall defects. METHODS Stratified and multivariable logistic regression analyses were performed on the 2003-2004 National Center for Health Statistics linked live birth-infant death cohort. Only Mexican American infants were studied. Maternal variables examined included nativity, age, education, marital status, parity, and prenatal care usage. RESULTS Infants with US-born Mexican American mothers (n=451,272) had an abdominal wall defect rate of 3.9/10,000 compared with 2.0/10,000 for those with Mexico-born mothers (n=786,878), RR=1.9 (1.5-2.4). Though a greater percentage of US-born (compared wtih Mexico-born) Mexican American mothers were teens, the nativity disparity was actually widest among women in their 20s. The adjusted (controlling for maternal age, education, marital status, parity, and prenatal care) odds ratio of abdominal wall defects among infants of US-born (compared with Mexico-born) Mexican American mothers was 1.6 (1.2-2.0). CONCLUSIONS US-born Mexican American women have nearly a two-fold greater rate of delivering an infant with an abdominal wall defect than their Mexico-born counterparts. This phenomenon is only partially explained by traditional risk factors and highlights a detrimental impact of lifelong residence in the United States, or something closely related to it, on the pregnancy outcome of Mexican American women.
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Sonographic Diagnosis of Omphalocele in the Second Trimester of Pregnancy. JOURNAL OF FETAL MEDICINE 2016. [DOI: 10.1007/s40556-016-0071-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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21
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Makhmudi A, Sadewa AH, Aryandono T, Chatterjee S, Heij HA, Gunadi. Effects ofMTHFRc.677C>T,F2c.20210G>A andF5Leiden Polymorphisms in Gastroschisis. J INVEST SURG 2015; 29:88-92. [DOI: 10.3109/08941939.2015.1077908] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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22
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Marshall J, Salemi JL, Tanner JP, Ramakrishnan R, Feldkamp ML, Marengo LK, Meyer RE, Druschel CM, Rickard R, Kirby RS. Prevalence, Correlates, and Outcomes of Omphalocele in the United States, 1995–2005. Obstet Gynecol 2015; 126:284-293. [DOI: 10.1097/aog.0000000000000920] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Peters NCJ, Visser 't Hooft ME, Eggink AJ, Tibboel D, Ursem N, Wijnen RMH, Bonsel GJ, Cohen-Overbeek TE. Prenatal Prediction of the Type of Omphalocele Closure by Different Medical Consultants. Fetal Diagn Ther 2015; 39:40-9. [PMID: 26066620 DOI: 10.1159/000430439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 03/27/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION To evaluate differences between consultants of different disciplines in the prenatal prediction of the type of postnatal surgical closure of an omphalocele. MATERIAL AND METHODS Twenty-one images of prenatally detected omphaloceles prior to 24 weeks of gestation were included. A standardized form provided known prenatal information and an ultrasound image for each case. Nineteen consultants were asked to assess the probability of primary closure of an omphalocele and to state which information was the most important for their assessment. RESULTS Primary closure (13/21 images) was predicted correctly in 5/13 images. The number of correct predictions per image ranged from 63 to 89%. The type of closure was predicted correctly in 7/8 images of cases which were not closed primarily, ranging from 58 to 84% correct predictions per image. There was no significant difference between consultants of different disciplines. Individual accuracy ranged from 10 to 62%. The consultants regarded omphalocele content as the most important information (34%) for counseling. DISCUSSION The consultants did not differ in their prenatal judgment of the primary closure of an omphalocele. The consultants tended to be too negative in their assessment, since 75% assessed the probability of primary closure overall to be <60%, whereas 62% of the cases were primarily closed. Omphalocele content was the most important information for the consultants' judgment.
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Affiliation(s)
- Nina C J Peters
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynecology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
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GAD65/GAD67 double knockout mice exhibit intermediate severity in both cleft palate and omphalocele compared with GAD67 knockout and VGAT knockout mice. Neuroscience 2015; 288:86-93. [DOI: 10.1016/j.neuroscience.2014.12.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 12/11/2014] [Accepted: 12/13/2014] [Indexed: 12/24/2022]
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Cloacal exstrophy associated with gastroschisis: Case report of a rare association with favorable outcome. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2015. [DOI: 10.1016/j.epsc.2015.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Abstract
Gastroschisis is a congenital anomaly characterised by a defect in the anterior abdominal wall through which the intestinal contents freely protrude. Defect is located almost always to right of umbilicus. To our knowledge very few cases of left-sided gastroschisis have occurred and presented in literature. We report case of left-sided gastroschisis with caecal agenesis, short gut, and malrotation of intestine.
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Affiliation(s)
| | - Abdul Rafe
- Department of Surgery, Government Medical College and Hospital, Miraj District, Sangli, Maharashtra, India
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Shin JH, Jeon GW, Sin JB. Left-Sided Gastroschisis: A Rare Congenital Abdominal Wall Defect. NEONATAL MEDICINE 2015. [DOI: 10.5385/nm.2015.22.3.168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Jae Ho Shin
- Division of Pediatric Surgery, Department of Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Ga Won Jeon
- Department of Pediatrics, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jong Beom Sin
- Department of Pediatrics, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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Peters NCJ, Hooft MEV', Ursem NTC, Eggink AJ, Wijnen RMH, Tibboel D, Bonsel GJ, Cohen-Overbeek TE. The relation between viscero-abdominal disproportion and type of omphalocele closure. Eur J Obstet Gynecol Reprod Biol 2014; 181:294-9. [PMID: 25201609 DOI: 10.1016/j.ejogrb.2014.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 07/28/2014] [Accepted: 08/07/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To investigate the relation between prenatal ultrasound measurements of viscero-abdominal disproportion and the expected type of postnatal surgical closure of an omphalocele. STUDY DESIGN Retrospectively, 24 fetuses diagnosed with an isolated omphalocele in the 2nd trimester of pregnancy were selected (period 2003-2013). An image of the axial plane of the abdomen at the level of the defect was retrieved. The ratio of omphalocele circumference to abdominal circumference (OC/AC), and the ratio of defect diameter to abdominal diameter (DD/DA) were calculated. Prognostic outcome was primary closure. Sensitivity and specificity and the corresponding area under the ROC curve of these ratios were calculated as measurements of prognostic accuracy. RESULTS Primary closure was achieved in 15/24 cases. For the OC/AC-ratio a cut-off value of 0.82 successfully predicted outcome in 23/24 cases with an area under the ROC curve of 0.99. A cut-off value of 0.61 for the DD/DA-ratio successfully predicted type of closure in 20/24 cases with an area under the ROC curve of 0.88. In all cases without eviscerated liver tissue, the defect was primarily closed. CONCLUSION In prenatal isolated omphalocele cases, the OC/AC-ratio is better at predicting postnatal surgical closure than the DD/DA-ratio and can be used as a prognostic tool for expected type of closure in the 2nd trimester of pregnancy.
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Affiliation(s)
- Nina C J Peters
- Erasmus MC, University Medical Center Rotterdam, Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Rotterdam, The Netherlands.
| | - Michele E Visser 't Hooft
- Erasmus MC, University Medical Center Rotterdam, Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Rotterdam, The Netherlands
| | - Nicolette T C Ursem
- Erasmus MC, University Medical Center Rotterdam, Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Rotterdam, The Netherlands
| | - Alex J Eggink
- Erasmus MC, University Medical Center Rotterdam, Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Rotterdam, The Netherlands
| | - René M H Wijnen
- Erasmus MC, University Medical Center Rotterdam, Department of Pediatric Surgery, Rotterdam, The Netherlands
| | - Dick Tibboel
- Erasmus MC, University Medical Center Rotterdam, Department of Pediatric Surgery, Rotterdam, The Netherlands
| | - Gouke J Bonsel
- Erasmus MC, University Medical Center Rotterdam, Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Rotterdam, The Netherlands
| | - Titia E Cohen-Overbeek
- Erasmus MC, University Medical Center Rotterdam, Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Rotterdam, The Netherlands
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Deng K, Qiu J, Dai L, Yi L, Deng C, Mu Y, Zhu J. Perinatal mortality in pregnancies with omphalocele: data from the Chinese national birth defects monitoring network, 1996-2006. BMC Pediatr 2014; 14:160. [PMID: 24953381 PMCID: PMC4075420 DOI: 10.1186/1471-2431-14-160] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 06/12/2014] [Indexed: 12/15/2022] Open
Abstract
Background Previous studies on the mortality rate of omphalocele are limited. The risk of death of non-isolated omphalocele and that of cases of omphalocele that are diagnosed prenatally by ultrasound are unclear. This study aimed to estimate the perinatal mortality of pregnancies with omphalocele. This study also examined the potential risk of death of non-isolated omphalocele and that of cases that are prenatally diagnosed by ultrasound. Methods Data were retrieved from the national birth defects registry in China, for 1996–2006. Multinomial logistic regression was used to calculate the adjusted odds ratios (AORs) and 95% confidence intervals (CIs) between perinatal mortality and selected maternal and fetal characteristics. Results Among 827 cases of omphalocele, 309 (37.4%) cases resulted in termination of pregnancy and stillbirth, and 124 (15.0%) cases resulted in death in the first 7 days after delivery, yielding a perinatal mortality rate of 52.4% (95% CI: 49.0–55.8%). The late fetal death rate (LFDR) of omphalocele that was diagnosed prenatally by ultrasound was 15.91-fold (AOR: 15.91, 95% CI: 10.18–24.87) higher than that of postnatally diagnosed cases. The LFDR of non-isolated omphalocele was 2.64-fold (AOR: 2.64, 95% CI: 1.62–4.29) higher than that of isolated cases. For the early neonatal death rate, neonates with non-isolated omphalocele had a 2.96-fold (AOR: 2.96, 95% CI: 1.82–4.81) higher risk than isolated cases, but the difference between prenatal ultrasound diagnosis and postnatal diagnosis was not significant. Conclusions Selected fetal characteristics are significantly associated with the perinatal risk of death from omphalocele. Our findings suggest that improving pregnancy and delivery care, as well as management for omphalocele are important.
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Affiliation(s)
| | | | | | | | | | | | - Jun Zhu
- National Center for Birth Defects monitoring of China, West China Second University Hospital, Sichuan University, 17, Section3, Ren Min South Road, Chengdu, China.
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Faugstad TM, Brantberg A, Blaas HGK, Vogt C. Prenatal examination and postmortem findings in fetuses with gastroschisis and omphalocele. Prenat Diagn 2014; 34:570-6. [DOI: 10.1002/pd.4350] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 01/14/2014] [Accepted: 02/26/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Tone Maeland Faugstad
- Faculty of Medicine; Norwegian University of Science and Technology (NTNU); Trondheim Norway
| | - Anne Brantberg
- National Center for Fetal Medicine, Department of Obstetrics and Gynecology; St Olavs Hospital, Trondheim University Hospital; Trondheim Norway
| | - Harm-Gerd K. Blaas
- National Center for Fetal Medicine, Department of Obstetrics and Gynecology; St Olavs Hospital, Trondheim University Hospital; Trondheim Norway
- Department of Laboratory Medicine, Children's and Women's Health; Norwegian University of Science and Technology (NTNU); Trondheim Norway
| | - Christina Vogt
- Department of Laboratory Medicine, Children's and Women's Health; Norwegian University of Science and Technology (NTNU); Trondheim Norway
- Department of Pathology and Medical Genetics; St Olavs Hospital, Trondheim University Hospital; Trondheim Norway
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Abstract
OBJECTIVE To identify trends in the prevalence and epidemiologic correlates of gastroschisis using a large population-based sample with cases identified by the National Birth Defects Prevention Network over the course of an 11-year period. METHODS This study examined 4,713 cases of gastroschisis occurring in 15 states during 1995-2005, using public use natality data sets for denominators. Multivariable Poisson regression was used to identify statistically significant risk factors, and Joinpoint regression analyses were conducted to assess temporal trends in gastroschisis prevalence by maternal age and race and ethnicity. RESULTS Results show an increasing temporal trend for gastroschisis (from 2.32 per 10,000 to 4.42 per 10,000 live births). Increasing prevalence of gastroschisis has occurred primarily among younger mothers (11.45 per 10,000 live births among mothers younger than age 20 years compared with 5.35 per 10,000 among women aged 20 to 24 years). In the multivariable analysis, using non-Hispanic whites as the referent group, non-Hispanic black women had the lowest risk of having a gastroschisis-affected pregnancy (prevalence ratio 0.42, 95% confidence interval [CI] 0.37-0.48), followed by Hispanics (prevalence ratio 0.86, 95% CI 0.81-0.92). Gastroschisis prevalence did not differ by newborn sex. CONCLUSIONS Our findings demonstrate that the prevalence of gastroschisis has been increasing since 1995 among 15 states in the United States, and that higher rates of gastroschisis are associated with non-Hispanic white maternal race and ethnicity, and maternal age younger than 25 years (particularly younger than 20 years of age). LEVEL OF EVIDENCE III.
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Abstract
This article reviews the incidence, presentation, anatomy, and surgical management of abdominal wall defects found in the pediatric population. Defects such as inguinal hernia and umbilical hernia are common and are encountered frequently by the pediatric surgeon. Recently developed techniques for repairing these hernias are aimed at improving cosmesis and decreasing pain while maintaining acceptably low recurrence rates. Less common conditions such as femoral hernia, Spigelian hernia, epigastric hernia, lumbar hernia, gastroschisis, and omphalocele are also discussed. The surgical treatment of gastroschisis and omphalocele has undergone some advancement with the use of various silos and meshes.
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Esposito F, De Fronzo S, Migliaccio B, Oresta P. Palpable inguinal mass in a girl after omphalocele repair: US findings. J Ultrasound 2013; 16:33-5. [DOI: 10.1007/s40477-013-0008-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 12/08/2012] [Indexed: 11/28/2022] Open
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Duess JW, Fujiwara N, Corcionivoschi N, Puri P, Thompson J. ROCK inhibitor (Y-27632) disrupts somitogenesis in chick embryos. Pediatr Surg Int 2013; 29:13-8. [PMID: 23124130 DOI: 10.1007/s00383-012-3202-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AIM In chick embryos, administration of cadmium (Cd) induces ventral body wall defects (VBWD) similar to human omphalocele. It has been shown that failure of proper VBW formation may be due to disruption of somite development during early embryogenesis. In the VBWD chick model, Cd causes abnormal cell death in the somitic region resulting in improperly developed somites and tortuosity of the neural tube. However, the exact molecular mechanisms leading to VBWD still remain unclear. Wnt signaling is crucial during embryogenesis and plays a key role in normal somite formation. The Rho-associated coiled-coil containing protein kinase (ROCK) is involved in the non-canonical Wnt pathway which controls actin cytoskeleton assembly and cell contractility, and contributes to several developmental processes including somitogenesis. ROCK gene expression levels have recently been reported to be significantly decreased in the Cd-induced VBWD chick model. We designed this study to investigate the hypothesis that administration of ROCK inhibitor (Y-27632) in the absence of Cd disrupts somitogenesis and could contribute to the development of VBWD during early embryogenesis. METHODS After 60 h of incubation chick embryos were transferred from eggs to culture dishes containing 20 μM of Y-27632 for experimental group (Y-27, n = 22) or chick saline for controls (n = 14). Following 24 h in the incubator they were assessed for stage development and gross abnormalities in morphology using the dissecting microscope. Western blot was performed to confirm Y-27632 inhibition of ROCK downstream signaling using an antibody against phosphorylated cofilin-2. RESULTS 20 (90.9 %) embryos from Y-27 group and all controls were alive at examination. Morphological abnormalities were detected in 14 (70 %) Y-27 embryos. Somites appeared improperly developed, flattened in the cranio-caudal direction, and elongated in transverse direction in relation to controls. Chick embryos in Y-27 also presented with tortuosity of the neural tube in the lumbosacral region. Western blot analysis showed inhibition of cofilin-2 phosphorylation in affected embryos in comparison to controls. CONCLUSION Our study provides evidence that ROCK inhibitor results in the disruption of normal somitogenesis in chick embryos which may contribute to the failure of fusion of the anterior abdominal wall causing VBWD.
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Affiliation(s)
- Johannes W Duess
- National Children's Research Centre, Our Lady's Children's Hospital, Dublin, Ireland
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Abstract
Infants born with a giant omphalocele often require multiple surgeries requiring a lengthy hospital stay. These vulnerable infants may experience a long period of being NPO (nothing by mouth), followed by slowly advancing to enteral feeds. Human milk is the ideal method of nutrition for all infants and should be used to initiate enteral feeds in infants recovering from omphalocele closure surgeries. Human milk provides immunological, nutritional, and developmental benefits for high-risk infants and may play a critical role in preventing associated morbidities often associated with infants born with giant omphalocele. Because of the stress of hospitalization, mother-infant dyads should be targeted to receive extensive lactation support, which can help ensure maintenance of milk supply and successful transition to breastfeeding once the infant is healthy enough to do so. Two case studies are presented as exemplars, demonstrating that the provision of human milk for even the most vulnerable infants can be achieved.
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Paranjothy S, Broughton H, Evans A, Huddart S, Drayton M, Jefferson R, Rankin J, Draper E, Cameron A, Palmer SR. The role of maternal nutrition in the aetiology of gastroschisis: an incident case-control study. Int J Epidemiol 2012; 41:1141-52. [PMID: 22798661 DOI: 10.1093/ije/dys092] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Gastroschisis, a congenital anomaly involving a defect in the fetal abdominal wall, has increased in prevalence in many countries, but the aetiology is uncertain. We tested the hypothesis that high maternal alcohol consumption and poor diet in the first trimester are risk factors in a case-control study in the UK (1 July 2007 to 28 February 2010). METHODS Gastroschisis cases and three controls per case (matched for maternal age) were identified at 18- to 20-week routine anomaly screening ultrasound scan (USS). Interviews were carried out during the antenatal period (median 24 weeks' gestation) using a piloted questionnaire. Conditional logistic regression was used to describe the associations between exposure variables and gastroschisis, adjusted for known confounding variables. RESULTS The response rate was 73% for cases (n = 91) and 70% for controls (n = 217). High consumption of fruits and vegetables during the first trimester (aOR 0.2; 95% CI 0.04-0.6), taking folic acid for at least 6 weeks during the first trimester (aOR 0.3; 95% CI 0.1-0.7) and increasing body fat percentage of total maternal body weight (aOR 0.9; 95% CI 0.8-0.9 per 1% increase) were independently associated with reduced risk. Cigarette smoking (aOR 2.7; 95% CI 1.1-6.8) was an independent risk factor. CONCLUSION We report for the first time that higher intake of fruits and vegetables during the first trimester, longer duration of folic acid supplementation and higher body fat percentage are associated with reduced risk of fetal gastroschisis, independent of cigarette smoking. The increased risk of cigarette smoking is greatest in older women and in high socio-economic groups.
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Affiliation(s)
- Shantini Paranjothy
- Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK.
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The Eccentricities of Nourishing the Infant With Abdominal Anomalies. TOP CLIN NUTR 2012. [DOI: 10.1097/tin.0b013e3182628933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kuleva M, Salomon LJ, Benoist G, Ville Y, Dumez Y. The value of daily fetal heart rate home monitoring in addition to serial ultrasound examinations in pregnancies complicated by fetal gastroschisis. Prenat Diagn 2012; 32:789-96. [DOI: 10.1002/pd.3903] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- M. Kuleva
- Department of Obstetrics and Gynecology, Hôpital Necker Enfants Malades, Assistance Publique, Hôpitaux de Paris; Université Paris Descartes; Paris; France
| | | | | | | | - Y. Dumez
- Department of Obstetrics and Gynecology, Hôpital Necker Enfants Malades, Assistance Publique, Hôpitaux de Paris; Université Paris Descartes; Paris; France
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Bowel-defect disproportion in gastroschisis: does the need to extend the fascial defect predict outcome? Pediatr Surg Int 2012; 28:495-500. [PMID: 22331201 DOI: 10.1007/s00383-012-3055-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND/PURPOSE Validated outcome prediction for gastroschisis (GS) permits early risk stratification. The aim of our study was to determine whether the need for GS defect extension: (a) correlates with bowel injury severity at birth, and (b) predicts outcome. METHODS A national dataset was used to study GS babies born between 2005 and 2010. The primary outcome was days of parenteral nutrition (PN). Outcomes were analyzed according to the need for fascial extension to facilitate closure or silo placement as follows: Group 1, no extension; Group 2A, extension <2 cm; Group 2B, extension >2 cm. Univariate and where appropriate, multivariate analyses were used. RESULTS Of 507 cases, 402 had complete defect extension data: Group 1, 297 (73%); Group 2A, 67 (17%); Group 2B, 42 (10%). Group 2B patients had higher rates of atresia, perforation and severe matting (P = 0.001) and required more days on PN compared to Group 1 (63.0 ± 100.4 vs. 39.7 ± 44.5 days: CI 1.2-45.1; P = 0.03). Multivariate analysis revealed that the presence of atresia (P = 0.01) and surgical site (P = 0.001) or bloodstream (P = 0.001) infections were predictive of prolonged PN; however, the need for fascial extension was not. CONCLUSIONS GS newborns who require fascial extension are more likely to have complicated GS and are at greater risk for adverse outcome, although it is not an independent predictor of the latter.
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Alaani S. Report of three cases of unusual anterior abdominal wall defects in fallujah general hospital during the year 2010. THE JOURNAL OF IMA 2012; 44:jima-44-1-10354. [PMID: 23864990 PMCID: PMC3708633 DOI: 10.5915/44-1-10354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Abdominal wall defects occur when the normal sequence of the gastro intestinal tract development is interrupted. Gastroschisis represents a herniation of abdominal contents through a paramedian full-thickness abdominal wall fusion defect without involving the umbilical cord. Evisceration usually only contains intestinal loops and has no surrounding membrane unlike omphalocoele. It is unusual for a newborn with gastroschisis to have other serious birth defects. Neonates with gastroschisis have better prognosis than those with omphalocele. Very rarely is gastroschisis associated with herniation of other organs, and their presence makes the prognosis worse. I report three cases of unusual anterior abdominal wall defects during the year 2010, each having specific associated abnormalities. One was stillborn, and the other two died shortly after delivery.
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Affiliation(s)
- Samira Alaani
- Fallujah General Hospital, Althubbadh, Fallujah, Iraq
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Lončar D, Varjačić M, Lončar S. DIAGNOSIS OF GASTROSCHISIS IN THE FIRST TRIMESTER OF PREGNANCY - CASE REPORT. ACTA MEDICA MEDIANAE 2011. [DOI: 10.5633/amm.2011.0407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Folate and vitamin B12-related genes and risk for omphalocele. Hum Genet 2011; 131:739-46. [PMID: 22116453 DOI: 10.1007/s00439-011-1117-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 11/14/2011] [Indexed: 10/15/2022]
Abstract
Both taking folic acid-containing vitamins around conception and consuming food fortified with folic acid have been reported to reduce omphalocele rates. Genetic factors are etiologically important in omphalocele as well; our pilot study showed a relationship with the folate metabolic enzyme gene methylenetetrahydrofolate reductase (MTHFR). We studied 169 non-aneuploid omphalocele cases and 761 unaffected, matched controls from all New York State births occurring between 1998 and 2005 to look for associations with single nucleotide polymorphisms (SNPs) known to be important in folate, vitamin B12, or choline metabolism. In the total study population, variants in the transcobalamin receptor gene (TCblR), rs2232775 (p.Q8R), and the MTHFR gene, rs1801131 (c.1298A>C), were significantly associated with omphalocele. In African-Americans, significant associations were found with SNPs in genes for the vitamin B12 transporter (TCN2) and the vitamin B12 receptor (TCblR). A SNP in the homocysteine-related gene, betaine-homocysteine S-methyltransferase (BHMT), rs3733890 (p.R239Q), was significantly associated with omphalocele in both African-Americans and Asians. Only the TCblR association in the total population remained statistically significant if Bonferroni correction was applied. The finding that transcobalamin receptor (TCblR) and transporter (TCN2) SNPs and a BHMT SNP were associated with omphalocele suggests that disruption of methylation reactions, in which folate, vitamin B12, and homocysteine play critical parts, may be a risk factor for omphalocele. Our data, if confirmed, suggest that supplements containing both folic acid and vitamin B12 may be beneficial in preventing omphaloceles.
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44
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Choi SO, Jung E, Park WH. Umbilical Cord Hernia Containing Vermiform Appendix Adherent to the Sac. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2011. [DOI: 10.4174/jkss.2011.80.2.161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Soon-Ok Choi
- Department of Pediatric Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Eunyoung Jung
- Department of Pediatric Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Woo-Hyun Park
- Department of Pediatric Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
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Whitehall JS, Kandasamy Y, Stalewski H, Gill A. Perinatal demography of gastroschisis in North Queensland. J Paediatr Child Health 2010; 46:749-53. [PMID: 21166913 DOI: 10.1111/j.1440-1754.2010.01833.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To review the demography of gastroschisis in North Queensland. METHODS A retrospective chart review of live born cases of gastroschisis originating in North Queensland from 1988 to 2007. RESULTS Fifty-nine cases were identified, giving an overall rate of 3.2 per 10,000 live births. In mothers <20 years old compared with 20-24 and 25-29 it was 12.1, 6.3 and 1.7. Overall, the rate was higher in Indigenous mothers (6.6 vs. 2.6, OR 2.5; 95% CI 1.4-4.5, P= 0.0018). Overall, the rate increased significantly from 0.7 per 10,000 live births in the first 5 years of the study to 4.8 in the last (trend test P= 0.0015), but it increased particularly in mothers <20 years old, from 2.40 in the first 5 years to 19.3 in the last (trend test P= 0.0177). It also rose from 0 to 3.6 in those aged 25-29 (P= 0.0337) but remained stable in other age groups. There was no difference in the outcomes of babies born to Indigenous or non-Indigenous mothers, or in outcomes of babies delivered vaginally or by Caesarean section, or in outcomes of babies from any particular location in North Queensland. There was no significant difference in the average age of Indigenous and non-Indigenous mothers. CONCLUSION Gastroschisis is increasing in North Queensland, especially in mothers <20. Overall, the rate in Indigenous mothers is two to three times higher.
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Affiliation(s)
- John S Whitehall
- Townsville Hospital, Neonatal Intensive Care Unit, Douglas, Queensland, Australia.
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Frolov P, Alali J, Klein MD. Clinical risk factors for gastroschisis and omphalocele in humans: a review of the literature. Pediatr Surg Int 2010; 26:1135-48. [PMID: 20809116 DOI: 10.1007/s00383-010-2701-7] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2010] [Indexed: 10/19/2022]
Abstract
Gastroschisis and omphalocele are usually considered together since they are both congenital abdominal wall defects, and yet their anatomy, embryogenesis, and clinical presentation and problems are quite different. In addition, it appears that the risk factors for their occurrence differ. Etiologic factors contributing to the development of these defects are unknown. To investigate this we have reviewed reports of risk factors for each anomaly and report them here. We conducted a literature search using PubMed (http://www.ncbi.nlm.nih.gov/pubmed/) for risk factors implicated in the development of gastroschisis and omphalocele. The data reviewed here from clinical studies in the literature, closely parallels the data in animal studies which we reported earlier. There is little evidence for a genetic cause in the development of gastroschisis and much evidence supporting the possibility that environmental teratogens are important contributors to the development of this defect. On the other hand, in the case of omphalocele, there was little evidence for environmental factors and substantial data indicating that genetic or familial factors may play an important role.
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Affiliation(s)
- Polina Frolov
- Department of Surgery, Children's Hospital of Michigan, Wayne State University, 3901 Beaubien Street, Detroit, MI 48201-2119, USA
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Leadbeater K, Kumar R, Feltrin R. Ward reduction of gastroschisis: risk stratification helps optimise the outcome. Pediatr Surg Int 2010; 26:1001-5. [PMID: 20658297 DOI: 10.1007/s00383-010-2659-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Categorization of gastroschisis into low risk (simple) and high risk (complex) has been reported as an important determinant of outcome. The role of risk categorization in choosing the optimal surgical approach is unreported. This study aims to investigate the role of risk categorization in decision making for ward reduction of gastroschisis. METHODS Data on a cohort of 52 consecutive neonates with gastroschisis between 2000 and 2009 were reviewed. A clinical pathway based on risk categorization was implemented in 2004, and children with simple gastroschisis underwent ward reduction and those with complex gastroschisis underwent surgical closure. Thirty-three neonates since 2004 were analysed and compared to the 19 born prior to 2004. RESULTS Of the 33 children with gastroschisis in the study group, 23 were assessed as simple and underwent ward reduction with 96% survival. Ten had complex gastroschisis and underwent varying surgical procedures. Only six out of ten children (60%) with complex gastroschisis survived in spite of multiple surgical attempts. CONCLUSIONS Risk stratification of gastroschisis at birth helps in choosing optimal surgical management. Ward reduction can be successfully and safely performed in all children with simple gastroschisis. Those with complex gastroschisis require conventional surgical treatment.
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Affiliation(s)
- Kate Leadbeater
- Department of Paediatric Surgery, John Hunter Children's Hospital, Locked Bag 1, Hunter Region Mail Centre, Newcastle, NSW 2310, Australia
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Abstract
Gastroschisis (GS) continues to increase in frequency, with several studies now reported an incidence of between 4 and 5 per 10,000 live births. The main risk factor would seem to be young maternal age, and it is in this group that the greatest increase has occurred. Whilst various geographical regions confer a higher risk, the impact of several other putative risk factors, including smoking and illicit drug use, may be less important than when first identified in early epidemiological studies. Over 90% of cases of GS will now be diagnosed on antenatal ultrasound, but its value in determining the need for early delivery remains unclear. There would appear no clear evidence for either routine early delivery or elective caesarean section for infants with antenatally diagnosed GS. Delivery at a centre with paediatric surgical facilities reduces the risk of subsequent morbidity and should represent the standard of care. The relative roles of primary closure, staged closure and ward reduction, with or without general anaesthesia, appear less clear with considerable variation between centres in both the use of these techniques and subsequent surgical outcomes. Survival rates continue to improve, with rates well in excess of 90% now routine. The limited long-term developmental data available would suggest that normal or near-normal outcomes may be expected although there remains a need for further studies.
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Kandasamy Y, Whitehall J, Gill A, Stalewski H. Surgical management of gastroschisis in North Queensland from 1988 to 2007. J Paediatr Child Health 2010; 46:40-4. [PMID: 19943863 DOI: 10.1111/j.1440-1754.2009.01615.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AIM To review outcomes of gastroschises originating in North Queensland and repaired in the neonatal centre in Townsville from 1988-2007, and compare these outcomes with published data from other centres. METHODS A retrospective chart review of outcomes after primary operative repair (POR) with wound closure in fascial layers in the theatre, primary non-operative repair (PNOR) with apposition of the umbilical cord and adhesive dressing in the ward, secondary repair (SR) after a silo, and complex repair (CR) of cases with obstruction, perforation or atresiae. Epidemiological data of babies originating in North Queensland but managed in Brisbane were secured from Mater Mothers' Hospital and the Royal Hospital for Children. RESULTS Fifty cases were treated in Townsville: 16 by PNOR, 22 by POR, 6 by SR and 6 by CR. Outcomes of uncomplicated cases treated by PNOR, POR and SR were similar. Outcomes of complicated cases after CR were significantly worse. No significant differences were found between PNOR in Townsvillle and published outcomes after SR from four overseas units. No differences were detected in outcomes of inborn and outborn babies, those delivered by vaginal or caesarean birth or between indigenous and non-indigenous babies. Three (6%) died. Gastroschisis is increasing in North Queensland, particularly in younger mothers. The incidence is 2-3 times higher in indigenous mothers. CONCLUSION No significant differences were found between PNOR and other techniques for uncomplicated cases. PNOR avoids the use of theatre and staff, reducing delay and cost, and the need to transport a sick baby.
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Affiliation(s)
- Yoga Kandasamy
- Department of Neonatology, The Townsville Hospital, 100 Angus Smith Drive Douglas, Queensland, Australia
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Possible Association of Maternal Haemorrhoid with Congenital Abnormalities in their Children - a Population-Based Case-Control Study. Balkan J Med Genet 2010. [DOI: 10.2478/v10034-010-0015-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Possible Association of Maternal Haemorrhoid with Congenital Abnormalities in their Children - a Population-Based Case-Control StudyObjectives: To look for a possible association of maternal haemorrhoid during pregnancy with a risk of congenital abnormalities in their children.Methods: Comparison of the prevalence of medically-recorded haemorrhoid in pregnant women who had fetuses/newborns (cases) with congenital abnormalities and healthy babies (controls) in the population-based Hungarian Case-Control Surveillance System of Congenital Abnormalities.Results: Of 22,843 cases with congenital abnormalities, 798 (3.49%), while of 38,151 controls, 1,624 (4.26%) had mothers with recorded and usually treated severe haemorrhoids. We found a higher risk for exomphalos (OR with 95% CI: 4.9, 1.7-7.9), and malposition-malrotation of gut (OR with 95% CI: 17.2, 2.1-142.0) which were present in 14 and 8 children of pregnant women with haemorrhoid, respectively. These associations could not be explained by teratogenic effect of maternal haemorrhoid or by drug treatments, so we hypothesized a possible common genetic background.Conclusions: The higher frequency of exomphalos and malposition-malrotation of gut found in the children of mothers with haemorrhoid during pregnancy requires further study.
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