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Tahkola E, Luoto T, Pakarinen MP. Management and Outcomes of Intestinal Atresia - A Single Institution Experience From 1947 to 2019. J Pediatr Surg 2024:S0022-3468(24)00417-2. [PMID: 39097495 DOI: 10.1016/j.jpedsurg.2024.07.007] [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: 03/27/2024] [Revised: 06/25/2024] [Accepted: 07/04/2024] [Indexed: 08/05/2024]
Abstract
AIM OF THE STUDY We aimed to evaluate disease characteristics, associated malformations and surgical outcomes of congenital intestinal atresia. METHODS We identified all patients with jejunoileal (JIA) or colonic atresia (CA) treated at the Helsinki University Children's hospital during 1947-2019 and collected clinical data retrospectively from archived and electronic medical records. RESULTS Of the 180 included patients, 156 had JIA and 24 CA. Overall survival improved markedly from 34% during 1947-1977 to 93% during 1978-2019. Rate of primary anastomosis (81% in JIA, 21% in CA) remained unchanged while early surgical complications decreased (32% vs 18%, P = 0.04) and prematurity rate increased (21% vs 45%, P = 0.002) among JIA patients over time. Around half of patients had associated, mostly gastrointestinal malformations which occurred comparably in JIA and CA. During 1978-2019, 20 (21%) JIA patients, but none of CA patients, developed short bowel syndrome. Presence of type 3b atresia (n = 16) or gastroschisis (n = 14), but not the extent of intestinal resection or surgical complications, was associated with development of short bowel syndrome without decreasing survival. Shorter primary bowel resection without tapering surgery in JIA predisposed to repeated resections due to obstructive symptoms, and prolonged duration of parenteral nutrition. CONCLUSION Survival of patients with JIA and CA has improved remarkably over time and is currently high despite frequent prematurity and associated malformations. In patients with JIA, apple peel atresia and gastroschisis predisposed to short bowel syndrome without jeopardizing high survival rates. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Esko Tahkola
- Department of Pediatric Surgery, Kuopio University Hospital, Finland and University of Helsinki, Finland.
| | - Topi Luoto
- Department of Pediatric Surgery, Tampere University Hospital, Tampere, Finland
| | - Mikko P Pakarinen
- Section of Pediatric Surgery, Pediatric Liver and Gut Research Group, Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Lotakis DM, Parekh B, Kim AG, Speck KE. Management of Complex Gastroschisis: Early Primary Anastomoses at the Time of Abdominal Wall Closure. Am Surg 2023; 89:6293-6295. [PMID: 36794527 DOI: 10.1177/00031348231157413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- Dimitra M Lotakis
- Section of Pediatric Surgery, Department of Surgery, Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Bela Parekh
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Aimee G Kim
- Section of Pediatric Surgery, Department of Surgery, Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - K Elizabeth Speck
- Section of Pediatric Surgery, Department of Surgery, Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
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Sparre S, Zachariassen G, Ellebæk MB, Husby S, Holm KG. Feeding Practice, Nutrition, and Growth in Infants with Abdominal Wall Defects and Esophageal Atresia: A Retrospective Case-Control Study. Eur J Pediatr Surg 2023; 33:367-376. [PMID: 36588282 DOI: 10.1055/s-0042-1757360] [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: 01/03/2023]
Abstract
INTRODUCTION Infants born with abdominal wall defects and esophageal atresia (EA) are at risk of impaired growth. Little is known about the optimal nutritional strategy and its impact on growth for these infants. This study aims to explore nutrition, focusing on breastfeeding, and the presumed impact on infant growth during the first year of life. MATERIALS AND METHODS We performed a registry study. The participants comprised infants born with gastroschisis, omphalocele, or EA from 2009 to 2020. Breastfed healthy infants from the Odense Child Cohort served as the control group. Descriptive statistics were applied when presenting data on nutrition. Growth data were converted to weight z-scores at birth and at discharge, and estimated weight z-scores at 6 and 12 months were calculated. Univariate regression analysis was applied. RESULTS The study included 168 infants in the study group and 403 infants in the control group. Exclusive breastfeeding rates at discharge were as follows: 55.7% (gastroschisis), 58.3% (omphalocele), 50.9% (EA), and 7.7% (long-gap EA). For the study group our data demonstrate no difference in growth at 1 year of age when comparing mother's milk to formula feeding. During the first year of life, infants in the study group showed slower growth compared with the control group. At 12 months of age, all infants had a mean weight z-score above -2. CONCLUSION Breastfeeding in infants with abdominal wall defects and EA can be established without compromising growth. Mother's milk can be recommended for infants with abdominal wall defects and EA.
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Affiliation(s)
- Signe Sparre
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense C, Denmark
- Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense C, Denmark
| | - Gitte Zachariassen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense C, Denmark
- Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense C, Denmark
- Odense Patient data Explorative Network, Odense University Hospital, Odense C, Denmark
| | - Mark Bremholm Ellebæk
- Surgical Research Unit, Odense University Hospital, Odense C, Denmark; University of Southern Denmark, Odense, Denmark
| | - Steffen Husby
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense C, Denmark
- Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense C, Denmark
| | - Kristina Garne Holm
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense C, Denmark
- Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense C, Denmark
- Odense Patient data Explorative Network, Odense University Hospital, Odense C, Denmark
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Sugita K, Muto M, Oshiro K, Kuda M, Kinjyo T, Masuya R, Machigashira S, Kawano T, Nakame K, Torikai M, Ibara S, Kaji T, Ieiri S. Is anemia frequently recognized in gastroschisis compared to omphalocele? A multicenter retrospective study in southern Japan. Pediatr Surg Int 2022; 38:1249-1256. [PMID: 35764762 DOI: 10.1007/s00383-022-05150-x] [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] [Accepted: 06/04/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE We compared cases of anemia in gastroschisis versus omphalocele and investigated this clinical question. METHODS A multicenter study of five pediatric surgery departments in southern Japan was planned. Sixty patients were collected between 2011 and 2020, with 33 (gastroschisis: n = 19, omphalocele: n = 14) who met the selection criteria ultimately being enrolled. Anemia was evaluated before discharge and at the first outpatient visit. RESULTS Despite gastroschisis cases showed more frequent iron administration during hospitalization than omphalocele (p = 0.015), gastroschisis cases tended to show lower hemoglobin values at the first outpatient visit than omphalocele cases (gastroschisis: 9.9 g/dL, omphalocele: 11.2 g/dL). Gastroschisis and the gestational age at birth were significant independent predictors of anemia at the first outpatient visit, (gastroschisis: adjusted odds ratio [OR] 19.00, p = 0.036; gestational age at birth: adjusted OR 0.341, p = 0.028). A subgroup analysis for gastroschisis showed that the ratio of anemia in the 35-36 weeks group (8/10, 80.0%) and the > 37 weeks group (6/6, 100%) was more than in the < 34 weeks group (0/3, 0.0%). CONCLUSIONS Gastroschisis may carry an increased risk of developing anemia compared with omphalocele due to the difference of direct intestinal exposure of amnion fluid in utero.
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Affiliation(s)
- Koshiro Sugita
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Mitsuru Muto
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Kiyotetsu Oshiro
- Department of Pediatric Surgery, Nanbu Medical Center and Children's Medical Center, Okinawa, Japan
| | - Masaaki Kuda
- Department of Digestive and General Surgery, Graduate School of Medicine, University of Ryukyu, Okinawa, Japan
| | - Tsukasa Kinjyo
- Department of Pediatric Surgery, Nanbu Medical Center and Children's Medical Center, Okinawa, Japan
| | - Ryuta Masuya
- Division of Gastrointestinal, Endocrine and Pediatric Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Seiro Machigashira
- Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Takafumi Kawano
- Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Kazuhiko Nakame
- Division of Gastrointestinal, Endocrine and Pediatric Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Motofumi Torikai
- Department of Neonatal Medicine, Kagoshima City Hospital, Kagoshima, Japan
| | - Satoshi Ibara
- Department of Neonatal Medicine, Kagoshima City Hospital, Kagoshima, Japan
| | - Tatsuru Kaji
- Department of Pediatric Surgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Satoshi Ieiri
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan.
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Merritt RJ. Gastroschisis: Progress and Challenges. J Pediatr 2022; 243:8-11. [PMID: 34958830 DOI: 10.1016/j.jpeds.2021.12.049] [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: 11/29/2021] [Accepted: 12/21/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Russell J Merritt
- Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California.
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