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Vinogradov R, Muthupunnackal A, Moffat M, Rankin J. Genitourinary infection and gastroschisis: A systematic review and meta-analysis. Birth Defects Res 2024; 116:e2377. [PMID: 38946111 DOI: 10.1002/bdr2.2377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/24/2024] [Accepted: 06/11/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND Gastroschisis is a congenital anomaly of the umbilical ring with increasing prevalence, especially amongst younger mothers. There is increasing evidence that exposure to genitourinary infections (GUTI) may play an important role in the etiology of gastroschisis. This systematic review and meta-analysis aimed to identify, appraise, and summarize the literature on exposure to GUTI and gastroschisis. METHODS Six electronic databases (MEDLINE, EMBASE, Web of Science, Scopus, Cochrane Library electronic databases, and Prospero) were searched using a comprehensive search strategy. Citations and cited articles for all included studies were searched. Peer-reviewed, quantitative studies reporting an association of urinary tract infections (UTI) and/or sexually transmitted infections (STI) with gastroschisis were included. Prospero registration CRD42022377420. RESULTS A total of 2392 papers were identified via the searches of which 15 met our inclusion criteria and were included after title and abstract and full text screening. The study period for included studies ranged from 1995 to 2016, most were from the USA. Four studies considering exposure to STIs and five to UTIs were eligible to progress to meta-analysis. Meta-analysis identified a significantly increased risk of gastroschisis in association with periconceptional exposure to UTI [OR 1.54 (95% CI 1.29, 1.8)], STI [OR 1.4 (95% CI 1.01, 1.79)]. CONCLUSIONS Periconceptional exposure to GUTI is associated with an increased risk of gastroschisis. The prevention and timely treatment of GUTI amongst women of childbearing age may help to reduce the occurrence of gastroschisis.
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Affiliation(s)
- Raya Vinogradov
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- NIHR Applied Research Collaboration (ARC) North East and North Cumbria (NENC), Newcastle upon Tyne, UK
| | | | - Malcolm Moffat
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- NIHR Applied Research Collaboration (ARC) North East and North Cumbria (NENC), Newcastle upon Tyne, UK
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2
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Muniz TD, Rolo LC, Araujo Júnior E. Gastroschisis: embriology, pathogenesis, risk factors, prognosis, and ultrasonographic markers for adverse neonatal outcomes. J Ultrasound 2024; 27:241-250. [PMID: 38553588 PMCID: PMC11178761 DOI: 10.1007/s40477-024-00887-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 02/26/2024] [Indexed: 06/15/2024] Open
Abstract
Gastroschisis is the most common congenital defect of the abdominal wall, typically located to the right of the umbilical cord, through which the intestinal loops and viscera exit without being covered by the amniotic membrane. Despite the known risk factors for gastroschisis, there is no consensus on the cause of this malformation. Prenatal ultrasound is useful for diagnosis, prognostic prediction (ultrasonographic markers) and appropriate monitoring of fetal vitality. Survival rate of children with gastroschisis is more than 95% in developed countries; however, complex gastroschisis requires multiple neonatal interventions and is associated with adverse perinatal outcomes. In this article, we conducted a narrative review including embryology, pathogenesis, risk factors, and ultrasonographic markers for adverse neonatal outcomes in fetuses with gastroschisis. Prenatal risk stratification of gastroschisis helps to better counsel parents, predict complications, and prepare the multidisciplinary team to intervene appropriately and improve postnatal outcomes.
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Affiliation(s)
- Thalita Diógenes Muniz
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), Rua Belchior de Azevedo, 156 Apto. 111 Torre Vitoria, Vila Leopoldina, São Paulo, SP, CEP 05089-030, Brazil
| | - Liliam Cristine Rolo
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), Rua Belchior de Azevedo, 156 Apto. 111 Torre Vitoria, Vila Leopoldina, São Paulo, SP, CEP 05089-030, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), Rua Belchior de Azevedo, 156 Apto. 111 Torre Vitoria, Vila Leopoldina, São Paulo, SP, CEP 05089-030, Brazil.
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Baldacci S, Santoro M, Mezzasalma L, Pierini A, Coi A. Medication use during pregnancy and the risk of gastroschisis: a systematic review and meta-analysis of observational studies. Orphanet J Rare Dis 2024; 19:31. [PMID: 38287353 PMCID: PMC10826191 DOI: 10.1186/s13023-023-02992-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/12/2023] [Indexed: 01/31/2024] Open
Abstract
OBJECTIVES The aetiology of gastroschisis is considered multifactorial. We conducted a systematic review and meta-analysis to assess whether the use of medications during pregnancy, is associated with the risk of gastroschisis in offspring. METHODS PubMed, EMBASE, and Scopus were searched from 1st January 1990 to 31st December 2020 to identify observational studies examining the association between medication use during pregnancy and the risk of gastroschisis. The Newcastle-Ottawa Scale was used for the quality assessment of the individual studies. We pooled adjusted measures using a random-effect model to estimate relative risk [RR] and the 95% confidence interval [CI]. I2 statistic for heterogeneity and publication bias was calculated. RESULTS Eighteen studies providing data on 751,954 pregnancies were included in the meta-analysis. Pooled RRs showed significant associations between aspirin (RR 1.66, 95% CI 1.16-2.38; I2 = 58.3%), oral contraceptives (RR 1.52, 95% CI 1.21-1.92; I2 = 22.0%), pseudoephedrine and phenylpropanolamine (RR 1.51, 95% CI 1.16-1.97; I2 = 33.2%), ibuprofen (RR 1.42, 95% CI 1.26-1.60; I2 = 0.0%), and gastroschisis. No association was observed between paracetamol and gastroschisis (RR 1.16, 95% CI 0.96-1.41; I2 = 39.4%). CONCLUSIONS These results suggest that the exposure in the first trimester of pregnancy to over the counter medications (OTC) such as aspirin, ibuprofen, pseudoephedrine and phenylpropanolamine as well as to oral contraceptives, was associated with an increased risk of gastroschisis. However, these associations are significant only in particular subgroups defined by geographic location, adjustment variables and type of control. Therefore, further research is needed to investigate them as potential risk factors for gastroschisis, to assess their safety in pregnancy and to develop treatment strategies to reduce the risk of gastroschisis in offspring. PROSPERO registration number: CRD42021287529.
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Affiliation(s)
- Silvia Baldacci
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, Via G. Moruzzi 1, 56124, Pisa, Italy.
| | - Michele Santoro
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, Via G. Moruzzi 1, 56124, Pisa, Italy
| | - Lorena Mezzasalma
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, Via G. Moruzzi 1, 56124, Pisa, Italy
| | - Anna Pierini
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, Via G. Moruzzi 1, 56124, Pisa, Italy
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Alessio Coi
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, Via G. Moruzzi 1, 56124, Pisa, Italy
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Tepper NK, Chowdhury J, Moore CA, Werler MM, Mishkin K, Reefhuis J. Public health priorities for gastroschisis: Summary of a meeting sponsored by the Centers for Disease Control and Prevention and the March of Dimes. Birth Defects Res 2024; 116:e2299. [PMID: 38277411 PMCID: PMC10983047 DOI: 10.1002/bdr2.2299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/15/2023] [Accepted: 12/22/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND Gastroschisis has increased worldwide over several decades; however, there are significant gaps in understanding risk factors for development of the defect, particularly those that might be modifiable. Despite advances in survival, little is known about longer-term outcomes for affected individuals. METHODS On April 27- and 28, 2023, the National Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention (CDC) and March of Dimes sponsored a meeting entitled "Public Health Priorities for Gastroschisis". The meeting goals were to review current knowledge on gastroschisis, discuss research gaps, and identify future priorities for public health surveillance, research, and action related to gastroschisis. Meeting participants encompassed a broad range of expertise and experience, including public health, clinical care of individuals with gastroschisis, affected individuals and families, and representatives from professional organizations and federal agencies. RESULTS Several goals were identified for future public health surveillance and research, including focused theory-driven research on risk factors and increased study of longer-term effects of gastroschisis through improved surveillance. Certain public health actions were identified, that which could improve the care of affected individuals, including increased education of providers and enhanced resources for patients and families. CONCLUSIONS These efforts may lead to an improved understanding of pathogenesis, risk factors, and outcomes and to improved care throughout the lifespan.
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Affiliation(s)
- Naomi K. Tepper
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Julia Chowdhury
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | | | - Jennita Reefhuis
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Liu S, Claude H, Yong SJ, Chen D. Association of maternal depression and hypothyroidism with infant gastroschisis: a population-based cohort study in Canada. Sci Rep 2023; 13:7540. [PMID: 37161036 PMCID: PMC10170067 DOI: 10.1038/s41598-023-34090-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/24/2023] [Indexed: 05/11/2023] Open
Abstract
Gastroschisis has increased globally over recent decades, and this increase has not been explained by identified risk factors. We conducted a population-based study of infants born in Canada, 2004-2020. We used "winter" months (i.e., September through June) and northern areas of residence as indicators of less sunlight/less active lifestyle, while "summer" (i.e., July and August) and southern areas were considered as reference. Rate of gastroschisis for infants conceived in winter (3.4 per 10,000) was higher than for infants conceived in summer (2.2 per 10,000; p < 0.001). Exposure to winter, and northern area, hypothyroidism, substance or tobacco uses and depressive disorder were initially identified as risk factors for gastroschisis. There was a significant interaction between women < 24 years of age and 2-month conception intervals (rate ratio (RR): 1.42 (95% confidence interval [CI] 1.19-1.70). The association of maternal depression (mean ratio 2.19, 95% CI 0.87-3.50, p = 0.001) with infant gastroschisis was mediated by hypothyroidism (mean ratio 1.04, 95% CI 1.01-1.07, p < 0.001), whereas substance use, hypothyroidism, tobacco smoking and gestational diabetes showed 5.5-, 3.1-, 2.7-, and 1.2-fold associations, respectively, with maternal depression. In contrast to the summer conception interval of low gastroschisis risk, an elevated risk of gastroschisis spans the other ten months in association with higher levels of stress adaptation, thermoregulation and metabolism, reproduction, and growth effector hormones. Our findings suggest that periconception depression with mediation by hypothyroidism, may play a causal role in offspring gastroschisis.
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Affiliation(s)
- Shiliang Liu
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada.
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - Hughes Claude
- Reproductive Health Center of Excellence and Therapeutic Science and Strategy Unit, IQVIA & Department of OB-GYN, Duke University Medical Center, Durham, NC, USA
| | - Shin Jie Yong
- Department of Biological Sciences, School of Medical and Life Sciences, Sunway University, Selangor, Malaysia
| | - Dunjin Chen
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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6
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Regadas CT, Escosteguy CC, Fonseca SC, Pinheiro RS, Coeli CM. Trends in prevalence of gastroschisis in Brazil from 2007 to 2020: A national population-based cross-sectional study. Birth Defects Res 2023; 115:633-646. [PMID: 36757175 DOI: 10.1002/bdr2.2156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 01/23/2023] [Accepted: 01/26/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Gastroschisis is a congenital abnormality of the abdominal wall which worldwide prevalence is increasing with time. Up to now, young maternal age is the main factor associated with gastroschisis. Brazil has a great proportion of adolescent mothers. OBJECTIVES To estimate prevalence of gastroschisis in Brazil, explore the effect of very young maternal age, and analyze regional distribution and time trends. METHODS Cross-sectional population-based study using data from official national information systems from 2007 to 2020, covering 9,831 gastroschisis cases. Low maternal age was assessed as risk factor through odds ratio. Prevalence time trends by maternal age and geographic area were analyzed using joinpoint regression. RESULTS Overall prevalence of gastroschisis in Brazil was 2.47 per 10,000 births. From first to last biennium, there was a 23% relative increase. Last biennium prevalence was higher in the Central-west region and lower in the Northeast. Compared to mothers of 20-34 years old (YO), the odds-ratio for prevalence and 95% confidence intervals for gastroschisis were, as follows: (a) 10-14 YO-4.9 (4.3,5.5); (b) 15-19 YO-3.6 (3.5,3.8); and (c) 35-49 YO-0.3 (95% CI 0.3, 0.4). CONCLUSIONS Prevalence of gastroschisis in Brazil relatively increased 23% from 2007 to 2020. This happened in all maternal age groups. Differences between regions may be associated to data quality. Young mothers had a higher prevalence of gastroschisis and still higher for those under 15 YO. Mother age over 34 YO was a protective factor.
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Affiliation(s)
- Claudia Tavares Regadas
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- Hospital Federal dos Servidores do Estado, Rio de Janeiro, RJ, Brazil
- Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
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Sjöström K, Mount J, Klocker A, Arthurson V. A review of adverse events in animals and children after secondary exposure to transdermal hormone‐containing medicinal products. Vet Rec Open 2022; 9:e48. [DOI: 10.1002/vro2.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/13/2022] [Accepted: 10/10/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Karin Sjöström
- Veterinary Medicine Group Department of Drug Safety Swedish Medical Products Agency (Läkemedelsverket) Uppsala Sweden
| | - James Mount
- Veterinary Medicine Group Department of Drug Safety Swedish Medical Products Agency (Läkemedelsverket) Uppsala Sweden
| | - Anna‐Karin Klocker
- Veterinary Medicine Group Department of Drug Safety Swedish Medical Products Agency (Läkemedelsverket) Uppsala Sweden
| | - Veronica Arthurson
- Veterinary Medicine Group Department of Drug Safety Swedish Medical Products Agency (Läkemedelsverket) Uppsala Sweden
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8
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ElHassan NO, Sharma M, Akmyradov C, Kaiser JR, Goudie A, Nembhard WN. Childhood Educational Outcomes of Children Born with Gastroschisis. J Pediatr 2022; 240:110-116.e3. [PMID: 34499945 DOI: 10.1016/j.jpeds.2021.08.086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/26/2021] [Accepted: 08/31/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare third grade literacy and mathematics test proficiency among children born with gastroschisis vs unaffected controls and identify predictors of academic proficiency among these children. STUDY DESIGN Infants born with gastroschisis (2000-2005) were identified from the Arkansas Reproductive Health Monitoring System. For each case, 2 controls were selected at random from birth certificates and matched for hospital and month of birth, sex, and race/ethnicity. Data on rehospitalization within the first 6 years and payer data were abstracted from the Arkansas Hospital Inpatient Discharge database. Surviving cases and controls were linked to the Arkansas Department of Education database containing achievement test scores. The primary outcome was proficiency, defined as performance at or above grade level, on third grade achievement tests. Cases and controls who did not attend public schools could not be linked to education records. Multivariable logistic regression models evaluated the association between study characteristics and academic proficiency. RESULTS The final study cohort included 47 cases and 63 controls. There was no statistically significant difference in the rate of literacy (68% vs 81%; P = .65) or mathematics proficiency (89% vs 87%; P = .15) between cases and controls. On multivariable analysis, a complex gastroschisis (defined as atresia, volvulus, necrosis, or perforation of the bowel) was associated with lower proficiency in literacy (aOR, 0.1; 95% CI, 0.02-0.58; P = .01). No neonatal or maternal characteristics predictive of lower proficiency in mathematics were identified. CONCLUSIONS Among children born with gastroschisis, the presence of a complex gastroschisis was associated with lower proficiency on third grade literacy achievement tests.
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Affiliation(s)
- Nahed O ElHassan
- Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, AR; Arkansas Center for Birth Defects Research and Prevention, Little Rock, AR.
| | - Megha Sharma
- Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, AR
| | | | - Jeffrey R Kaiser
- Department of Pediatrics, Penn State Children's Hospital, Hershey, PA; Department of Obstetrics and Gynecology, Penn State Children's Hospital, Hershey, PA
| | - Anthony Goudie
- Department of Health Policy and Management, Fay W. Boozman College of Public Heath, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Wendy N Nembhard
- Arkansas Center for Birth Defects Research and Prevention, Little Rock, AR; Department of Epidemiology, Fay W. Boozman College of Public Heath, University of Arkansas for Medical Sciences, Little Rock, AR
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Le-Nguyen A, Piché N, Lee GE, Auger N. Maternal mental disorders and risk of pathological abdominal conditions in children. Arch Womens Ment Health 2021; 24:925-932. [PMID: 33834267 DOI: 10.1007/s00737-021-01126-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/30/2021] [Indexed: 11/24/2022]
Abstract
The etiology of pediatric abdominal disorders is poorly understood, and the relationship with maternal mental health is understudied. We sought to determine the association between maternal psychiatric disorders and abdominal conditions in childhood. We performed a retrospective cohort study of 1,080,518 newborns in Quebec, Canada, between 2006 and 2020. We identified maternal mental disorders before or during pregnancy and computed the incidence of abdominal disorders in offspring before 1 year of age. Outcomes included Hirschsprung disease; hypertrophic pyloric stenosis; and esophageal, intestinal, and biliary atresia. We calculated adjusted risk ratios (RR) with 95% confidence intervals (CI) for the association of maternal mental disorders with these pediatric abdominal disorders. Among 51,371 children exposed to maternal mental disorders, 200 children had an abdominal condition, for a rate of 38.9 cases per 10,000 children (95% CI 33.6-44.3) compared with 27.7 per 10,000 for children who were unexposed to maternal mental disorders (95% CI 26.7-28.7). Compared with no mental disorder, maternal mental disorders were associated with hypertrophic pyloric stenosis (RR 1.39, 95% CI 1.16-1.68). Associations were stronger for severe mental disorders and were more marked for depression and stress and anxiety disorders. Maternal mental disorders are associated with the risk of hypertrophic pyloric stenosis in offspring. The origin of hypertrophic pyloric stenosis may relate to maternal mental disorders that were present during pregnancy.
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Affiliation(s)
- Annie Le-Nguyen
- Department of General Surgery, University of Montreal, Montreal, Canada
| | - Nelson Piché
- Department of Pediatric Surgery, Sainte-Justine Hospital Centre for Children, University of Montreal, Montreal, Canada
| | - Ga Eun Lee
- University of Montreal Hospital Research Centre, Montreal, Canada.,Institut national de santé publique du Québec, Montreal, Canada
| | - Nathalie Auger
- University of Montreal Hospital Research Centre, Montreal, Canada. .,Institut national de santé publique du Québec, Montreal, Canada. .,Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Canada. .,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada.
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10
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Al Maawali A, Skarsgard ED. The medical and surgical management of gastroschisis. Early Hum Dev 2021; 162:105459. [PMID: 34511287 DOI: 10.1016/j.earlhumdev.2021.105459] [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] [Indexed: 10/20/2022]
Abstract
Gastroschisis (GS) is a full-thickness abdominal wall defect in which fetal intestine herniates alongside the umbilical cord into the intrauterine cavity, resulting in an intestinal injury of variable severity. An increased prevalence of gastroschisis has been observed across several continents and is a focus of epidemiologic study. Prenatal diagnosis of GS is common and allows for delivery planning and treatment in neonatal intensive care units (NICUs) by collaborative interdisciplinary teams (neonatology, neonatal nursing and pediatric surgery). Postnatal treatment focuses on closure of the defect, optimized nutrition, complication avoidance and a timely transition to enteral feeding. Babies born with complex GS are more vulnerable to complications, have longer and more resource intensive hospital stays and benefit from standardized care pathways provided by teams with expertise in managing infants with intestinal failure. This article will review the current state of knowledge related to the medical and surgical management and outcomes of gastroschisis with a special focus on the role of the neonatologist in supporting integrated team-based care.
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Affiliation(s)
| | - Erik D Skarsgard
- Department of Surgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
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Serunjogi R, Barlow-Mosha L, Mumpe-Mwanja D, Williamson D, Valencia D, Tinker SC, Adler MR, Namale-Matovu J, Kalibbala D, Nankunda J, Nabunya E, Birabwa-Male D, Byamugisha J, Musoke P. Comparative analysis of perinatal outcomes and birth defects amongst adolescent and older Ugandan mothers: evidence from a hospital-based surveillance database. Reprod Health 2021; 18:56. [PMID: 33663555 PMCID: PMC7934544 DOI: 10.1186/s12978-021-01115-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 02/22/2021] [Indexed: 12/17/2022] Open
Abstract
Background Uganda has one of the highest adolescent pregnancy rates in sub-Saharan Africa. We compared the risk of adverse birth outcomes between adolescents (age 12–19 years) and mothers (age 20–34 years) in four urban hospitals. Methods Maternal demographics, HIV status, and birth outcomes of all live births, stillbirths, and spontaneous abortions delivered from August 2015 to December 2018 were extracted from a hospital-based birth defects surveillance database. Differences in the distributions of maternal and infant characteristics by maternal age groups were tested with Pearson’s chi-square. Adjusted odds ratios (aORs) and 95% confidence intervals (CI) were calculated using logistic regression to compare the prevalence of adverse birth outcomes among adolescents to mothers 20–34 years. Results A total of 100,189 births were analyzed, with 11.1% among adolescent mothers and 89.0% among older mothers. Adolescent mothers had an increased risk of preterm delivery (aOR: 1.14; CI 1.06–1.23), low birth weight (aOR: 1.46; CI 1.34–1.59), and early neonatal deaths (aOR: 1.58; CI 1.23–2.02). Newborns of adolescent mothers had an increased risk of major external birth defects (aOR: 1.33; CI 1.02–1.76), specifically, gastroschisis (aOR: 3.20; CI 1.12–9.13) compared to mothers 20–34 years. The difference between the prevalence of gastroschisis among adolescent mothers (7.3 per 10,000 births; 95% CI 3.7–14.3) was statistically significant when compared to mothers 20–34 years (1.6 per 10,000 births; 95% CI 0.9–2.6). Conclusions This study found that adolescent mothers had an increased risk for several adverse birth outcomes compared to mothers 20–34 years, similar to findings in the region and globally. Interventions are needed to improve birth outcomes in this vulnerable population. Adolescent pregnancies are a global problem occurring in high-, middle-, and low-income countries with Uganda having one of the highest adolescent pregnancy rates in sub-Saharan Africa. We compared the risk of adverse birth outcomes, including major external birth defects, between adolescents, (age 12–19 years) and mothers (age 20–34 years) in four urban hospitals. All informative births, including live births, stillbirths, and spontaneous abortions; regardless of gestational age, delivered at four selected hospitals in Kampala from August 2015 to December 2018 were examined. Demographic data were obtained by midwives through maternal interviews and review of hospital patient notes. Of the 100,189 births, 11.0% were among adolescent mothers and 89.0% among mothers (20–34 years). Adolescent mothers were more likely than mothers (20–34 years) to have an infant with preterm delivery, low birth weight, early neonatal death, and major external birth defects. Adolescent pregnancies were also associated with an increased risk of gastroschisis when compared to mothers (20–34 years). In conclusion, this study found that adolescent mothers had an increased risk for several adverse birth outcomes compared to mothers 20–34 years. Research on the potential underlying causes or mechanisms for these adverse outcomes among adolescent births is necessary to identify possible interventions.
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Affiliation(s)
- Robert Serunjogi
- Makerere University-Johns Hopkins University Research Collaboration, P. O. Box 23491, Kampala, Uganda.
| | - Linda Barlow-Mosha
- Makerere University-Johns Hopkins University Research Collaboration, P. O. Box 23491, Kampala, Uganda
| | - Daniel Mumpe-Mwanja
- Makerere University-Johns Hopkins University Research Collaboration, P. O. Box 23491, Kampala, Uganda
| | - Dhelia Williamson
- US Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Diana Valencia
- US Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Sarah C Tinker
- US Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Michelle R Adler
- US Centers for Disease Control and Prevention (CDC), Kampala, Uganda
| | - Joyce Namale-Matovu
- Makerere University-Johns Hopkins University Research Collaboration, P. O. Box 23491, Kampala, Uganda
| | - Dennis Kalibbala
- Makerere University-Johns Hopkins University Research Collaboration, P. O. Box 23491, Kampala, Uganda
| | - Jolly Nankunda
- Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Evelyn Nabunya
- Department of Obstetrics and Gynaecology, College of Health Sciences, Makerere University Kampala, Kampala, Uganda
| | - Doreen Birabwa-Male
- Department of Obstetrics and Gynaecology, College of Health Sciences, Makerere University Kampala, Kampala, Uganda
| | - Josaphat Byamugisha
- Department of Obstetrics and Gynaecology, College of Health Sciences, Makerere University Kampala, Kampala, Uganda
| | - Philippa Musoke
- Makerere University-Johns Hopkins University Research Collaboration, P. O. Box 23491, Kampala, Uganda.,Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
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12
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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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13
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Asthma Medication Use and Risk of Birth Defects: National Birth Defects Prevention Study, 1997-2011. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:3490-3499.e9. [PMID: 32745701 DOI: 10.1016/j.jaip.2020.07.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/13/2020] [Accepted: 07/16/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Evidence regarding associations between maternal asthma medication use and birth defects is mixed. OBJECTIVE Estimate associations between asthma medciation use and 52 birth defects using National Birth Defects Prevention Study data from 1997 to 2011. METHODS We compared self-reported maternal asthma medication use for 28,481 birth defect cases and 10,894 nonmalformed controls. We calculated adjusted odds ratios (95% CIs) to estimate the risk of birth defects associated with early pregnancy asthma medication use (the month before through the third month of pregnancy), controlling for maternal age, race/ethnicity, body mass index, smoking, folic acid-containing supplement use, and parity. We calculated risks by medication groupings: bronchodilators, anti-inflammatories, and both. RESULTS Overall, 1304 (5%) case and 449 (4%) control women reported early pregnancy asthma medication use. We observed an association between asthma medication use and longitudinal limb deficiency (1.81; 95% CI, 1.27-2.58). Early pregnancy bronchodilator-only use was associated with cleft palate (1.50; 95% CI, 1.11-2.02), cleft lip (1.58; 95% CI, 1.12-2.23), longitudinal limb deficiency (2.35; 95% CI, 1.55-3.54), and truncus arteriosus (2.48; 95% CI, 1.13-5.42). Although early pregnancy anti-inflammatory-only use was not associated with the birth defects studied, use of both medications was associated with biliary atresia (3.60; 95% CI, 1.55-8.35) and pulmonary atresia (2.50; 95% CI, 1.09-5.78). CONCLUSIONS Consistent with previous National Birth Defects Prevention Study analyses, asthma medication use was not associated with most birth defects examined, but we observed modest risks for bronchodilator use and several birth defects. Our findings support maintaining adequate asthma treatment during pregnancy, because early pregnancy asthma exacerbations have been associated with adverse birth outcomes, including birth defects.
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14
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Raitio A, Tauriainen A, Leinonen MK, Syvänen J, Kemppainen T, Löyttyniemi E, Sankilampi U, Gissler M, Hyvärinen A, Helenius I. Maternal risk factors for gastroschisis: A population‐based case–control study. Birth Defects Res 2020; 112:989-995. [DOI: 10.1002/bdr2.1703] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/20/2020] [Accepted: 04/22/2020] [Indexed: 01/18/2023]
Affiliation(s)
- Arimatias Raitio
- Department of Paediatric Surgery and OrthopaedicsUniversity of Turku and Turku University Hospital Turku Finland
| | - Asta Tauriainen
- Department of Paediatric SurgeryKuopio University Hospital Kuopio Finland
| | - Maarit K Leinonen
- Information Services DepartmentFinnish Institute for Health and Welfare Helsinki Finland
| | - Johanna Syvänen
- Department of Paediatric Surgery and OrthopaedicsUniversity of Turku and Turku University Hospital Turku Finland
| | - Teemu Kemppainen
- Department of BiostatisticsUniversity of Turku and Turku University Hospital Turku Finland
| | - Eliisa Löyttyniemi
- Department of BiostatisticsUniversity of Turku and Turku University Hospital Turku Finland
| | - Ulla Sankilampi
- Department of PaediatricsKuopio University Hospital Kuopio Finland
| | - Mika Gissler
- Information Services DepartmentFinnish Institute for Health and Welfare Helsinki Finland
- Department of NeurobiologyCare Sciences and Society, Karolinska Institute Stockholm Sweden
| | - Anna Hyvärinen
- Department of Paediatric SurgeryTampere University Hospital and Tampere University Tampere Finland
| | - Ilkka Helenius
- Department of Paediatric Surgery and OrthopaedicsUniversity of Turku and Turku University Hospital Turku Finland
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15
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Spinder N, Almli LM, Desrosiers TA, Arnold KE, Bergman JEH, Kromhout H, Boezen HM, de Walle HEK, Rocheleau C, Reefhuis J. Maternal occupational exposure to solvents and gastroschisis in offspring - National Birth Defects Prevention Study 1997-2011. Occup Environ Med 2020; 77:172-178. [PMID: 31949041 PMCID: PMC7035687 DOI: 10.1136/oemed-2019-106147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/27/2019] [Accepted: 12/14/2019] [Indexed: 11/22/2022]
Abstract
Objectives The aim of this study was to assess the association between maternal occupational exposure to solvents and gastroschisis in offspring. Methods We used data from the National Birth Defects Prevention Study, a large population-based case-control study of major birth defects conducted in 10 US states from 1997 to 2011. Infants with gastroschisis were ascertained by active birth defects surveillance systems. Control infants without major birth defects were selected from vital records or birth hospital records. Self-reported maternal occupational histories were collected by telephone interview. Industrial hygienists reviewed this information to estimate exposure to aromatic, chlorinated and petroleum-based solvents from 1 month before conception through the first trimester of pregnancy. Cumulative exposure to solvents was estimated for the same period accounting for estimated exposure intensity and frequency, job duration and hours worked per week. ORs and 95% CIs were estimated to assess the association between exposure to any solvents or solvent classes, and gastroschisis risk. Results Among 879 cases and 7817 controls, the overall prevalence of periconceptional solvent exposure was 7.3% and 7.4%, respectively. Exposure to any solvent versus no exposure to solvents was not associated with gastroschisis after adjusting for maternal age (OR 1.00, 95% CI 0.75 to 1.32), nor was an association noted for solvent classes. There was no exposure-response relationship between estimated cumulative solvent exposure and gastroschisis after adjusting for maternal age. Conclusion Our study found no association between maternal occupational solvent exposure and gastroschisis in offspring. Further research is needed to understand risk factors for gastroschisis.
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Affiliation(s)
- Nynke Spinder
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, United States .,Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.,Department of Genetics, Univeristy of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Lynn M Almli
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Tania A Desrosiers
- Gillings School of Global Public Health, Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Kathryn E Arnold
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Jorieke E H Bergman
- Department of Genetics, Univeristy of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Hans Kromhout
- Institute for Risk Assessment Sciences, Division of Environmental Epidemiology, Utrecht University, Utrecht, Netherlands
| | - H Marike Boezen
- Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Hermien E K de Walle
- Department of Genetics, Univeristy of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Carissa Rocheleau
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio, United States
| | - Jennita Reefhuis
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
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16
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Parker SE, Yarrington C. Gastroschisis and mode of delivery: It's complex. Paediatr Perinat Epidemiol 2019; 33:213-214. [PMID: 31131917 DOI: 10.1111/ppe.12556] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 04/08/2019] [Indexed: 02/03/2023]
Affiliation(s)
- Samantha E Parker
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Christina Yarrington
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, Massachusetts
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17
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Wright N, Abantanga F, Amoah M, Appeadu-Mensah W, Bokhary Z, Bvulani B, Davies J, Miti S, Nandi B, Nimako B, Poenaru D, Tabiri S, Yifieyeh A, Ade-Ajayi N, Sevdalis N, Leather A. Developing and implementing an interventional bundle to reduce mortality from gastroschisis in low-resource settings. Wellcome Open Res 2019; 4:46. [PMID: 30984879 PMCID: PMC6456836 DOI: 10.12688/wellcomeopenres.15113.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2019] [Indexed: 12/14/2022] Open
Abstract
Background: Gastroschisis is associated with less than 4% mortality in high-income countries and over 90% mortality in many tertiary paediatric surgery centres across sub-Saharan Africa (SSA). The aim of this trial is to develop, implement and prospectively evaluate an interventional bundle to reduce mortality from gastroschisis in seven tertiary paediatric surgery centres across SSA. Methods: A hybrid type-2 effectiveness-implementation, pre-post study design will be utilised. Using current literature an evidence-based, low-technology interventional bundle has been developed. A systematic review, qualitative study and Delphi process will provide further evidence to optimise the interventional bundle and implementation strategy. The interventional bundle has core components, which will remain consistent across all sites, and adaptable components, which will be determined through in-country co-development meetings. Pre- and post-intervention data will be collected on clinical, service delivery and implementation outcomes for 2-years at each site. The primary clinical outcome will be all-cause, in-hospital mortality. Secondary outcomes include the occurrence of a major complication, length of hospital stay and time to full enteral feeds. Service delivery outcomes include time to hospital and primary intervention, and adherence to the pre-hospital and in-hospital protocols. Implementation outcomes are acceptability, adoption, appropriateness, feasibility, fidelity, coverage, cost and sustainability. Pre- and post-intervention clinical outcomes will be compared using Chi-squared analysis, unpaired t-test and/or Mann-Whitney U test. Time-series analysis will be undertaken using Statistical Process Control to identify significant trends and shifts in outcome overtime. Multivariate logistic regression analysis will be used to identify clinical and implementation factors affecting outcome with adjustment for confounders. Outcome: This will be the first multi-centre interventional study to our knowledge aimed at reducing mortality from gastroschisis in low-resource settings. If successful, detailed evaluation of both the clinical and implementation components of the study will allow sustainability in the study sites and further scale-up. Registration: ClinicalTrials.gov Identifier NCT03724214.
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Affiliation(s)
- Naomi Wright
- King's Centre for Global Health and Health Partnerships, School of Population Health and Environmental Sciences, King's College London, London, SE5 9RJ, UK
| | - Francis Abantanga
- Department of Surgery, Tamale Teaching Hospital, Tamale, P.O. Box TL 16, Ghana
| | - Michael Amoah
- Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, P.O.Box 1934, Ghana
| | | | - Zaitun Bokhary
- Department of Paediatric Surgery, Muhimbili National Hospital, Dar es Salaam, P.O Box 65000, Tanzania
| | - Bruce Bvulani
- Department of Paediatric Surgery, University Teaching Hospital of Lusaka, Lusaka, 10101, Zambia
| | - Justine Davies
- Global Health and Education Department, University of Birmingham, Birmingham, B15 2TT, UK
| | - Sam Miti
- Department of Paediatrics, Arthur Davison Children's Hospital, Ndola, Zambia
| | - Bip Nandi
- Department of Paediatric Surgery, Kamuzu Central Hospital, Lilongwe, P.O. Box 149, Malawi
| | - Boateng Nimako
- Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, P.O.Box 1934, Ghana
| | - Dan Poenaru
- McGill University, Montreal, Quebec, H3A 0G4, Canada
| | - Stephen Tabiri
- Department of Surgery, Tamale Teaching Hospital, Tamale, P.O. Box TL 16, Ghana
| | - Abiboye Yifieyeh
- Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, P.O.Box 1934, Ghana
| | - Niyi Ade-Ajayi
- Department of Paediatric Surgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Nick Sevdalis
- Centre for Implementation Science, King's College London, London, SE5 8AF, UK
| | - Andy Leather
- King's Centre for Global Health and Health Partnerships, School of Population Health and Environmental Sciences, King's College London, London, SE5 9RJ, UK
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18
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Hijkoop A, Rietman AB, Wijnen RMH, Tibboel D, Cohen-Overbeek TE, van Rosmalen J, IJsselstijn H. Gastroschisis at school age: what do parents report? Eur J Pediatr 2019; 178:1405-1412. [PMID: 31325028 PMCID: PMC6694033 DOI: 10.1007/s00431-019-03417-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/17/2019] [Accepted: 06/18/2019] [Indexed: 01/27/2023]
Abstract
Children with gastroschisis are at high risk of morbidity in early life, which could affect long-term outcomes. We determined parent-reported outcomes in school-aged children born in 2000-2012, using paper questionnaires. Parent-perceived child vulnerability and motor function were compared with the Dutch reference data; parent-rated data on cognition, health status, quality of life, and behavior were compared with those of controls matched for age, gender, and maternal education level. Of 77 eligible participants, 31 (40%) returned the questionnaires. Parent-reported motor function was normal in 23 (74%) children. Total scores on health status, quality of life, and behavior did not differ significantly from those of matched controls. Children with gastroschisis had lower scores on cognition (median (interquartile range); 109 (87-127)) than their matched controls (124 (113-140); p = 0.04). Neonatal intestinal failure and increased parent-perceived vulnerability were associated with lower scores on cognition (β - 25.66 (95% confidence interval - 49.41, - 1.91); - 2.76 (- 5.27, - 0.25), respectively).Conclusion: Parent-reported outcomes of school-aged children with gastroschisis were mainly reassuring. Clinicians and parents should be aware of the higher risk of cognitive problems, especially in those with neonatal intestinal failure or increased parent-perceived vulnerability. We recommend multidisciplinary follow-up at school age of children with gastroschisis and neonatal intestinal failure. What is Known: • Many infants with gastroschisis experience morbidity in early life. • Data on developmental outcomes and daily functioning in children with gastroschisis beyond the age of 5 years are scarce and conflicting. What is New: • Parents of school-aged children treated for gastroschisis report normal motor function, health status, quality of life, and behavior. • Children with gastroschisis, especially those with intestinal failure, may be at risk for cognitive problems at school age. Parents who reported their child as being more vulnerable also reported more cognitive problems at school age.
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Affiliation(s)
- Annelieke Hijkoop
- Department of Pediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Room SP-3506, P.O. Box 2060, 3000, CB, Rotterdam, The Netherlands.
| | - André B. Rietman
- Department of Pediatric Surgery and Intensive Care, Erasmus MC–Sophia Children’s Hospital, Room SP-3506, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands ,Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC–Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - René M. H. Wijnen
- Department of Pediatric Surgery and Intensive Care, Erasmus MC–Sophia Children’s Hospital, Room SP-3506, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Dick Tibboel
- Department of Pediatric Surgery and Intensive Care, Erasmus MC–Sophia Children’s Hospital, Room SP-3506, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Titia E. Cohen-Overbeek
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC–Sophia Children’s Hospital, Rotterdam, The Netherlands
| | | | - Hanneke IJsselstijn
- Department of Pediatric Surgery and Intensive Care, Erasmus MC–Sophia Children’s Hospital, Room SP-3506, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
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19
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Anderson JE, Galganski LA, Cheng Y, Stark RA, Saadai P, Stephenson JT, Hirose S. Epidemiology of gastroschisis: A population-based study in California from 1995 to 2012. J Pediatr Surg 2018; 53:2399-2403. [PMID: 30266482 PMCID: PMC6327946 DOI: 10.1016/j.jpedsurg.2018.08.035] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 08/25/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although the incidence of gastroschisis is increasing, risk factors are not clearly identified. METHODS Using the Linked Birth Database from the California Office of Statewide Health Planning and Development from 1995 to 2012, patients with gastroschisis were identified by ICD-9 diagnosis/procedure code or birth certificate designation. Logistic regressions examined demographics, birth factors, and maternal exposures on risk of gastroschisis. RESULTS The prevalence of gastroschisis was 2.7 cases per 10,000 live births. Patients with gastroschisis had no difference in fetal exposure to alcohol (p = 0.609), narcotics (p = 0.072), hallucinogenics (p = 0.239), or cocaine (p = 0.777), but had higher exposure to unspecified/other noxious substances (OR 3.27, p = 0.040; OR 2.02, p = 0.002). Gastroschisis was associated with low/very low birthweight (OR 5.08-16.21, p < 0.001) and preterm birth (OR 3.26-10.0, p < 0.001). Multivariable analysis showed lower risk in black (OR 0.44, p < 0.001), Asian/Pacific Islander (OR 0.76, p = 0.003), and Hispanic patients (OR 0.72, p < 0.001) compared to white patients. Risk was higher in rural areas (OR 1.24-1.76, p = 0.001). Compared to women age < 20, risk decreased with advancing maternal age (OR 0.49-OR 0.03, p < 0.001). Patients with gastroschisis had increased total charges ($336,270 vs. $9012, p < 0.001) and length of stay (38.1 vs. 2.9 days, p < 0.001). Mortality was 4.6%. CONCLUSIONS This is the largest population-based study summarizing current epidemiology of gastroschisis in California. TYPE OF STUDY Retrospective comparative cohort study. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Jamie E Anderson
- Division of Pediatric General, Thoracic, and Fetal Surgery, University of California, Davis Medical Center, Sacramento, CA.
| | - Laura A Galganski
- Division of Pediatric General, Thoracic, and Fetal Surgery, University of California, Davis Medical Center, Sacramento, CA
| | - Yvonne Cheng
- Division of Pediatric General, Thoracic, and Fetal Surgery, University of California, Davis Medical Center, Sacramento, CA
| | - Rebecca A Stark
- Division of Pediatric General, Thoracic, and Fetal Surgery, University of California, Davis Medical Center, Sacramento, CA
| | - Payam Saadai
- Division of Pediatric General, Thoracic, and Fetal Surgery, University of California, Davis Medical Center, Sacramento, CA
| | - Jacob T Stephenson
- Division of Pediatric General, Thoracic, and Fetal Surgery, University of California, Davis Medical Center, Sacramento, CA
| | - Shinjiro Hirose
- Division of Pediatric General, Thoracic, and Fetal Surgery, University of California, Davis Medical Center, Sacramento, CA
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20
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Wright NJ, Sekabira J, Ade-Ajayi N. Care of infants with gastroschisis in low-resource settings. Semin Pediatr Surg 2018; 27:321-326. [PMID: 30413264 PMCID: PMC7116007 DOI: 10.1053/j.sempedsurg.2018.08.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
There is great global disparity in the outcome of infants born with gastroschisis. Mortality approaches 100% in many low income countries. Barriers to better outcomes include lack of antenatal diagnosis, deficient pre-hospital care, ineffective neonatal resuscitation and venous access, limited intensive care facilities, poor access to the operating theatre and safe neonatal anesthesia, and lack of neonatal parenteral nutrition. However, lessons can be learned from the evolution in management of gastroschisis in high-income countries, generic efforts to improve neonatal survival in low- and middle-income countries as well as specific gastroschisis management initiatives in low-resource settings. Micro and meso-level interventions include educational outreach programs, and pre and in hospital management protocols that focus on resuscitation and include the delay or avoidance of early neonatal anesthesia by using a preformed silo or equivalent. Furthermore, multidisciplinary team training, nurse empowerment, and the intentional involvement of mothers in monitoring and care provision may contribute to improving survival. Macro level interventions include the incorporation of ultrasound into World Health Organisation antenatal care guidelines to improve antenatal detection and the establishment of the infrastructure to enable parenteral nutrition provision for neonates in low- and middle-income countries. On a global level, gastroschisis has been suggested as a bellwether condition for evaluating access to and outcomes of neonatal surgical care provision.
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Affiliation(s)
- Naomi J. Wright
- King’s Centre for Global Health and Health Partnerships, School of Population Health and Environmental Sciences, King’s College London, United Kingdom
| | - John Sekabira
- Paediatric Surgery Department, Mulago University Hospital, Kampala, Uganda
| | - Niyi Ade-Ajayi
- Paediatric Surgery Department, King's College Hospital, Denmark Hill, London SE5 9RS, United Kingdom.
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Haddock C, Skarsgard ED. Understanding gastroschisis and its clinical management: where are we? Expert Rev Gastroenterol Hepatol 2018; 12:405-415. [PMID: 29419329 DOI: 10.1080/17474124.2018.1438890] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Gastroschisis is the commonest developmental defect of the anterior abdominal wall in both developed and developing countries. The past 30 years have seen transformational improvements in outcome due to advances in neonatal intensive care and enhanced integration between the disciplines of maternal fetal medicine, neonatology and pediatric surgery. A review of gastroschisis, which emphasizes its epidemiology, multidisciplinary care strategies and contemporary outcomes is timely. Areas covered: This review discusses the current state of knowledge related to prevalence and causation, and postulated embryopathologic mechanisms contributing to the development of gastroschisis. Using relevant, current literature with an emphasis on high level evidence where it exists, we review modern techniques of prenatal diagnosis, pre and postnatal risk stratification, preferred timing and method of delivery, options for abdominal wall closure, nutritional management, and short and long term clinical and neurodevelopmental follow-up. Expert commentary: This section explores controversies in contemporary management which contribute to practice and cost variation and discusses the benefits of novel nutritional therapies and care standardization that target unnecessary practice variation and improve overall cost-effectiveness of gastroschisis care. The commentary concludes with a review of fertile areas of gastroschisis research, which represent opportunities for knowledge synthesis and further outcome improvement.
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Affiliation(s)
- Candace Haddock
- a Department of Surgery , British Columbia Children's Hospital , Vancouver , Canada
| | - Erik D Skarsgard
- a Department of Surgery , British Columbia Children's Hospital , Vancouver , Canada
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22
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Werler MM, Parker SE. The Gastroschisis Puzzle: Where are We and What is Next? Paediatr Perinat Epidemiol 2017; 31:560-562. [PMID: 29096040 DOI: 10.1111/ppe.12423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Martha M Werler
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Samantha E Parker
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
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