1
|
Jaczyńska R, Mikulska B, Nimer A, Mydlak D, Sawicka E, Maciejewski T. Prenatal ultrasound markers for prediction of complex gastroschisis-single-center retrospective cohort study. J Perinatol 2024; 44:1325-1334. [PMID: 38898181 DOI: 10.1038/s41372-024-02009-y] [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] [Received: 02/11/2024] [Revised: 04/22/2024] [Accepted: 05/14/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVE To evaluate prenatal ultrasound markers for distinguishing simple gastroschisis (sGS) from complex gastroschisis (cGS) and identifying fetuses at risk of complications. STUDY DESIGN A retrospective cohort study analyzed 61 fetuses with isolated gastroschisis at a tertiary center from 2011 to 2021, utilizing serial ultrasounds from 14 to 35 weeks' gestation. A general linear model, quantile regression, and logistic regression assessed ultrasound markers, fetal weeks, and gastroschisis risk, yielding predictive models. RESULTS IABL dilatation showed the highest PPV but low NPV. Non-free floating bowel loops (NFFBL) indicated the best PPV to NPV ratio. Combinations of markers yielded the highest predictive value for cGS. EABL collapsed and non-free floating bowel loops were significant, consistent risk factors. CONCLUSIONS Prenatal ultrasounds can predict cGS risk, particularly using IABL dilatation and NFFBL as markers. Accurate assessment requires considering gestational age, qualitative symptoms, emphasizing experienced perinatologists' role and monitoring, particularly after 30 weeks of gestation.
Collapse
Affiliation(s)
- Renata Jaczyńska
- Department of Obstetrics and Gyneacology, Institute of Mother and Child, Warsaw, Poland.
| | - Boyana Mikulska
- Department of Obstetrics and Gyneacology, Institute of Mother and Child, Warsaw, Poland
| | - Anna Nimer
- Department of Obstetrics and Gyneacology, Institute of Mother and Child, Warsaw, Poland
| | - Dariusz Mydlak
- Department of Pediatric and Adolescent Surgery, Institute of Mother and Child, Warsaw, Poland
| | - Ewa Sawicka
- Department of Pediatric and Adolescent Surgery, Institute of Mother and Child, Warsaw, Poland
| | - Tomasz Maciejewski
- Department of Obstetrics and Gyneacology, Institute of Mother and Child, Warsaw, Poland
| |
Collapse
|
2
|
Rundell MR, Bailey RA, Wagner AJ, Warner BB, Miller LE. Long-Term Neurodevelopmental Outcomes in Children with Gastroschisis: A Review of the Literature. Am J Perinatol 2024. [PMID: 38810899 DOI: 10.1055/s-0044-1787173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
This study aimed to investigate and present a review of the literature on long-term neurodevelopmental outcomes in children with gastroschisis. Gastroschisis is the most common abdominal wall defect. Children with gastroschisis are at high risk for premature birth, intestinal failure, sepsis, and repeated anesthesia exposure, which collectively increase the risk for adverse long-term neurodevelopmental outcomes. The existing literature on neurodevelopmental outcomes is limited in number, quality, and generalizability, creating a gap in clinical knowledge and care. Five internet databases were searched by a professional research librarian: Ovid MEDLINE, Scopus, Web of Science, PsycINFO, and Cochrane Library. Included articles were (1) published in English, (2) included postneonatal hospital discharge neurodevelopmental outcomes of children with gastroschisis, and (3) included patients under the age of 18 years. No date parameters were applied. The paucity of literature on long-term neurodevelopmental outcomes in gastroschisis children has left large gaps in the body of knowledge on post-hospital care of such children. In this review, 37 articles were found evaluating neurodevelopmental outcomes in gastroschisis and, while conclusions were contradictory, the literature broadly indicated the potential for neurodevelopmental deficits in the gastroschisis pediatric population. A significant limitation of this review was the heterogeneous samples included in available literature, which confounded the ability to determine cognitive risk of gastroschisis independent of other abdominal wall defects. Findings of this review demonstrate potential risk for neurodevelopmental deficits in the pediatric gastroschisis population exist, yet additional research is needed to definitively predict the significance, type, onset, and trajectory of neurodevelopmental impairment in this population. The significant gaps in long-term outcomes data have elucidated the need for prospective, longitudinal investigation of various cognitive domains in homogenous gastroschisis populations to properly evaluate prevalence of neurodevelopmental deficits and guide recommendations for long-term clinical care. KEY POINTS: · Limited literature exists regarding long-term neurodevelopmental outcomes in gastroschisis.. · There is some evidence to suggest worse cognitive behavioral outcomes in gastroschisis over time.. · Developmental surveillance, screening, and evaluation may be beneficial for gastroschisis patients..
Collapse
Affiliation(s)
- Maddie R Rundell
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Rachel A Bailey
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Amy J Wagner
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Barbara B Warner
- Department of Pediatrics, Washington University, St. Louis, Missouri
| | - Lauren E Miller
- Division of Neuropsychology, Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Jaczyńska R, Mydlak D, Mikulska B, Nimer A, Maciejewski T, Sawicka E. Perinatal Outcomes of Neonates with Complex and Simple Gastroschisis after Planned Preterm Delivery-A Single-Centre Retrospective Cohort Study. Diagnostics (Basel) 2023; 13:2225. [PMID: 37443619 DOI: 10.3390/diagnostics13132225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
This research analysed early neonatal outcomes of complex and simple gastroschisis following planned elective preterm delivery in relation to prenatal ultrasound assessment of bowel conditions. A retrospective study of 61 neonates with prenatal gastroschisis diagnosis, birth, and management at a single tertiary centre from 2011 to 2021 showed a 96.72% survival rate with no intrauterine fatalities. Most cases (78.7%) were simple gastroschisis. Neonates with complex gastroschisis had longer hospital stays and time to full enteral feeding compared to those with simple gastroschisis-75.4 versus 35.1 days and 58.1 versus 24.1 days, respectively. A high concordance of 86.90% between the surgeon's and perinatologist's bowel condition assessments was achieved. The caesarean delivery protocol demonstrated safety, high survival rate, primary closure, and favourable outcomes compared to other reports. Prenatal ultrasound effectively evaluated bowel conditions and identified complex gastroschisis cases.
Collapse
Affiliation(s)
- Renata Jaczyńska
- Department of Obstetrics and Gyneacology, Institute of Mother and Child, 01-211 Warsaw, Poland
| | - Dariusz Mydlak
- Department of Pediatrics Surgery, Institute of Mother and Child, 01-211 Warsaw, Poland
| | - Boyana Mikulska
- Department of Obstetrics and Gyneacology, Institute of Mother and Child, 01-211 Warsaw, Poland
| | - Anna Nimer
- Department of Obstetrics and Gyneacology, Institute of Mother and Child, 01-211 Warsaw, Poland
| | - Tomasz Maciejewski
- Department of Obstetrics and Gyneacology, Institute of Mother and Child, 01-211 Warsaw, Poland
| | - Ewa Sawicka
- Department of Pediatrics Surgery, Institute of Mother and Child, 01-211 Warsaw, Poland
| |
Collapse
|
5
|
Sun RC, Hessami K, Krispin E, Pammi M, Mostafaei S, Joyeux L, Deprest J, Keswani S, Lee TC, King A, Belfort MA, Shamshirsaz AA. Prenatal ultrasonographic markers for prediction of complex gastroschisis and adverse perinatal outcomes: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2022; 107:371-379. [PMID: 34607856 DOI: 10.1136/archdischild-2021-322612] [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: 06/09/2021] [Accepted: 09/17/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE We sought to perform a meta-analysis of the predictive value of antenatal ultrasonographic markers of bowel dilation, gastric dilation, polyhydramnios and abdominal circumference that predict complex gastroschisis and adverse perinatal outcomes DATA SOURCES: PubMed, Web of Science, Scopus and Embase were searched for relevant articles up to December 2020. Studies reporting prenatal ultrasonographic markers including intra-abdominal bowel dilation (IABD), extra-abdominal bowel dilation (EABD), bowel wall thickness, polyhydramnios, abdominal circumference <5th percentile, gastric dilation (GD) and bowel dilation not otherwise specified (BD-NOS) were included. The primary outcome was prediction of complex gastroschisis; secondary outcomes were length of hospital stay for newborn, time to full enteral feeding, postnatal mortality rate, incidence of necrotising enterocolitis and short bowel syndrome. RESULTS Thirty-six studies were included in this meta-analysis. We found significant associations between complex gastroschisis and IABD (OR=5.42; 95% CI 3.24 to 9.06), EABD (OR=2.27; 95% CI 1.40 to 3.66), BD-NOS (OR=6.27; 95% CI 1.97 to 19.97), GD (OR=1.88; 95% CI 1.22 to 2.92) and polyhydramnios (OR=6.93; 95% CI 3.39 to 14.18). Second trimester IABD and EABD have greater specificity for the prediction of complex gastroschisis than third trimester values with specificity of 95.6% (95% CI 58.1 to 99.7) and 94.6% (95% CI 86.7 to 97.9) for the second trimester IABD and EABD, respectively. CONCLUSION Prenatal ultrasonographic markers, especially the second trimester IABD and EABD, can identify fetuses that develop complex gastroschisis. Furthermore, these specific ultrasonographic markers can identify those babies at the highest risk for severe complications of this congenital anomaly and hence selected for future antenatal interventions.
Collapse
Affiliation(s)
- Raphael C Sun
- Division of Pediatric Surgery, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon, USA.,Division of Fetal Therapy and Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Kamran Hessami
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Eyal Krispin
- Division of Fetal Therapy and Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Mohan Pammi
- Section of Neonatology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Shayan Mostafaei
- Department of Biostatistics, Faculty of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran (the Islamic Republic of)
| | - Luc Joyeux
- MyFetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, Leuven, Belgium
| | - Jan Deprest
- Department of Obstetrics and Gynecology, Division Woman and Child, Fetal Medicine Unit, Katholieke Universiteit Leuven, Leuven, Belgium.,Institute of Women's Health, University College London Hospitals, University College London Medical School, London, UK
| | - Sundeep Keswani
- Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Timothy C Lee
- Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Alice King
- Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Michael A Belfort
- Division of Fetal Therapy and Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Alireza A Shamshirsaz
- Division of Fetal Therapy and Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| |
Collapse
|
6
|
Vlug LE, Verloop MW, Dierckx B, Bosman L, de Graaff JC, Rings EH, Wijnen RM, de Koning BA, Legerstee JS. Cognitive Outcomes in Children With Conditions Affecting the Small Intestine: A Systematic Review and Meta-analysis. J Pediatr Gastroenterol Nutr 2022; 74:368-376. [PMID: 35226646 PMCID: PMC8860224 DOI: 10.1097/mpg.0000000000003368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 11/09/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The aim of the study was to assess cognitive outcomes in children with intestinal failure (IF) and children at high risk of IF with conditions affecting the small intestine requiring parenteral nutrition. METHODS EMBASE, Cochrane, Web of Science, Google Scholar, MEDLINE, and PsycINFO were searched from inception to October 2020. Studies were included constituting original data on developmental quotient (DQ), intelligence quotient (IQ) and/or severe developmental delay/disability (SDD) rates assessed with standardized tests. We used appropriate standardized tools to extract data and assess study quality. We performed random effects meta-analyses to estimate pooled means of DQ/IQ and pooled SDD rates (general population mean for DQ/IQ: 100, for percentage with SDD: 1.8%) for 4 groups: IF, surgical necrotizing enterocolitis (NEC), abdominal wall defects (AWD), and midgut malformations (MM). Associations of patient characteristics with DQ/IQ were evaluated with meta-regressions. RESULTS Thirty studies met the inclusion criteria. The pooled mean DQ/IQ for IF, NEC, AWD, and MM were 86.8, 83.3, 96.6, and 99.5, respectively. The pooled SDD rates for IF, NEC, AWD and MM were 28.6%, 32.8%, 8.5%, and 3.7%, respectively. Meta-regressions indicated that lower gestational age, longer hospital stay, and higher number of surgeries but not parenteral nutrition duration, were associated with lower DQ/IQ. CONCLUSIONS Adverse developmental outcomes are common in children with IF and NEC, and to a much lesser extent in children with AWD and MM. It is important to monitor cognitive development in children with conditions affecting the small intestine and to explore avenues for prevention and remediation.
Collapse
Affiliation(s)
- Lotte E. Vlug
- Division of Gastroenterology, Department of Pediatrics
| | | | - Bram Dierckx
- Department of Child and Adolescent Psychiatry/Psychology
| | - Lotte Bosman
- Department of Child and Adolescent Psychiatry/Psychology
| | - Jurgen C. de Graaff
- Department of Anesthesiology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam
| | - Edmond H.H.M. Rings
- Division of Gastroenterology, Department of Pediatrics
- Division of Gastroenterology, Department of Pediatrics, Willem Alexander Children's Hospital, Leiden University Medical Center, Leiden
| | - René M.H. Wijnen
- Department of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | | |
Collapse
|
7
|
Joyeux L, Belfort MA, De Coppi P, Basurto D, Valenzuela I, King A, De Catte L, Shamshirsaz AA, Deprest J, Keswani SG. Complex gastroschisis: a new indication for fetal surgery? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:804-812. [PMID: 34468062 DOI: 10.1002/uog.24759] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/16/2021] [Accepted: 08/19/2021] [Indexed: 06/13/2023]
Abstract
Gastroschisis (GS) is a congenital abdominal wall defect, in which the bowel eviscerates from the abdominal cavity. It is a non-lethal isolated anomaly and its pathogenesis is hypothesized to occur as a result of two hits: primary rupture of the 'physiological' umbilical hernia (congenital anomaly) followed by progressive damage of the eviscerated bowel (secondary injury). The second hit is thought to be caused by a combination of mesenteric ischemia from constriction in the abdominal wall defect and prolonged amniotic fluid exposure with resultant inflammatory damage, which eventually leads to bowel dysfunction and complications. GS can be classified as either simple or complex, with the latter being complicated by a combination of intestinal atresia, stenosis, perforation, volvulus and/or necrosis. Complex GS requires multiple neonatal surgeries and is associated with significantly greater postnatal morbidity and mortality than is simple GS. The intrauterine reduction of the eviscerated bowel before irreversible damage occurs and subsequent defect closure may diminish or potentially prevent the bowel damage and other fetal and neonatal complications associated with this condition. Serial prenatal amnioexchange has been studied in cases with GS as a potential intervention but never adopted because of its unproven benefit in terms of survival and bowel and lung function. We believe that recent advances in prenatal diagnosis and fetoscopic surgery justify reconsideration of the antenatal management of complex GS under the rubric of the criteria for fetal surgery established by the International Fetal Medicine and Surgery Society (IFMSS). Herein, we discuss how conditions for fetoscopic repair of complex GS might be favorable according to the IFMSS criteria, including an established natural history, an accurate prenatal diagnosis, absence of fully effective perinatal treatment due to prolonged need for neonatal intensive care, experimental evidence for fetoscopic repair and maternal and fetal safety of fetoscopy in expert fetal centers. Finally, we propose a research agenda that will help overcome barriers to progress and provide a pathway toward clinical implementation. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- L Joyeux
- MyFetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, Division Woman and Child, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
- Department of Pediatric Surgery, Queen Fabiola Children's University Hospital, Brussels, Belgium
- Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - M A Belfort
- Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- Department of Obstetrics and Gynecology, Division Maternal-Fetal Medicine, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- Texas Children's Fetal Center, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - P De Coppi
- MyFetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, Division Woman and Child, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
- Specialist Neonatal and Paediatric Surgery Unit and NIHR Biomedical Research Center, Great Ormond Street Hospital, and Great Ormond Street Institute of Child Health, University College London, London, UK
| | - D Basurto
- MyFetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, Division Woman and Child, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
| | - I Valenzuela
- MyFetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - A King
- Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- Texas Children's Fetal Center, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- Department of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - L De Catte
- Department of Obstetrics and Gynecology, Division Woman and Child, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
| | - A A Shamshirsaz
- Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- Department of Obstetrics and Gynecology, Division Maternal-Fetal Medicine, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- Texas Children's Fetal Center, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - J Deprest
- MyFetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, Division Woman and Child, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
- Institute of Women's Health, University College London Hospitals, London, UK
| | - S G Keswani
- Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- Texas Children's Fetal Center, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- Department of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
8
|
Identifying prenatal ultrasound predictors and the ideal neonatal management of closing gastroschisis: the key is prevention. J Perinatol 2021; 41:2789-2794. [PMID: 33790403 DOI: 10.1038/s41372-021-01006-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 11/24/2020] [Accepted: 02/11/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the optimal approaches to initial surgical management and the potential for prenatal ultrasound detection of patients with closing gastroschisis. STUDY DESIGN We performed a retrospective analysis of patients born with gastroschisis to determine clinical and surgical outcomes and the ability to determine prognosis by prenatal imaging. Data collected included operative findings and postoperative outcome, as well as prenatal imaging features from a subset of cases with and without closing gastroschisis. Statistical analyses were performed as appropriate. RESULTS We included 197 patients with gastroschisis. No statistical significance was seen in outcomes between closing gastroschisis patients undergoing resection versus intracorporeal parking (n = 18). Ultrasound review was performed on 33 of these patients, 11 with closing gastroschisis, and 22 without. Significantly more closing gastroschisis patients had imaging indicative of progressive defect narrowing and defect diameter ≤8 mm after 30 weeks of gestation versus non-closing patients (p = 0.002). CONCLUSION Parking of extruded bowel offers potential for intestinal remodeling. In addition, prenatal ultrasound may be useful in detection of closing gastroschisis in utero.
Collapse
|
9
|
Ferreira RG, Mendonça CR, de Moraes CL, de Abreu Tacon FS, Ramos LLG, e Melo NC, Sbragia L, do Amaral WN, Ruano R. Ultrasound Markers for Complex Gastroschisis: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10225215. [PMID: 34830497 PMCID: PMC8619043 DOI: 10.3390/jcm10225215] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/20/2021] [Accepted: 11/01/2021] [Indexed: 11/23/2022] Open
Abstract
Although gastroschisis is often diagnosed by prenatal ultrasound, there is still a gap in the literature about which prenatal ultrasound markers can predict complex gastroschisis. This systematic review and meta-analysis aimed to investigate the ultrasound markers that characterize complex gastroschisis. A systematic review of the literature was conducted according to the guidelines of PRISMA. The protocol was registered (PROSPERO ID CRD42020211685). Meta-analysis was displayed graphically on Forest plots, which estimate prevalence rates and risk ratios, with 95% confidence intervals, using STATA version 15.0. The combined prevalence of intestinal complications in fetuses with complex gastroschisis was 27.0%, with a higher prevalence of atresia (about 48%), followed by necrosis (about 25%). The prevalence of deaths in newborns with complex gastroschisis was 15.0%. The predictive ultrasound markers for complex gastroschisis were intraabdominal bowel dilatation (IABD) (RR 3.01, 95% CI 2.22 to 4.07; I2 = 15.7%), extra-abdominal bowel dilatation (EABD) (RR 1.55, 95% CI 1.01 to 2.39; I2 = 77.1%), and polyhydramnios (RR 3.81, 95% CI 2.09 to 6.95; I2 = 0.0%). This review identified that IABD, EABD, and polyhydramnios were considered predictive ultrasound markers for complex gastroschisis. However, evidence regarding gestational age at the time of diagnosis is needed.
Collapse
Affiliation(s)
- Rui Gilberto Ferreira
- Postgraduate Program in Health Sciences, Universidade Federal de Goiás, Goiânia 74650-050, GO, Brazil; (C.R.M.); (C.L.d.M.); (F.S.d.A.T.); (W.N.d.A.)
- Department of Obstetrics and Gynaecology, Hospital das Clínicas, Universidade Federal de Goiás, Goiânia 74605-020, GO, Brazil
- Correspondence: (R.G.F.); (R.R.)
| | - Carolina Rodrigues Mendonça
- Postgraduate Program in Health Sciences, Universidade Federal de Goiás, Goiânia 74650-050, GO, Brazil; (C.R.M.); (C.L.d.M.); (F.S.d.A.T.); (W.N.d.A.)
| | - Carolina Leão de Moraes
- Postgraduate Program in Health Sciences, Universidade Federal de Goiás, Goiânia 74650-050, GO, Brazil; (C.R.M.); (C.L.d.M.); (F.S.d.A.T.); (W.N.d.A.)
| | - Fernanda Sardinha de Abreu Tacon
- Postgraduate Program in Health Sciences, Universidade Federal de Goiás, Goiânia 74650-050, GO, Brazil; (C.R.M.); (C.L.d.M.); (F.S.d.A.T.); (W.N.d.A.)
| | | | - Natalia Cruz e Melo
- Departamento de Ginecologia, Universidade de São Paulo, São Paulo 04024-002, SP, Brazil;
| | - Lourenço Sbragia
- Division of Pediatric Surgery, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of Sao Paulo (USP), Ribeirão Preto 14049-900, SP, Brazil;
| | - Waldemar Naves do Amaral
- Postgraduate Program in Health Sciences, Universidade Federal de Goiás, Goiânia 74650-050, GO, Brazil; (C.R.M.); (C.L.d.M.); (F.S.d.A.T.); (W.N.d.A.)
| | - Rodrigo Ruano
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Science Center Houston (UTHealth), Houston 77030, TX, USA
- Correspondence: (R.G.F.); (R.R.)
| |
Collapse
|
10
|
Roorda D, Königs M, Eeftinck Schattenkerk L, van der Steeg L, van Heurn E, Oosterlaan J. Neurodevelopmental outcome of patients with congenital gastrointestinal malformations: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2021; 106:635-642. [PMID: 34112720 PMCID: PMC8543204 DOI: 10.1136/archdischild-2021-322158] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 04/12/2021] [Indexed: 12/29/2022]
Abstract
AIM Children with congenital gastrointestinal malformations may be at risk of neurodevelopmental impairment due to challenges to the developing brain, including perioperative haemodynamic changes, exposure to anaesthetics and postoperative inflammatory influences. This study aggregates existing evidence on neurodevelopmental outcome in these patients using meta-analysis. METHOD PubMed, Embase and Web of Science were searched for peer-reviewed articles published until October 2019. Out of the 5316 unique articles that were identified, 47 studies met the inclusion criteria and were included. Standardised mean differences (Cohen's d) between cognitive, motor and language outcome of patients with congenital gastrointestinal malformations and normative data (39 studies) or the studies' control group (8 studies) were aggregated across studies using random-effects meta-analysis. The value of (clinical) moderators was studied using meta-regression and diagnostic subgroups were compared. RESULTS The 47 included studies encompassed 62 cohorts, representing 2312 patients. Children with congenital gastrointestinal malformations had small-sized cognitive impairment (d=-0.435, p<0.001; 95% CI -0.567 to -0.302), medium-sized motor impairment (d=-0.610, p<0.001; 95% CI -0.769 to -0.451) and medium-sized language impairment (d=-0.670, p<0.001; 95% CI -0.914 to -0.425). Patients with short bowel syndrome had worse motor outcome. Neurodevelopmental outcome was related to the number of surgeries and length of total hospital stay, while no relations were observed with gestational age, birth weight, age and sex. INTERPRETATION This study shows that children with congenital gastrointestinal malformations exhibit impairments in neurodevelopmental outcome, highlighting the need for routine screening of neurodevelopment during follow-up.
Collapse
Affiliation(s)
- Daniëlle Roorda
- Department of Pediatric Surgery, Amsterdam Reproduction and Development Research Institute, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Free University Amsterdam, Amsterdam, The Netherlands
- Department of Pediatrics, Emma Neuroscience Group, Amsterdam Reproduction & Development Research Institute, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marsh Königs
- Department of Pediatrics, Emma Neuroscience Group, Amsterdam Reproduction & Development Research Institute, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Laurens Eeftinck Schattenkerk
- Department of Pediatric Surgery, Amsterdam Reproduction and Development Research Institute, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Free University Amsterdam, Amsterdam, The Netherlands
| | - Lideke van der Steeg
- Department of Pediatric Surgery, Amsterdam Reproduction and Development Research Institute, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Free University Amsterdam, Amsterdam, The Netherlands
- Pediatric Surgery, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Ernest van Heurn
- Department of Pediatric Surgery, Amsterdam Reproduction and Development Research Institute, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Free University Amsterdam, Amsterdam, The Netherlands
| | - Jaap Oosterlaan
- Department of Pediatrics, Emma Neuroscience Group, Amsterdam Reproduction & Development Research Institute, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
11
|
Strobel KM, Purdy I, Romero T, Calkins KL. Growth from Birth to 30 months for Infants Born with Congenital Gastrointestinal Anomalies and Disorders. Am J Perinatol 2021; 38:e33-e38. [PMID: 32168528 DOI: 10.1055/s-0040-1705136] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This study aimed to investigate growth among neonates with gastrointestinal disorders. STUDY DESIGN Inclusion criteria included neonates with gastroschisis, omphalocele, intestinal atresia, tracheoesophageal fistula, Hirschsprung's disease, malabsorption disorders, congenital diaphragmatic hernia, and imperforate anus born between 2010 and 2018. Anthropometrics were collected for the first 30 months, and a subgroup analysis was performed for gastroschisis infants. RESULTS In 61 subjects, 13% developed severe growth failure within the first month. One-, four-, and nine-month weight and length z-scores were less than birth weight in all infants (p < 0.05). In infants with gastroschisis, a similar pattern was observed for weight z-scores only (p < 0.05). From birth to 15 months, head circumference z-score increased over time in all infants (p = 0.001), while in gastroschisis infants, weight, length, and head circumference z-scores increased over time (p < 0.05). CONCLUSION In a cohort of infants with gastrointestinal disorders, growth failure was followed by catch-up growth.
Collapse
Affiliation(s)
- Katie M Strobel
- Division of Neonatology and Developmental Biology, Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Mattel Children's Hospital at UCLA, Los Angeles, California
| | - Isabell Purdy
- Division of Neonatology and Developmental Biology, Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Mattel Children's Hospital at UCLA, Los Angeles, California
| | - Tahmineh Romero
- Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Kara L Calkins
- Division of Neonatology and Developmental Biology, Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Mattel Children's Hospital at UCLA, Los Angeles, California
| |
Collapse
|
12
|
De Bie F, Swaminathan V, Johnson G, Monos S, Adzick NS, Laje P. Long-term core outcomes of patients with simple gastroschisis. J Pediatr Surg 2021; 56:1365-1369. [PMID: 33012557 DOI: 10.1016/j.jpedsurg.2020.09.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/28/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To report the long-term core outcome set of patients with simple gastroschisis. METHODS This was a retrospective chart review of all patients with simple gastroschisis managed at our hospital between August 2008 and July 2016. We collected all data included in the core outcome set developed for the standardization of gastroschisis outcomes reporting. We conducted a phone survey of the patients' parents using the PedsQL™ Pediatric Quality of Life Inventory, Cognitive Functioning Scale, and Gastrointestinal Symptoms Scale (GSS). Additionally, parents reported their subjective evaluation of the patients' cosmetic result and overall quality of life. RESULTS There were 124 patients included in the study. The majority (76.5%) was born prematurely at a median gestational age of 36 (range 27.6-38) weeks. At neonatal discharge (median 36 days [18-150] days) most patients were below the 10th percentile for height (81.4%) and weight (87%). Their growth, however, normalized during early childhood. Seven patients (5.6%) required at some point an operation for acute abdominal complications. One-third of patients required long-term treatment for constipation and one-third of patients required long-term treatment for gastroesophageal reflux disease (GERD). Thirty-five parents participated in the phone survey. Mean parent-reported quality of life score was better than healthy controls (87.5% vs. 82.3%, p = 0.049). Cognitive functions and gastrointestinal symptoms scores were similar to healthy controls. All patients are alive. CONCLUSION Growth restriction in patients with simple gastroschisis is common at birth and during the neonatal period, but it improves during the first three years of life. Abdominal operations are rarely needed in patients with simple gastroschisis. GERD and constipation, on the other hand, are common and often require long-term medical management. The overall parent-reported quality of life of patients with simple gastroschisis is excellent. LEVEL OF EVIDENCE Level II.
Collapse
Affiliation(s)
- Felix De Bie
- Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia
| | - Vishal Swaminathan
- Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia
| | - Gabrielle Johnson
- Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia
| | - Stylianos Monos
- Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia
| | - N Scott Adzick
- Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia
| | - Pablo Laje
- Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia.
| |
Collapse
|
13
|
Strobel KM, Romero T, Kramer K, Fernandez E, Rottkamp C, Uy C, Keller R, Moyer L, Poulain F, Kim JH, DeUgarte DA, Calkins KL. Growth Failure Prevalence in Neonates with Gastroschisis : A Statewide Cohort Study. J Pediatr 2021; 233:112-118.e3. [PMID: 33647253 PMCID: PMC8154735 DOI: 10.1016/j.jpeds.2021.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To perform a multicenter study to assess growth failure in hospitalized infants with gastroschisis. STUDY DESIGN This study included neonates with gastroschisis within sites in the University of California Fetal Consortium. The study's primary outcome was growth failure at hospital discharge, defined as a weight or length z score decrease >0.8 from birth. Regression analysis was performed to assess changes in z scores over time. RESULTS Among 125 infants with gastroschisis, the median gestational age was 37 weeks (IQR 35-37). Length of stay was 32 days (23-60); 55% developed weight or length growth failure at discharge (28% had weight growth failure, 42% had length growth failure, and 15% had both weight and length growth failure). Weight and length z scores at 14 days, 30 days, and discharge were less than birth (P < .01 for all). Weight and length z scores declined from birth to 30 days (-0.10 and -0.11 z score units/week, respectively, P < .001). Length growth failure at discharge was associated with weight and length z score changes over time (P < .05 for both). Lower gestational age was associated with weight growth failure (OR 0.70 for each gestational age week, 95% CI 0.55-0.89, P = .004). CONCLUSIONS Growth failure, in particular linear growth failure, is common in infants with gastroschisis. These data suggest the need to improve nutritional management in these infants.
Collapse
Affiliation(s)
- Katie M Strobel
- Division of Neonatology and Developmental Biology, Department of Pediatrics, University of California Los Angeles, Los Angeles, CA.
| | - Tahmineh Romero
- Division of General Internal Medicine and Health Services Research, Department of Medicine Statistics Core, University of California Los Angeles, Los Angeles, CA
| | - Katelin Kramer
- Division of Neonatology, Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Erika Fernandez
- Division of Neonatology, Department of Pediatrics, University of California San Diego, San Diego, CA
| | - Catherine Rottkamp
- Division of Neonatology, Department of Pediatrics, University of California Davis, Davis, CA
| | - Cherry Uy
- Division of Neonatal/Perinatal Medicine, Department of Pediatrics, University of California Irvine, Irvine, CA
| | - Roberta Keller
- Division of Neonatology, Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Laurel Moyer
- Division of Neonatology, Rady Children's Hospital, San Diego, CA
| | - Francis Poulain
- Division of Neonatology, Department of Pediatrics, University of California Davis, Davis, CA
| | - Jae H Kim
- Division of Neonatology, Department of Pediatrics, University of California San Diego, San Diego, CA
| | - Daniel A DeUgarte
- Division of Pediatric Surgery, Department of Surgery, University of California Los Angeles, Los Angeles, CA
| | - Kara L Calkins
- Division of Neonatology and Developmental Biology, Department of Pediatrics, University of California Los Angeles, Los Angeles, CA
| |
Collapse
|
14
|
Ferreira RG, Mendonça CR, Gonçalves Ramos LL, de Abreu Tacon FS, Naves do Amaral W, Ruano R. Gastroschisis: a systematic review of diagnosis, prognosis and treatment. J Matern Fetal Neonatal Med 2021; 35:6199-6212. [PMID: 33899664 DOI: 10.1080/14767058.2021.1909563] [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] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The present systematic review aims to investigate the diagnosis, prognosis, delivery assistance, pregnancy results and postnatal management in gastroschisis. STUDY DESIGN The following data sources were evaluated: The CINAHL, Embase and MEDLINE/PubMed databases were searched, observational and intervention studies published over the past 20 years. The quality of the studies was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). RESULTS A total of 3770 infants diagnosed with gastroschisis were included (44 studies); 1534 fetuses were classified as simple gastroschisis and 288 as complex gastroschisis. Intrauterine fetal demise occurred in 0.47% and elective termination occurred in 0.13%. Preterm delivery occurred in 23.23% and intrauterine growth restriction in 4.43%. Cesarean section delivery was performed in 54.6%. Neonatal survival was 91.29%. The main neonatal complications were: sepsis (11.78%), necrotizing enterocolitis (2.33%), short bowel syndrome (1.37%), bowel obstruction (0.79%), and volvulus (0.23%). Immediate surgical repair was performed in 80.1% with primary closure in 69%. The average to oral feeding was 33 (range: 11-124.5) days. Average hospital duration was 38 days and 89 days in neonates with simple and complex grastroschisis, respectively. CONCLUSIONS The present systematic review provides scientific data for counseling families with fetal gastroschisis.
Collapse
Affiliation(s)
- Rui Gilberto Ferreira
- Postgraduate program in Health Sciences, Universidade Federal de Goiás, Goiania, Brazil.,Department of Obstetrics and Gynaecology, Hospital das Clínicas, Universidade Federal de Goiás, Goiania, Brazil
| | | | | | | | - Waldemar Naves do Amaral
- Postgraduate program in Health Sciences, Universidade Federal de Goiás, Goiania, Brazil.,Department of Obstetrics and Gynaecology, Hospital das Clínicas, Universidade Federal de Goiás, Goiania, Brazil
| | - Rodrigo Ruano
- Department of Obstetrics and Gynecology, Pediatrics and Physiology, Division of Maternal-Fetal Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| |
Collapse
|
15
|
Lap CCMM, Pistorius LR, Mulder EJH, Aliasi M, Kramer WLM, Bilardo CM, Cohen‐Overbeek TE, Pajkrt E, Tibboel D, Wijnen RMH, Visser GHA, Manten GTR. Ultrasound markers for prediction of complex gastroschisis and adverse outcome: longitudinal prospective nationwide cohort study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 55:776-785. [PMID: 31613023 PMCID: PMC7318303 DOI: 10.1002/uog.21888] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 09/18/2019] [Accepted: 09/19/2019] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To identify antenatal ultrasound markers that can differentiate between simple and complex gastroschisis and assess their predictive value. METHODS This was a prospective nationwide study of pregnancies with isolated fetal gastroschisis that underwent serial longitudinal ultrasound examination at regular specified intervals between 20 and 37 weeks' gestation. The primary outcome was simple or complex (i.e. involving bowel atresia, volvulus, perforation or necrosis) gastroschisis at birth. Fetal biometry (abdominal circumference and estimated fetal weight), the occurrence of polyhydramnios, intra- and extra-abdominal bowel diameters and the pulsatility index (PI) of the superior mesenteric artery (SMA) were assessed. Linear mixed modeling was used to compare the individual trajectories of cases with simple and those with complex gastroschisis, and logistic regression analysis was used to estimate the strength of association between the ultrasound parameters and outcome. RESULTS Of 104 pregnancies with isolated fetal gastroschisis included, four ended in intrauterine death. Eighty-one (81%) liveborn infants with simple and 19 (19%) with complex gastroschisis were included in the analysis. We found no relationship between fetal biometric variables and complex gastroschisis. The SMA-PI was significantly lower in fetuses with gastroschisis than in healthy controls, but did not differentiate between simple and complex gastroschisis. Both intra- and extra-abdominal bowel diameters were larger in cases with complex, compared to those with simple, gastroschisis (P < 0.001 and P < 0.005, respectively). The presence of intra-abdominal bowel diameter ≥ 97.7th percentile on at least three occasions, not necessarily on successive examinations, was associated with an increased risk of the fetus having complex gastroschisis (relative risk, 1.56 (95% CI, 1.02-2.10); P = 0.006; positive predictive value, 50.0%; negative predictive value, 81.4%). CONCLUSIONS This large prospective longitudinal study found that intra-abdominal bowel dilatation when present repeatedly during fetal development can differentiate between simple and complex gastroschisis; however, the positive predictive value is low, and therefore the clinical usefulness of this marker is limited. © 2019 Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- C. C. M. M. Lap
- Department of Obstetrics, Division Woman and BabyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - L. R. Pistorius
- Department of Obstetrics and GynecologyUniversity of StellenboschStellenboschSouth Africa
| | - E. J. H. Mulder
- Department of Obstetrics, Division Woman and BabyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - M. Aliasi
- Department of Obstetrics, Division Woman and BabyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - W. L. M. Kramer
- Department of Pediatric SurgeryUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - C. M. Bilardo
- Department of Obstetrics and GynecologyAmsterdam University Medical Centers, University of Amsterdam, Amsterdam Reproduction and Development Research InstituteAmsterdamThe Netherlands
- Department of Obstetrics and Gynaecology, University Medical Centre GroningenUniversity of GroningenGroningenThe Netherlands
| | - T. E. Cohen‐Overbeek
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal MedicineErasmus MC, Sophia Children's HospitalRotterdamThe Netherlands
| | - E. Pajkrt
- Department of Obstetrics and GynecologyAmsterdam University Medical Centers, University of Amsterdam, Amsterdam Reproduction and Development Research InstituteAmsterdamThe Netherlands
| | - D. Tibboel
- Department of Pediatric Surgery and Intensive Care ChildrenErasmus Medical Center, Sophia Children's HospitalRotterdamThe Netherlands
| | - R. M. H. Wijnen
- Department of Pediatric Surgery and Intensive Care ChildrenErasmus Medical Center, Sophia Children's HospitalRotterdamThe Netherlands
| | - G. H. A. Visser
- Department of Obstetrics, Division Woman and BabyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - G. T. R. Manten
- Department of Obstetrics, Division Woman and BabyUniversity Medical Center UtrechtUtrechtThe Netherlands
- Department of ObstetricsIsala Women and Children's HospitalZwolleThe Netherlands
| | | |
Collapse
|
16
|
Hijkoop A, Lap CCMM, Aliasi M, Mulder EJH, Kramer WLM, Brouwers HAA, van Baren R, Pajkrt E, van Kaam AH, Bilardo CM, Pistorius LR, Visser GHA, Wijnen RMH, Tibboel D, Manten GTR, Cohen-Overbeek TE. Using three-dimensional ultrasound in predicting complex gastroschisis: A longitudinal, prospective, multicenter cohort study. Prenat Diagn 2019; 39:1204-1212. [PMID: 31600419 PMCID: PMC6972561 DOI: 10.1002/pd.5568] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 08/28/2019] [Accepted: 09/07/2019] [Indexed: 12/29/2022]
Abstract
Objective To determine whether complex gastroschisis (ie, intestinal atresia, perforation, necrosis, or volvulus) can prenatally be distinguished from simple gastroschisis by fetal stomach volume and stomach‐bladder distance, using three‐dimensional (3D) ultrasound. Methods This multicenter prospective cohort study was conducted in the Netherlands between 2010 and 2015. Of seven university medical centers, we included the four centers that performed longitudinal 3D ultrasound measurements at a regular basis. We calculated stomach volumes (n = 223) using Sonography‐based Automated Volume Count. The shortest stomach‐bladder distance (n = 241) was determined using multiplanar visualization of the volume datasets. We used linear mixed modelling to evaluate the effect of gestational age and type of gastroschisis (simple or complex) on fetal stomach volume and stomach‐bladder distance. Results We included 79 affected fetuses. Sixty‐six (84%) had been assessed with 3D ultrasound at least once; 64 of these 66 were liveborn, nine (14%) had complex gastroschisis. With advancing gestational age, stomach volume significantly increased, and stomach‐bladder distance decreased (both P < .001). The developmental changes did not differ significantly between fetuses with simple and complex gastroschisis, neither for fetal stomach volume (P = .85), nor for stomach bladder distance (P = .78). Conclusion Fetal stomach volume and stomach‐bladder distance, measured during pregnancy using 3D ultrasonography, do not predict complex gastroschisis. What's already known about this topic?
Infants with complex gastroschisis have a higher risk of morbidity than those with simple gastroschisis. Many attempts have been made to prenatally predict complex gastroschisis, using two‐dimensional ultrasound parameters.
What does this study add?
This longitudinal prospective multicenter study is the first to evaluate the possible benefit of the use of three‐dimensional ultrasound in fetuses with gastroschisis. Fetal stomach volume and stomach‐bladder distance, measured during pregnancy using three‐dimensional ultrasound, cannot predict complex gastroschisis.
Collapse
Affiliation(s)
- Annelieke Hijkoop
- Department of Pediatric Surgery and Intensive Care Children, Erasmus Medical Center-Sophia Children's Hospital, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Chiara C M M Lap
- Department of Obstetrics, Division Woman and Baby, University Medical Center UtrechtUtrecht University, Utrecht, The Netherlands
| | - Moska Aliasi
- Department of Obstetrics, Division Woman and Baby, University Medical Center UtrechtUtrecht University, Utrecht, The Netherlands
| | - Eduard J H Mulder
- Department of Obstetrics, Division Woman and Baby, University Medical Center UtrechtUtrecht University, Utrecht, The Netherlands
| | - William L M Kramer
- Department of Pediatric Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Hens A A Brouwers
- Department of Neonatology, Division Woman and Baby, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Robertine van Baren
- Department of Pediatric Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Eva Pajkrt
- Department of Obstetrics and Gynecology, Amsterdam Reproduction and Development Research Institute, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Anton H van Kaam
- Department of Neonatology, Emma Children's Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Caterina M Bilardo
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lourens R Pistorius
- Department of Obstetrics and Gynecology, University of Stellenbosch, Stellenbosch, South Africa
| | - Gerard H A Visser
- Department of Obstetrics, Division Woman and Baby, University Medical Center UtrechtUtrecht University, Utrecht, The Netherlands
| | - René M H Wijnen
- Department of Pediatric Surgery and Intensive Care Children, Erasmus Medical Center-Sophia Children's Hospital, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Dick Tibboel
- Department of Pediatric Surgery and Intensive Care Children, Erasmus Medical Center-Sophia Children's Hospital, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Gwendolyn T R Manten
- Department of Obstetrics, Division Woman and Baby, University Medical Center UtrechtUtrecht University, Utrecht, The Netherlands
| | - Titia E Cohen-Overbeek
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC-Sophia Children's Hospital, Erasmus University Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
17
|
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.
Collapse
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
| |
Collapse
|
18
|
Hijkoop A, Peters NCJ, Lechner RL, van Bever Y, van Gils-Frijters APJM, Tibboel D, Wijnen RMH, Cohen-Overbeek TE, IJsselstijn H. Omphalocele: from diagnosis to growth and development at 2 years of age. Arch Dis Child Fetal Neonatal Ed 2019; 104:F18-F23. [PMID: 29563149 DOI: 10.1136/archdischild-2017-314700] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 03/01/2018] [Accepted: 03/03/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To compare the prenatal frame of reference of omphalocele (ie, survival of fetuses) with that after birth (ie, survival of liveborn neonates), and to assess physical growth and neurodevelopment in children with minor or giant omphalocele up to 2 years of age. DESIGN We included fetuses and neonates diagnosed in 2000-2012. Physical growth (SD scores, SDS) and mental and motor development at 12 and 24 months were analysed using general linear models, and outcomes were compared with reference norms. Giant omphalocele was defined as defect ≥5 cm, with liver protruding. RESULTS We included 145 fetuses and neonates. Of 126 (87%) who were diagnosed prenatally, 50 (40%) were liveborn and 35 (28%) survived at least 2 years. Nineteen (13%) neonates were diagnosed after birth. Of the 69 liveborn neonates, 52 (75%) survived and 42 children (81% of survivors) were followed longitudinally. At 24 months, mean (95% CI) height and weight SDS were significantly below 0 in both minor (height: -0.57 (-1.05 to -0.09); weight: -0.86 (-1.35 to -0.37)) and giant omphalocele (height: -1.32 (-2.10 to -0.54); weight: -1.58 (-2.37 to -0.79)). Mental development was comparable with reference norms in both groups. Motor function delay was found significantly more often in children with giant omphalocele (82%) than in those with minor omphalocele (21%, P=0.002). CONCLUSIONS The prenatal and postnatal frames of reference of omphalocele differ considerably; a multidisciplinary approach in parental counselling is recommended. As many children with giant omphalocele had delayed motor development, we recommend close monitoring of these children and early referral to physical therapy.
Collapse
Affiliation(s)
- Annelieke Hijkoop
- Department of Paediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Nina C J Peters
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Rosan L Lechner
- Department of Paediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Yolande van Bever
- Department of Clinical Genetics, Erasmus MC, Rotterdam, The Netherlands
| | | | - Dick Tibboel
- Department of Paediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - René M H Wijnen
- Department of Paediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Titia E Cohen-Overbeek
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Hanneke IJsselstijn
- Department of Paediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| |
Collapse
|
19
|
Osmundo Junior GDS, Mohamed SHM, Nishie EN, Tannuri ACA, Gibelli MABC, Francisco RPV, Brizot MDL. Association of spontaneous labor onset with neonatal outcomes in pregnancies with fetal gastroschisis: A retrospective cohort analysis. Acta Obstet Gynecol Scand 2018; 98:154-161. [PMID: 30264855 DOI: 10.1111/aogs.13473] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 09/21/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The present study aims to investigate the association of spontaneous labor onset with neonatal outcomes in pregnancies with fetal gastroschisis. The secondary goal was to evaluate the association between ultrasound markers and labor onset in pregnancies with fetal gastroschisis. MATERIAL AND METHODS A retrospective analysis was performed for 207 pregnancies with fetal gastroschisis between 2005 and 2017. Patients were followed according to a strict protocol involving ultrasound scans and routine evaluations of fetal biophysical profile parameters and intra- and extra-abdominal bowel diameters. Labor, delivery and neonatal records were reviewed. The neonatal outcomes were complex gastroschisis, staged surgical closure of the abdominal defect, short bowel syndrome, time on mechanical ventilation, time to full enteral feeding and necrotizing enterocolitis. RESULTS Spontaneous labor onset was associated with complex gastroschisis (30.7% vs 6.8%, P = 0.002) and short bowel syndrome (13.2% vs none, P = 0.013) in cases with spontaneous preterm delivery compared with the indicated preterm deliveries. Spontaneous labor onset was associated with a longer time on mechanical ventilation for term and preterm newborns. Associations were not observed between ultrasound markers and spontaneous labor onset. CONCLUSIONS Spontaneous labor onset in pregnancies with fetal gastroschisis was associated with adverse neonatal outcomes, particularly in those born preterm.
Collapse
Affiliation(s)
| | | | - Estela Naomi Nishie
- Department of Obstetrics and Gynecology, Hospital das Clínicas, São Paulo University Medical School, Sao Paulo, Brazil
| | - Ana Cristina Aoun Tannuri
- Division of Pediatric Surgery, Department of Pediatrics, São Paulo University Medical School, Sao Paulo, Brazil
| | - Maria Augusta Bento Cicaroni Gibelli
- Division of Neonatology, Department of Pediatrics, Hospital das Clínicas, São Paulo University Medical School, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Maria de Lourdes Brizot
- Department of Obstetrics and Gynecology, Hospital das Clínicas, São Paulo University Medical School, Sao Paulo, Brazil
| |
Collapse
|
20
|
Abstract
Currently, the most important determinant of gastroschisis outcomes in high resource settings is whether the condition is associated with intestinal complications, such as atresia, necrosis, perforation, or volvulus. This form of the anomaly, known as complex gastroschisis, accounts for most of the mortality and a disproportionate burden of the morbidity from gastroschisis. There is some disagreement about what constitutes complex gastroschisis, and little consensus on the type and timing of surgical interventions. This article establishes a clear definition of complex gastroschisis. Surgical approaches to treatment of the diverse presentations of complex gastroschisis will be described and the timing of such interventions will be discussed. Contemporary outcomes of complex gastroschisis will be reviewed. Finally, a non-congenital intestinal complications that may arise in gastroschisis patients will be discussed.
Collapse
Affiliation(s)
- Sherif Emil
- Department of Pediatric Surgery; The Montreal Children's Hospital, McGill University Health Centre, Room B04.2028, 1001 Decarie Boulevard, Montreal, QC, Canada H4A 3J1.
| |
Collapse
|