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Diniz AMB, Gualberto IJN, Lima LA, Cirino MLDA, Murakami RK, Ishikiriama BLC, Ruano R, da Silva LFF, Tirapelli D, Sbragia L. miRNA-143 expression is associated with inflammation and time of exposure to amniotic fluid in experimental gastroschisis. Clinics (Sao Paulo) 2023; 78:100311. [PMID: 38008037 PMCID: PMC10757286 DOI: 10.1016/j.clinsp.2023.100311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/27/2023] [Accepted: 10/02/2023] [Indexed: 11/28/2023] Open
Abstract
OBJECTIVE Gastroschisis (GS) is a congenital anomaly in the abdominal wall with the intestinal loops exiting laterally to the umbilicus. The contact of the loops with Amniotic Fluid (AF) causes an inflammatory process in the exposed part, leading to an extended hospital stay and an increased risk of morbidity due to alterations related to intestinal motility. The authors aimed to evaluate the time of exposure to the AF in the experimental GS and to search for potential biomarkers of intestinal inflammation by measuring microRNAs. METHODS Rat fetuses were divided into three groups: a) CONTROL, b) GS reared on day 18 (GS = 18), and c) GS reared on day 19.5 (GS = 19) (term = 22 days). On day 21.5, the fetuses were removed for biometric parameters and biochemical analyses: 1) Biometrics: Body and Intestinal Weight (BW, IW), and intestinal-body weight ratio (IW/BW); 2) Descriptive histopathology and 3) miR-143 quantification by real-time Polymerase Chain Reaction (PCR). RESULTS BW was higher in CONTROL than GS 18 and G19 (p < 0.05). IW, IW/BW, intestinal water, and mRNA-143 were higher in GS 18 and GS 19 than in CONTROL, and GS 18 was higher than GS 19 (p < 0.05). The average of the inflammation score from the intestinal wall with mucosal inflammation and intra-epithelial lymphocytes shows worst in GS 18 and GS 19 vs. CONTROL (p < 0.05). CONCLUSIONS The tissue expression of mRNA-143 and the morphological changes in the intestine of GS worsened according to the time of exposure to AF, which could be a possible marker of fetal intestinal damage.
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Affiliation(s)
- Ana Maria Bicudo Diniz
- Division of Pediatric Surgery and Anatomy, Department of Surgery and Anatomy, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirao Preto, SP, Brazil
| | - Igor José Nogueira Gualberto
- Faculdade de Medicina de Bauru, Department of Pediatric Dentistry, Orthodontics and Public Health, Faculdade de Odontologia de Bauru, Universidade de São Paulo (USP), Bauru, SP, Brazil
| | - Luiza Almeida Lima
- Division of Maternal Fetal Medicine, Jackson Fetal Care, Department Obstetrics, Gynecology and Reproductive Sciences, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Mucio Luiz de Assis Cirino
- Division of Pediatric Surgery and Anatomy, Department of Surgery and Anatomy, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirao Preto, SP, Brazil
| | - Rodrigo Kendi Murakami
- Faculdade de Medicina de Bauru, Department of Pediatric Dentistry, Orthodontics and Public Health, Faculdade de Odontologia de Bauru, Universidade de São Paulo (USP), Bauru, SP, Brazil
| | - Bella Luna Colombini Ishikiriama
- Faculdade de Medicina de Bauru, Department of Pediatric Dentistry, Orthodontics and Public Health, Faculdade de Odontologia de Bauru, Universidade de São Paulo (USP), Bauru, SP, Brazil
| | - Rodrigo Ruano
- Division of Maternal Fetal Medicine, Jackson Fetal Care, Department Obstetrics, Gynecology and Reproductive Sciences, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Luiz Fernando Ferraz da Silva
- Department of Pathology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo Death Verification Service (SVO), São Paulo, SP, Brazil
| | - Daniela Tirapelli
- Division of Pediatric Surgery and Anatomy, Department of Surgery and Anatomy, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirao Preto, SP, Brazil
| | - Lourenço Sbragia
- Division of Pediatric Surgery and Anatomy, Department of Surgery and Anatomy, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirao Preto, SP, Brazil.
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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.
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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
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Kapapa M, Rieg T, Serra A. Does meconium contaminated amniotic fluid affect intestinal wall thickness and functional outcome in patients with anterior abdominal wall defects? Afr J Paediatr Surg 2022; 19:46-51. [PMID: 34916352 PMCID: PMC8759423 DOI: 10.4103/ajps.ajps_8_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Gastroschisis (GS) and omphalocele (OC) are congenital abdominal wall defects, the main difference between is the direct exposure of intestinal loops in amniotic fluid in children with a GS. This leads to a reduced primary closure rate and a higher number of intraoperative abnormalities and post-operative complications. AIMS AND OBJECTIVES We analysed abdominal wall defect patients over an 11-year period, aiming to assess the influence of meconium-contaminated amniotic fluid. This study has different objectives to show the consequence of functional outcome of abdominal wall defects (AWD) children in reliance to colour of amniotic fluid, to assess the effect of reduced bowel exposure time to meconium contaminated amniotic fluid on edematous inflammatory thickening of the bowel loops, to show an positively influence in the number of primary AWD closures, to demonstrate a reduced incidence of post-natal complications and to verify a better outcome of OC children because of failing exposure to amniotic fluid. METHODS A retrospective, observational case-control design was used to compare GS (n = 36) and OC (n = 18) children. Physical data, colour of amniotic fluid, pre- and perinatal problems, operative complications and surgical technique, post-operative complications, duration of intensive care unit (ICU) stay, mechanical ventilation, parenteral nutrition, commencement of oral feeding and total hospital stay were collected. Data were analysed with descriptive methods, t-test and non-parametric tests such as Wilcoxon and Kruskal-Wallis were performed in addition to the analysis of variance, including post hoc testing accepting a confidence interval of 95% (P < 0.05) by using IBM SPSS software, version 23 (IBM, Illinois, USA). RESULTS Rate of meconium-contaminated amniotic fluid is significantly higher in GS compared to OC (P < 0.001), delivery problems such as congenital infections are also significantly higher (P < 0.001), this yields in significantly more bowel loops anomalies and problems during surgery (P < 0.036) but had no significant influence on primary abdominal wall closures rate (P = 0.523). The post-surgical outcome of OC was significantly better as compared to GS. Within the GS, those with swollen intestines had significantly longer ICU stays (P = 0.045) due to extended mechanical ventilation (P = 0.007), parenteral nutrition (P = 0.011) and delayed initiation of oral feeding (P < 0.001. Same results were found for the duration of ICU stay (P = 0.008), mechanical ventilation (P = 0.006), parenteral nutrition (P = 0.011) and delayed initiation of oral feeding (P < 0.001) in secondary closures as compared to primary abdominal wall closures in the GS group. CONCLUSIONS Worsen functional short-term outcome of GS children was directly addicted to meconium contamination of amniotic fluid due to swollen intestines and because of this more post-surgical problem including significantly extended hospital stays were observed.
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Affiliation(s)
- Melanie Kapapa
- Department of Surgery, Division of Pediatric Surgery, University Ulm Medical Centre, Eythstrasse, Ulm, Germany
| | - Teresa Rieg
- Department of Gynaecology and Obstetrics, Hospital Heidenheim, Heidenheim an der Brenz, Germany
| | - Alexandre Serra
- Department of Surgery, Division of Pediatric Surgery, University Ulm Medical Centre, Eythstrasse, Ulm, Germany
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The pediatric stomach - congenital abnormalities. Pediatr Radiol 2021; 51:2461-2469. [PMID: 34351495 DOI: 10.1007/s00247-021-05155-z] [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: 09/01/2020] [Revised: 06/07/2021] [Accepted: 07/12/2021] [Indexed: 01/19/2023]
Abstract
Diagnostic imaging of the pediatric stomach often provides a challenge for practicing radiologists. Radiologists should be aware of relatively unusual congenital pathology, especially when imaging very young children with gastrointestinal symptoms. We review congenital pathology of the pediatric stomach.
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Alexander W, Nightingale M, Penington A, Coombs C. A Systematic Review of Intra-abdominal Tissue Expansion for the Treatment of Exomphalos Major and a Case Report Describing a Refinement of the Technique. Ann Plast Surg 2021; 87:e107-e112. [PMID: 33661222 DOI: 10.1097/sap.0000000000002740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT The management of complex exomphalos major is difficult, and traditional techniques fail to address the visceroabdominal disproportion in the most severe cases. Intra-abdominal tissue expansion is a novel technique and has been used in a small number of patients to safely increase the intra-abdominal volume and allow the reduction of viscera and subsequent closure of the abdominal domain. We review 7 published reports of this technique and add a case report describing our refinement of the technique. We propose that the use of multiple expanders placed in the intra-abdominal preperitoneal space, when expanded slowly, can allow safe reduction of viscera and immediate direct closure of the musculofascial layer of the abdomen.
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Stoll C, Alembik Y, Roth MP. Co-occurring non-omphalocele and non-gastroschisis anomalies among cases with congenital omphalocele and gastroschisis. Am J Med Genet A 2021; 185:1954-1971. [PMID: 33881198 DOI: 10.1002/ajmg.a.62112] [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: 09/15/2020] [Revised: 12/22/2020] [Accepted: 12/24/2020] [Indexed: 11/08/2022]
Abstract
The pathogenesis of omphalocele and gastroschisis is not obvious. Their etiology is disputed. The prevalence and the types of anomalies co-occurring with omphalocele and gastroschisis are variable in the different series published. The aim of this study was to estimate the frequency and the types of co-occurring anomalies in cases with gastroschisis and omphalocele. This study was performed in a well-described population of 387,067 consecutive births between 1979 and 2007. Hundred-one cases with omphalocele were registered (2.61 per 10,000), 75 (74.3%) had co-occurring anomalies comprising chromosomal anomalies (28 cases, 27.7%, including 18 trisomy 18), non-chromosomal syndromes (16 cases, 15.8%, including 3 cases with Beckwith-Wiedemann syndrome, 2 cases with the OEIS sequence, and one case with the Pentalogy of Cantrell complex), and 31 cases, 30.7% with MCA (multiple congenital anomalies). The most common MCA were musculoskeletal (23.5%), urogenital (20.4%), cardiovascular (15.1%), and central nervous (9.1%). Seventy-one cases of gastroschisis were ascertained (1.83 per 10,000). However, the prevalence increased during the study period. The frequency was highest in the mothers 15-19 years old. Sixteen out of the 71 cases with gastroschisis, (22.5%) had co-occurring anomalies including 11 cases of MCA and 5 cases with syndromes. To conclude, the frequency and the types of anomalies co-occurring with omphalocele and gastroschisis are peculiar. Therefore, cases with gastroschisis and omphalocele need to be screened for co-occurring anomalies.
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Affiliation(s)
- Claude Stoll
- Laboratoire de Génétique Médicale, Faculté de Médecine, University of Strasbourg, Strasbourg Cedex, France
| | - Yves Alembik
- Laboratoire de Génétique Médicale, Faculté de Médecine, University of Strasbourg, Strasbourg Cedex, France
| | - Marie-Paule Roth
- Laboratoire de Génétique Médicale, Faculté de Médecine, University of Strasbourg, Strasbourg Cedex, France
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Ghabisha S, Ahmed F, Al-wageeh S, Al-shami E, Al-naggar K, Obaid G, Askarpour MR. Newborn with Hernia Umbilical Cord: A Case Report and Review of Literature. OPEN ACCESS SURGERY 2021. [DOI: 10.2147/oas.s307223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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8
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Congenital Abdominal Wall Defects: A Topic Review and a Case Report of a Lethal Polymalformation Syndrome with a Giant Abdominoschisis. ACTA MEDICA MARTINIANA 2020. [DOI: 10.2478/acm-2020-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Abdominal wall defects (AWDs) represent a wide spectrum of congenital anomalies which are characterized by a herniation of abdominal organs through a pathologic opening in the abdominal region. The author describes a 29-year-old pregnant woman who was prenatally found to have a living female fetus with a giant omphalocele and a spinal deformation in the lumbosacral region. An evisceration of the abdominal contents into the amnionic cavity was visible. Based on USG findings the limb-body wall complex was suggested. An amniocentesis was performed and a genetic testing identified a chromosome 17q23.1–q23.2 duplication. As the fetal anomaly was considered incompatible with life, a medical termination of the pregnancy was carried out. Postmortem examination of the fetus revealed a huge abdominoschisis with a complete evisceration of the liver, stomach, small and large intestines, spleen, and the right kidney. A severe left-sided scoliosis deformity of the spine with crooked trunk was evident. The gross findings shared the features of omphalocele and limb-body wall complex with no postnatal life expectancy. Most fetal AWDs have poor prognosis. The pathology of these conditions differ greatly and require specific prenatal evaluation and pregnancy management for each entity. Accurate assessment of AWDs will allow the identification of isolated forms with better clinical outcomes compared to associated multiple malformations with chromosomal anomalies or genetic syndromes.
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Alexander G, Silva J, Curi B, Yancy J, Bogojevic A, Gaither K. Giant Omphalocele Complicated by 9P Minus Syndrome. J Natl Med Assoc 2020; 113:51-53. [PMID: 32747314 DOI: 10.1016/j.jnma.2020.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 07/10/2020] [Indexed: 10/23/2022]
Abstract
Omphalocele is characterized as a ventral wall defect in which there exists a midline herniation of abdominal viscera into the base of the umbilical cord. Fetuses with a diagnosis of this entity are at a significantly increased risk of having an aneuploidy, additional anomalies, or associations with other syndromes such as Beckwith Wiederman. Secondary to these interconnections, there is an elevated risk of fetal loss in affected pregnancies. Detection of concordant abnormalities, appropriate genetic counseling, and involvement of pediatric subspecialties are paramount in affording a prognosis, and providing optimal perinatal management of omphalocele.
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Affiliation(s)
| | - Jessica Silva
- NYC Health+Hospital/Lincoln, Department of Ob/Gyn, Bronx, NY
| | - Berenice Curi
- NYC Health+Hospital/Lincoln, Department of Ob/Gyn, Bronx, NY
| | - Jana Yancy
- NYC Health+Hospital/Lincoln, Department of Ob/Gyn, Bronx, NY
| | | | - Kecia Gaither
- NYC Health+Hospital/Lincoln, Department of Ob/Gyn, Bronx, NY.
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Anyanwu LJC, Ade-Ajayi N, Rolle U. Major abdominal wall defects in the low- and middle-income setting: current status and priorities. Pediatr Surg Int 2020; 36:579-590. [PMID: 32200405 PMCID: PMC7165143 DOI: 10.1007/s00383-020-04638-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/05/2020] [Indexed: 12/28/2022]
Abstract
Major congenital abdominal wall defects (gastroschisis and omphalocele) may account for up to 21% of emergency neonatal interventions in low- and middle-income countries. In many low- and middle-income countries, the reported mortality of these malformations is 30-100%, while in high-income countries, mortality in infants with major abdominal wall reaches less than 5%. This review highlights the challenges faced in the management of newborns with major congenital abdominal wall defects in the resource-limited setting. Current high-income country best practice is assessed and opportunities for appropriate priority setting and collaborations to improve outcomes are discussed.
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Affiliation(s)
| | - Niyi Ade-Ajayi
- Department of Paediatric Surgery, King’s College Hospital, London, UK
| | - Udo Rolle
- Department of Paediatric Surgery and Paediatric Urology, University Hospital Frankfurt/M., Theodor-Stern-Kai 7, 60598 Frankfurt, Germany
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Spaulding P, Edwards A, Coombs P, Davies-Tuck M, Robinson A. Accuracy of sonographic estimation of weight in fetuses with abdominal wall defects. Aust N Z J Obstet Gynaecol 2020; 60:766-772. [PMID: 32291746 DOI: 10.1111/ajo.13162] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 03/01/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Accurate estimation of fetal weight is essential in guiding management of fetuses with abdominal wall defects (AWDs), as growth restriction is an important predictor of perinatal morbidity and mortality. Several sonographic formulae are available involving multiple biometric parameters, but abdominal circumference measurements may underestimate weight in fetuses with AWDs. No formula has yet shown superior accuracy. AIMS The objectives of this study were to evaluate, in fetuses with gastroschisis and omphalocoele, the accuracy of a sonographic estimated fetal weight (EFW) formula proposed by Siemer and colleagues, specifically for use in fetuses with AWDs compared to the commonly used Hadlock IV formula in estimating fetal weight, and detecting small for gestational age (SGA) fetuses. MATERIALS AND METHODS A retrospective cohort of 113 fetuses with AWDs was identified from an Australian teaching hospital over 13 years. Pregnancy data and sonographic fetal biometry parameters were obtained. The accuracy of each formula in predicting birthweight was compared using Bland-Altman limits of agreement, and the intraclass correlation coefficient between EFW and actual birthweight. Performance of each formula in detecting SGA fetuses was determined. RESULTS The Siemer and Hadlock formulae have similar accuracies for predicting birthweight in fetuses with AWDs. The Hadlock formula has a higher detection rate for SGA < 10th centile and < 3rd centile compared to the Seimer formula (84% vs 68% and 83% vs 67% respectively), albeit with a higher false-positive rate. CONCLUSION There is no clear clinical advantage in using the Siemer formula, which is specifically designed for fetuses with AWDs, over the Hadlock formula to estimate weight in fetuses with AWDs.
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Affiliation(s)
| | - Andrew Edwards
- Fetal Diagnostic Unit, Monash Health, Melbourne, Victoria, Australia.,The Ritchie Centre, Monash University, Melbourne, Victoria, Australia
| | - Peter Coombs
- Monash Women's, Monash Health, Melbourne, Victoria, Australia.,Department of Medical Imaging and Radiation Services, Faculty of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Miranda Davies-Tuck
- The Ritchie Centre, The Hudson Institute of Medical Research, Monash Health, Melbourne, Victoria, Australia
| | - Alice Robinson
- Fetal Diagnostic Unit, Monash Health, Melbourne, Victoria, Australia
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Kapapa M, Rieg T, Henne-Bruns D, Serra A. Risk factors for abdominal wall defects. Congenit Anom (Kyoto) 2020; 60:54-61. [PMID: 30932237 DOI: 10.1111/cga.12336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 01/24/2023]
Abstract
In the last decades, the prevalence of gastroschisis (GS) has increased worldwide. The purpose of this study was to identify maternal risk factors explaining the described gain and to identify differences between GS and omphalocele (OC). A case-control design was used to compare GS (n = 36) and OC (n = 18) mothers to control group (CG; n = 30) matched for maternal age. Specialized questionnaires and mothers' prenatal records were used, and participants completed a structured interview. Focus was on medical history, changing nutrition, drug consumption, and external risk factors. The local ethics committee approved this study. GS mothers were significantly younger (mean 23.00; median 24; SD ±5) than OC (P = 0.007; mean 28.61; median 28, 19-41; SD ±5.1) and CG (P = 0.001; mean 30.77; median 31, SD ±6.2). Mothers with abdominal wall defects (AWD) ingested antibiotics more often (P = 0.008) than CG. Socioeconomic characteristics, for example, level of profession, of GS mothers was significantly lower than OC (P = 0.039) and CG (P = 0.05) mothers, and their cohabitation time was shorter (P < 0.05; mean 35 month/median 24 month, SD ±35.8). Incidence of OC significantly increased after hormonal treatment (P = 0.022) and invasive prenatal diagnostics (P < 0.05) compared to GS. GS mothers took folic acid prophylaxis less often than OC (P = 0.02). Smoking, illicit drugs, and external risks like herbicides showed no influence, but GS mothers drink significantly more often alcohol (P = 0.05). We confirmed an increased risk for GS if several factors such as young maternal age, short cohabitation time, and usage of antibiotics coincide with alcohol consumption and associated immune diseases. OC increased after hormonal treatment and invasive prenatal diagnostics.
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Affiliation(s)
- Melanie Kapapa
- Department of Surgery (Paediatric Surgery Section), University of Ulm, Ulm, Germany
| | - Teresa Rieg
- Department of Surgery (Paediatric Surgery Section), University of Ulm, Ulm, Germany
| | - Doris Henne-Bruns
- Department of Surgery (Paediatric Surgery Section), University of Ulm, Ulm, Germany
| | - Alexandre Serra
- Department of Surgery (Paediatric Surgery Section), University of Ulm, Ulm, Germany
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Shalaby A, Obeida A, Khairy D, Bahaaeldin K. Assessment of gastroschisis risk factors in Egypt. J Pediatr Surg 2020; 55:292-295. [PMID: 31759649 DOI: 10.1016/j.jpedsurg.2019.10.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 10/26/2019] [Indexed: 01/15/2023]
Abstract
AIM Mortality in infants born with gastroschisis (GS) in low-to-middle-income countries (LMICs) is high. This study aimed to assess factors which might affect outcome in Egypt in order to improve survival. METHODS A prospective study over a 15-month duration was completed. Variables assessed covered patient, maternal, antenatal, treatment, and complications. The Gastroschisis Prognostic Score (GPS) was used to predict outcome. A validated questionnaire was used to assess socioeconomic status. The main outcome was mortality. RESULTS Twenty-four cases were studied. Median gestational age was 37 (26-40) weeks, and 9 (38%) were preterm. Mortality occurred in 15 (62%) infants. Median transfer time was 8 (1.5-35) hours, and 64% survived if transferred before 8 h. Median maternal age was 20 (16-27) years. All families were of a low or very-low socioeconomic level. Only 25% had antenatal scans. Most cases were simple GS, and only 3 (12.5%) were complex GS. Median length of stay was 14 (1-52) days, TPN duration was 12 (0-49) days, and days to full feeds was 5 (3-11) days. The GPS score ranged from 0 to 6 in the studied cases and negatively correlated with outcome (rS = -0.98; p = 0.03). CONCLUSION The mortality of GS in Egypt is very high, mainly due to sepsis and prematurity. Young maternal age and poor socioeconomic status are linked to GS. The GPS is a good indicator of morbidity and mortality in a LMIC setting. Survival improved with better resuscitation and strict management protocols. More effort is needed to improve antenatal detection, and transfer time should be ideally below 8 h. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Aly Shalaby
- Department of Pediatric Surgery, Cairo University Specialized Pediatric Hospital.
| | - Alaa Obeida
- Department of Pediatric Surgery, Cairo University Specialized Pediatric Hospital
| | - Dalia Khairy
- Department of Pediatrics, Cairo University Specialized Pediatric Hospital
| | - Khaled Bahaaeldin
- Department of Pediatric Surgery, Cairo University Specialized Pediatric Hospital
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Abstract
OBJECTIVE. The purpose of this article is to describe the imaging findings associated with complex fetal abdominal wall defects and provide an algorithmic method for arriving at a final diagnosis. CONCLUSION. Fetal ventral abdominal wall defects are a complex group of conditions with a broad spectrum of associated multisystem anomalies and manifestations. Correct characterization and classification of these defects require not only familiarity with imaging findings but also a systematic approach to avoid diagnostic confusion.
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Di Filippo D, Henry A, Patel J, Jiwane A, Welsh AW. Fetal abdominal wall defects in an Australian tertiary setting: contemporary characteristics, ultrasound accuracy, and outcome. J Matern Fetal Neonatal Med 2019; 34:1269-1276. [PMID: 31242785 DOI: 10.1080/14767058.2019.1633303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE In this study, we aimed to comprehensively evaluate risk factors, ultrasound estimation of fetal weight, prenatal management, and pregnancy outcomes of gastroschisis and omphalocele at a metropolitan Australian hospital. MATERIAL AND METHODS This was a retrospective single-center cohort study from 2006 to 2014 at a tertiary hospital with colocated neonatal surgical facilities. Demographic, pregnancy, ultrasound, birth and neonatal data were compared between gastroschisis and omphalocele. Correlation between routine (Hadlock 1 &2) and specific (Siemer) estimated fetal weight (EFW) estimation formulae with birth weight (BW) was made for those 50 gastroschisis cases with ≥2 third trimester scans and last scan ≤2 weeks prior to birth. RESULTS There were 126 abdominal wall defects: 83 gastroschisis and 43 omphalocele. Consistent with international literature, the average maternal age was lower for gastroschisis and rates of smoking higher, while there were more intrauterine deaths and pregnancy terminations in omphalocele. Gastroschisis mothers were more likely living outside Sydney, had more infections in pregnancy and were followed with a larger number of antenatal visits, with a shorter period from the last visit to birth. In omphalocele pregnancies, amniocentesis was more likely performed, with more abnormal results than in gastroschisis fetuses. All EFW formulae had a good correlation between Z score for the last US and actual BW (ICC 0.693-0.815), with Hadlock 2 being the best. Siemer formula had the best correlation from first to the last scan. Gastroschisis newborns were born earlier (36.8 versus 38.2 wks p = .001), with smaller birthweight (2.52 versus 3.03 kg, p < .001), a longer request of intensive care (central line, parenteral nutrition, intubation) and second surgery, along with more multisystem complications (average 1.5 versus 0.7, p = .004) and a longer hospital stay (58.8 versus 36.8 d, p < .001). CONCLUSION Demographic, antenatal, and pregnancy outcome data for abdominal wall defects correlated well with the international literature. Hadlock 1-2 gave the most consistent EFW estimate, with all formulae showing good correlation.
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Affiliation(s)
- Daria Di Filippo
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Amanda Henry
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Jamie Patel
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Ashish Jiwane
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Alec W Welsh
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia.,Department of Maternal Fetal Medicine, Royal Hospital for Women, Sydney, Australia
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Impact of maternal education on the outcome of newborns requiring surgery for congenital malformations. PLoS One 2019; 14:e0214967. [PMID: 30958858 PMCID: PMC6453467 DOI: 10.1371/journal.pone.0214967] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 03/22/2019] [Indexed: 11/20/2022] Open
Abstract
Objective Numerous studies established a link between socioeconomic status (SES) and several dimensions of general health. This study examines the association between maternal education as a widely used indicator of SES and outcome in newborns requiring surgical correction of congenital anomalies. Methods Ambispective data analysis of newborns with esophageal atresia (EA), intestinal atresia (IA), congenital diaphragmatic hernia (CDH), omphalocele (OC), gastroschisis (GS) undergoing surgery between 01/2008-11/2017 accessing the clinical databases Neodat and Viewpoint. Maternal education was determined according to the validated education classification CASMIN and stratified into “low” SES and “high” SES group. Endpoints were incidence of postoperative complications, length of mechanical ventilation, and readmission to NICU. Results Inclusion of 169 patients with EA (n = 32), IA (n = 24), CDH (n = 47), OC (n = 19), GS (n = 47). Women of low SES (n = 67, 40%) attended fewer prenatal screenings (total, 4.6 vs. 7.9, P<0.0001; EA, 3.7 vs. 7.1, P = 0.0002; IA, 3.5 vs. 9.4, P = 0.0006; OC, 2.5 vs. 8.8, P = 0.009; GS, 4.1 vs. 7.0, P = 0.002). Low SES was associated with higher incidence of patients born small for gestational age (37% vs. 20%, P = 0.019), with additional congenital malformations (37% vs. 15%, P = 0.001), being born in a peripheral center (7% vs. 0%, P = 0.008), and with higher incidence of 5´APGAR scores <7 (23% vs. 7%, P = 0.004). Moreover, low SES was associated with higher incidence of postoperative complications (total 70% vs. 32%, P<0.0001; EA, 60% vs. 23%, P = 0.04; IA, 67% vs. 11%, P = 0.008; CDH, 83% vs. 46%, P = 0.009; GS, 74% vs. 25%, P = 0.001), and higher readmission rate to NICU (IA, 33% vs. 0%, P = 0.043; GS, 32% vs. 4%, P = 0.007). Conclusions Low maternal education is associated with a reduced uptake of prenatal screenings, adverse neonatal outcomes, and higher incidence of postoperative complications in newborns with congenital anomalies. Primary prevention and specific support should be provided prenatally for families with low SES to avoid adverse outcomes.
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Fujiogi M, Michihata N, Matsui H, Fushimi K, Yasunaga H, Fujishiro J. Clinical features and practice patterns of gastroschisis: a retrospective analysis using a Japanese national inpatient database. Pediatr Surg Int 2018; 34:727-733. [PMID: 29770842 DOI: 10.1007/s00383-018-4277-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE The number of infants with gastroschisis is increasing worldwide, but advances in neonatal intensive care and parenteral nutrition have reduced gastroschisis mortality. Recent clinical data on gastroschisis are often from Western nations. This study aimed to examine clinical features and practice patterns of gastroschisis in Japan. METHODS We examined treatment options, outcomes, and discharge status among inpatients with simple gastroschisis (SG) and complex gastroschisis (CG), 2010-2016, using a national inpatient database in Japan. RESULTS The 247 eligible patients (222 with SG) had average birth weight of 2102 g and average gestational age of 34 weeks; 30% had other congenital anomalies. Digestive anomalies were most common, followed by circulatory anomalies. In-hospital mortality was 8.1%. The median age at start of full enteral feeding was 30 days. The median length of stay was 46 days. There were no significant differences in outcomes except for length of stay, starting full enteral feeding and total hospitalization costs between the SG and CG groups. About 80% of patients were discharged to home without home medical care. The readmission rate was 28%. CONCLUSION This study's findings on the clinical characteristics and outcomes of gastroschisis are useful for the clinical management of gastroschisis.
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Affiliation(s)
- Michimasa Fujiogi
- Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 112-0002, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Jun Fujishiro
- Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
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18
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Conner P, Vejde JH, Burgos CM. Accuracy and impact of prenatal diagnosis in infants with omphalocele. Pediatr Surg Int 2018; 34:629-633. [PMID: 29637257 PMCID: PMC5954074 DOI: 10.1007/s00383-018-4265-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/06/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Associated anomalies in omphalocele are common, but to which extent these anomalies are diagnosed before or after birth is less well documented. AIM To investigate the different types of associated anomalies, long-term survival and the extent whether these are diagnosed pre- or postnatally in children with a prenatal diagnosis of omphalocele at a single institution. MATERIALS AND METHODS Retrospective review of all pregnancies with omphalocele managed and/or born at our institution between 2006 and 2016. RESULTS A total of 42 cases with prenatally diagnosed omphalocele were identified. Of those 14 (31%) decided to terminate the pregnancy (TOP). Of the remaining 28 that continued, 12 were giant omphaloceles. The overall mortality rate was 18, 25% for giant and 12% for non-giant omphaloceles. 64% had associated anomalies. Only 1/3 of these anomalies is diagnosed prenatally. CONCLUSION The rate of associated malformations that are diagnosed postnatally is high, but the majority was malformations with a minor clinical significance or impact on future health. Beckwith-Wiedemann syndrome was present only in cases of non-giant omphalocele in our cohort.
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Affiliation(s)
- Peter Conner
- Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | | | - Carmen Mesas Burgos
- Department of Pediatric Surgery, S3:03, Karolinska University Hospital, 17176 Stockholm, Sweden
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19
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Omphalocele and Gastroschisis. Anesthesiology 2018. [DOI: 10.1007/978-3-319-74766-8_41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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20
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Aldeiri B, Roostalu U, Albertini A, Wong J, Morabito A, Cossu G. Transgelin-expressing myofibroblasts orchestrate ventral midline closure through TGFβ signalling. Development 2017; 144:3336-3348. [PMID: 28807903 PMCID: PMC5612253 DOI: 10.1242/dev.152843] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 08/04/2017] [Indexed: 01/09/2023]
Abstract
Ventral body wall (VBW) defects are among the most common congenital malformations, yet their embryonic origin and underlying molecular mechanisms remain poorly characterised. Transforming growth factor beta (TGFβ) signalling is essential for VBW closure, but the responding cells are not known. Here, we identify in mouse a population of migratory myofibroblasts at the leading edge of the closing VBW that express the actin-binding protein transgelin (TAGLN) and TGFβ receptor (TGFβR). These cells respond to a temporally regulated TGFβ2 gradient originating from the epithelium of the primary body wall. Targeted elimination of TGFβR2 in TAGLN+ cells impairs midline closure and prevents the correct subsequent patterning of the musculature and skeletal components. Remarkably, deletion of Tgfbr2 in myogenic or chondrogenic progenitor cells does not manifest in midline defects. Our results indicate a pivotal significance of VBW myofibroblasts in orchestrating ventral midline closure by mediating the response to the TGFβ gradient. Altogether, our data enable us to distinguish highly regulated epithelial-mesenchymal signalling and successive cellular migration events in VBW closure that explain early morphological changes underlying the development of congenital VBW defects. Summary: A population of migratory myofibroblasts at the leading edge of the closing ventral body wall expresses cytoskeletal components and TGFβR2 and responds to an epithelial TGFβ2 morphogen gradient to drive midline closure.
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Affiliation(s)
- Bashar Aldeiri
- Manchester Academic Health Science Centre, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK.,Royal Manchester Children's Hospital, Manchester M13 9WL, UK
| | - Urmas Roostalu
- Manchester Academic Health Science Centre, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
| | - Alessandra Albertini
- Manchester Academic Health Science Centre, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
| | - Jason Wong
- Manchester Academic Health Science Centre, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK.,University Hospitals of South Manchester, Manchester M23 9LT, UK
| | - Antonino Morabito
- Manchester Academic Health Science Centre, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK.,Royal Manchester Children's Hospital, Manchester M13 9WL, UK
| | - Giulio Cossu
- Manchester Academic Health Science Centre, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
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21
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Mohsina A, Kumar N, Sharma A, Shrivastava S, Mathew DD, Remya V, Sonal, Maiti S, Singh K, Singh K. Polypropylene mesh seeded with fibroblasts: A new approach for the repair of abdominal wall defects in rats. Tissue Cell 2017; 49:383-392. [DOI: 10.1016/j.tice.2017.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 04/07/2017] [Indexed: 11/29/2022]
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22
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Geslin D, Clermidi P, Gatibelza ME, Boussion F, Saliou AH, Le Manac'h Dove G, Margaryan M, De Vries P, Sentilhes L, Levard G, Lardy H, Arnaud A, Leclair MD, Podevin G, Schmitt F. What prenatal ultrasound features are predictable of complex or vanishing gastroschisis? A retrospective study. Prenat Diagn 2017; 37:168-175. [DOI: 10.1002/pd.4984] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 10/19/2016] [Accepted: 12/09/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Dorothée Geslin
- Paediatric Surgery Department; University Hospital of Angers; Angers France
- Paediatric Surgery Department; University Hospital of Lyon; Lyon France
| | - Pauline Clermidi
- Paediatric Surgery Department; University Hospital of Nantes; Nantes France
- Paediatric Surgery Department; Robert Debré University Hospital; Paris France
| | - Marie-Eve Gatibelza
- Paediatric Surgery Department; University Hospital of Poitiers; Poitiers France
- Paediatric Surgery Department; University Hospital of Rennes; Rennes France
| | - Françoise Boussion
- Department of Obstetrics and Gynecology; Angers University; Angers France
| | - Anne-Hélène Saliou
- Department of Obstetrics and Gynecology; University Hospital of Brest; Brest France
| | | | - Marc Margaryan
- Paediatric Surgery Department; Le Mans Hospital; Le Mans France
| | - Philine De Vries
- Paediatric Surgery Department; University Hospital of Brest; Brest France
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology; University Hospital of Bordeaux; Bordeaux France
| | - Guillaume Levard
- Paediatric Surgery Department; University Hospital of Poitiers; Poitiers France
| | - Hubert Lardy
- Paediatric Surgery Department; University Hospital of Tours; Tours France
| | - Alexis Arnaud
- Paediatric Surgery Department; University Hospital of Rennes; Rennes France
| | - Marc-David Leclair
- Paediatric Surgery Department; University Hospital of Nantes; Nantes France
| | - Guillaume Podevin
- Paediatric Surgery Department; University Hospital of Angers; Angers France
| | - Françoise Schmitt
- Paediatric Surgery Department; University Hospital of Angers; Angers France
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23
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Razumovskiy AY, Smirnov AN, Dronov AF, Chundokova MA, Chirkov IS. [Differentiated approach to the treatment of large hernial defects of the anterior abdominal wall in children (clinical observations)]. Khirurgiia (Mosk) 2017:46-50. [PMID: 28418368 DOI: 10.17116/hirurgia2017446-50] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
AIM To present an experience of treatment of children with large hernial defects of the anterior abdominal wall. MATERIAL AND METHODS This article describes management of 43 children with large (n=31) and giant (n=12) ventral hernia who were at N.F. Filatov Children´s City Hospital #13 for the period 2005-2015. All patients underwent surgical correction using local tissues in 'edge to edge' fashion (n=23), aponeurosis dublication of 'coat floors' type (n=14) and biological implant 'Permacol' (n=6). Etiological causes of ventral hernias in children were comprehensively analyzed. Optimal time for surgical treatment and features of viscero-abdominal disproportion were discussed. CONCLUSION Early restoration of anatomical and functional structures of the anterior abdominal wall is necessary for good cosmetic result and prevention of recurrent ventral hernia. We presented three clinical examples of commonly used surgical procedures in children including anterior abdominal wall repair using biological material 'Permacol'.
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Affiliation(s)
- A Yu Razumovskiy
- N.I. Pirogov Russian National Research Medical University, Department of Pediatric Surgery, Russian Ministry of Health, Moscow, Russia; N.F. Filatov Children's City Hospital #13, Moscow, Russia
| | - A N Smirnov
- N.I. Pirogov Russian National Research Medical University, Department of Pediatric Surgery, Russian Ministry of Health, Moscow, Russia; N.F. Filatov Children's City Hospital #13, Moscow, Russia
| | - A F Dronov
- N.I. Pirogov Russian National Research Medical University, Department of Pediatric Surgery, Russian Ministry of Health, Moscow, Russia; N.F. Filatov Children's City Hospital #13, Moscow, Russia
| | - M A Chundokova
- N.I. Pirogov Russian National Research Medical University, Department of Pediatric Surgery, Russian Ministry of Health, Moscow, Russia; N.F. Filatov Children's City Hospital #13, Moscow, Russia
| | - I S Chirkov
- N.I. Pirogov Russian National Research Medical University, Department of Pediatric Surgery, Russian Ministry of Health, Moscow, Russia; N.F. Filatov Children's City Hospital #13, Moscow, Russia
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24
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Lalani A, Ham PB, Wise LJ, Daniel JM, Walters KC, Pipkin WL, Stansfield B, Hatley RM, Bhatia J. Management of Patients with Gastroschisis Requiring Extracorporeal Membrane Oxygenation for Concurrent Respiratory Failure. Am Surg 2016. [DOI: 10.1177/000313481608200929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Treatment of gastroschisis often requires multiple surgical procedures to re-establish abdominal domain, reduce abdominal contents, and eventually close the abdominal wall. In patients who have concomitant respiratory failure requiring extracorporeal membrane oxygenation (ECMO), this process becomes further complicated. This situation is rare and only five such cases have been reported in the ECMO registry database. Management of three of the five patients along with results and implications for future care of similar patients is discussed here. Two patients had respiratory failure due to meconium aspiration syndrome and one patient had persistent acidosis as well as worsening pulmonary hypertension leading to the decision of ECMO. The abdominal contents were placed in a spring-loaded silastic silo while on ECMO and primary closure was performed three to six days after the decannulation. All three patients survived and are developmentally appropriate. We recommend avoiding aggressively reducing the abdominal contents and using a silo to conservatively reducing the gastroschisis while the patient is on ECMO therapy. Keeping the intra-abdominal pressure below 20 mm Hg can possibly reduce ECMO days and ventilator time and has been shown to decrease morbidity and mortality. Patients with gastroschisis and respiratory failure requiring ECMO can have good outcomes despite the complexity of required care.
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Affiliation(s)
- Alykhan Lalani
- Medical College of Georgia, Georgia Regents University, Augusta, Georgia
| | - P. Benson Ham
- Section of Pediatric Surgery, Children's Hospital of Georgia, Georgia Regents University, Augusta, Georgia
| | - Linda J. Wise
- Division of Neonatology, Children's Hospital of Georgia, Georgia Regents University, Augusta, Georgia
| | - John M. Daniel
- Division of Neonatology, Kentucky Children's Hospital, Lexington, Kentucky
| | - K. Christian Walters
- Section of Pediatric Surgery, Children's Hospital of Georgia, Georgia Regents University, Augusta, Georgia
| | - Walter L. Pipkin
- Section of Pediatric Surgery, Children's Hospital of Georgia, Georgia Regents University, Augusta, Georgia
| | - Brian Stansfield
- Division of Neonatology, Children's Hospital of Georgia, Georgia Regents University, Augusta, Georgia
| | - Robyn M. Hatley
- Section of Pediatric Surgery, Children's Hospital of Georgia, Georgia Regents University, Augusta, Georgia
| | - Jatinder Bhatia
- Division of Neonatology, Children's Hospital of Georgia, Georgia Regents University, Augusta, Georgia
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25
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Bassil KL, Yang J, Arbour L, Moineddin R, Brindle ME, Hazell E, Skarsgard ED. Spatial variability of gastroschisis in Canada, 2006-2011: An exploratory analysis. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2016; 107:e62-e67. [PMID: 27348112 PMCID: PMC6972289 DOI: 10.17269/cjph.107.5084] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 01/21/2016] [Accepted: 08/30/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Gastroschisis is a serious birth defect of the abdominal wall that is associated with mortality and significant morbidity. Our understanding of the factors causing this defect is limited. The objective of this paper is to describe the geographic variation in incidence of gastroschisis and characterize the spatial pattern of all gastroschisis cases in Canada between 2006 and 2011. Specifically, we aimed to ascertain the differences in spatial patterns between geographic regions and identify significant clusters and their location. METHODS The study population included 641 gastroschisis cases from the Canadian Pediatric Surgery Network (CAPSNet) database, a population-based dataset of all gastroschisis cases in Canada. Cases were geocoded based on maternal residence. Using Statistics Canada live-birth data as a denominator, the total prevalence of gastroschisis was calculated at the provincial/territorial levels. Random effects logistic models were used to estimate the rates of gastroschisis in each census division. These rates were then mapped using ArcGIS. Cluster detection was performed using Local Indicators of Spatial Association (LISA). RESULTS There is significant spatial heterogeneity of the rate of gastroschisis across Canada at both the provincial/territorial and census-division level. The Yukon, Northwest Territories and Prince Edward Island have higher overall rates of gastroschisis relative to other provinces/territories. Several census divisions in Alberta, Manitoba, Saskatchewan, Ontario, Northwest Territories and British Columbia demonstrated case "clusters", i.e., focally higher rates in discrete areas relative to surrounding areas. CONCLUSIONS There is clear evidence of spatial variation in the rates of gastroschisis across Canada. Future research should explore the role of area-based variables in these patterns to improve our understanding of the etiology of gastroschisis.
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Affiliation(s)
| | - Junmin Yang
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, ON, Canada
| | - Laura Arbour
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Mary E Brindle
- Departments of Surgery and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Emily Hazell
- Department of Geography, Ryerson University, Toronto, ON, Canada
| | - Erik D Skarsgard
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
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26
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Rosa RFM, Michelon L, Masiero Á, Faria AEV, De Souza VF, Dietrich C, Targa LV, Provenzi VO, Pires SRS, Zen PRG. Gastroschisis in a fetus with a congenital neuroblastoma: Association or coincidence? ACTA ACUST UNITED AC 2016; 106:208-12. [PMID: 26875914 DOI: 10.1002/bdra.23484] [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: 06/09/2015] [Revised: 12/18/2015] [Accepted: 12/22/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND Gastroschisis is the most common abdominal wall defect. It is characterized by herniation of the intestine and other abdominal organs through a defect in the abdominal wall. Neuroblastoma is the most common malignant tumor observed during the neonatal period. It is a neuroendocrine tumor derived from neural crest cells that develops into the adrenal gland. CASE We report on the undescribed association between gastrochisis and congenital neuroblastoma, diagnosised during the prenatal period. The mother was a 20-year-old healthy pregnant woman in her second pregnancy. Obstetric ultrasound examination showed a fetus presenting an abdominal wall defect on the right side of the umbilical cord, compatible with gastroschisis, and a hyperechogenic and spherical solid lesion on the left adrenal gland. Fetal magnetic resonance imaging disclosed similar features associated to a heterogeneous aspect of the liver. The diagnosis of metastatic neuroblastoma was confirmed after birth through liver biopsy. At 2 days of life, the prothrombrin time was abnormal, and the patient needed vitamin K. CONCLUSION We cannot rule out the possibility that a clotting defect, commonly observed in disseminated malignancies such as a metastatic neuroblastoma may be associated with the etiology of the gastroschisis, as this defect may result from a thrombosis occurring around 3 to 4 weeks of gestation, a period when neuroblasts development occurs into the adrenal medulla. However, we cannot exclude the possibility that both events may have occurred simultaneously by chance.
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Affiliation(s)
- Rafael F M Rosa
- Clinical Genetics, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) and Complexo Hospitalar Santa Casa de Porto Alegre (CHSCPA), RS, Brazil.,Clinical Genetics, Hospital Materno Infantil Presidente Vargas (HMIPV), RS, Brazil.,Graduate Program in Pathology, UFCSPA, RS, Brazil.,Fetal Medicine, HMIPV, RS, Brazil
| | - Laura Michelon
- Graduation in Medicine, Universidade Luterana do Brasil (ULBRA), RS, Brazil
| | - Átila Masiero
- Graduation in Medicine, Universidade Luterana do Brasil (ULBRA), RS, Brazil
| | | | | | | | | | | | | | - Paulo R G Zen
- Clinical Genetics, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) and Complexo Hospitalar Santa Casa de Porto Alegre (CHSCPA), RS, Brazil.,Graduate Program in Pathology, UFCSPA, RS, Brazil
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27
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Abstract
The abdominal wall is an integral component of the chest wall. Defects in the ventral abdominal wall alter respiratory mechanics and can impair diaphragm function. Congenital abdominal wall defects also are associated with abnormalities in lung growth and development that lead to pulmonary hypoplasia, pulmonary hypertension, and alterations in thoracic cage formation. Although infants with ventral abdominal wall defects can experience life-threatening pulmonary complications, older children typically experience a more benign respiratory course. Studies of lung and chest wall function in older children and adolescents with congenital abdominal wall defects are few; such investigations could provide strategies for improved respiratory performance, avoidance of respiratory morbidity, and enhanced exercise ability for these children.
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Affiliation(s)
- Howard B Panitch
- Professor of Pediatrics, Perelman School of Medicine at The University of Pennsylvania, Division of Pulmonary Medicine, The Children's Hospital of Philadelphia.
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28
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Bioengineered acellular dermal matrices for the repair of abdominal wall defects in rats. Hernia 2014; 19:219-29. [DOI: 10.1007/s10029-014-1308-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 08/23/2014] [Indexed: 10/24/2022]
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Gamba P, Midrio P. Abdominal wall defects: prenatal diagnosis, newborn management, and long-term outcomes. Semin Pediatr Surg 2014; 23:283-90. [PMID: 25459013 DOI: 10.1053/j.sempedsurg.2014.09.009] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Omphalocele and gastroschisis represent the most frequent congenital abdominal wall defects a pediatric surgeon is called to treat. There has been an increased reported incidence in the past 10 years mainly due to the diffuse use of prenatal ultrasound. The early detection of these malformations, and related associated anomalies, allows a multidisciplinary counseling and planning of delivery in a center equipped with high-risk pregnancy assistance, pediatric surgery, and neonatology. At present times, closure of defects, even in multiple stages, is always possible as well as management of most of cardiac-, urinary-, and gastrointestinal-associated malformations. The progress, herein discussed, in the care of newborns with abdominal wall defects assures most of them survive and reach adulthood. Some aspects of transition of medical care will also be considered, including fertility and cosmesis.
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Affiliation(s)
- Piergiorgio Gamba
- Pediatric Surgery, Department of Woman and Child Health, University Hospital, Via Giustiniani 3, Padua 35121, Italy.
| | - Paola Midrio
- Pediatric Surgery, Department of Woman and Child Health, University Hospital, Via Giustiniani 3, Padua 35121, Italy
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Peters NCJ, Hooft MEV', Ursem NTC, Eggink AJ, Wijnen RMH, Tibboel D, Bonsel GJ, Cohen-Overbeek TE. The relation between viscero-abdominal disproportion and type of omphalocele closure. Eur J Obstet Gynecol Reprod Biol 2014; 181:294-9. [PMID: 25201609 DOI: 10.1016/j.ejogrb.2014.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 07/28/2014] [Accepted: 08/07/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To investigate the relation between prenatal ultrasound measurements of viscero-abdominal disproportion and the expected type of postnatal surgical closure of an omphalocele. STUDY DESIGN Retrospectively, 24 fetuses diagnosed with an isolated omphalocele in the 2nd trimester of pregnancy were selected (period 2003-2013). An image of the axial plane of the abdomen at the level of the defect was retrieved. The ratio of omphalocele circumference to abdominal circumference (OC/AC), and the ratio of defect diameter to abdominal diameter (DD/DA) were calculated. Prognostic outcome was primary closure. Sensitivity and specificity and the corresponding area under the ROC curve of these ratios were calculated as measurements of prognostic accuracy. RESULTS Primary closure was achieved in 15/24 cases. For the OC/AC-ratio a cut-off value of 0.82 successfully predicted outcome in 23/24 cases with an area under the ROC curve of 0.99. A cut-off value of 0.61 for the DD/DA-ratio successfully predicted type of closure in 20/24 cases with an area under the ROC curve of 0.88. In all cases without eviscerated liver tissue, the defect was primarily closed. CONCLUSION In prenatal isolated omphalocele cases, the OC/AC-ratio is better at predicting postnatal surgical closure than the DD/DA-ratio and can be used as a prognostic tool for expected type of closure in the 2nd trimester of pregnancy.
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Affiliation(s)
- Nina C J Peters
- Erasmus MC, University Medical Center Rotterdam, Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Rotterdam, The Netherlands.
| | - Michele E Visser 't Hooft
- Erasmus MC, University Medical Center Rotterdam, Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Rotterdam, The Netherlands
| | - Nicolette T C Ursem
- Erasmus MC, University Medical Center Rotterdam, Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Rotterdam, The Netherlands
| | - Alex J Eggink
- Erasmus MC, University Medical Center Rotterdam, Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Rotterdam, The Netherlands
| | - René M H Wijnen
- Erasmus MC, University Medical Center Rotterdam, Department of Pediatric Surgery, Rotterdam, The Netherlands
| | - Dick Tibboel
- Erasmus MC, University Medical Center Rotterdam, Department of Pediatric Surgery, Rotterdam, The Netherlands
| | - Gouke J Bonsel
- Erasmus MC, University Medical Center Rotterdam, Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Rotterdam, The Netherlands
| | - Titia E Cohen-Overbeek
- Erasmus MC, University Medical Center Rotterdam, Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Rotterdam, The Netherlands
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Deng K, Qiu J, Dai L, Yi L, Deng C, Mu Y, Zhu J. Perinatal mortality in pregnancies with omphalocele: data from the Chinese national birth defects monitoring network, 1996-2006. BMC Pediatr 2014; 14:160. [PMID: 24953381 PMCID: PMC4075420 DOI: 10.1186/1471-2431-14-160] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 06/12/2014] [Indexed: 12/15/2022] Open
Abstract
Background Previous studies on the mortality rate of omphalocele are limited. The risk of death of non-isolated omphalocele and that of cases of omphalocele that are diagnosed prenatally by ultrasound are unclear. This study aimed to estimate the perinatal mortality of pregnancies with omphalocele. This study also examined the potential risk of death of non-isolated omphalocele and that of cases that are prenatally diagnosed by ultrasound. Methods Data were retrieved from the national birth defects registry in China, for 1996–2006. Multinomial logistic regression was used to calculate the adjusted odds ratios (AORs) and 95% confidence intervals (CIs) between perinatal mortality and selected maternal and fetal characteristics. Results Among 827 cases of omphalocele, 309 (37.4%) cases resulted in termination of pregnancy and stillbirth, and 124 (15.0%) cases resulted in death in the first 7 days after delivery, yielding a perinatal mortality rate of 52.4% (95% CI: 49.0–55.8%). The late fetal death rate (LFDR) of omphalocele that was diagnosed prenatally by ultrasound was 15.91-fold (AOR: 15.91, 95% CI: 10.18–24.87) higher than that of postnatally diagnosed cases. The LFDR of non-isolated omphalocele was 2.64-fold (AOR: 2.64, 95% CI: 1.62–4.29) higher than that of isolated cases. For the early neonatal death rate, neonates with non-isolated omphalocele had a 2.96-fold (AOR: 2.96, 95% CI: 1.82–4.81) higher risk than isolated cases, but the difference between prenatal ultrasound diagnosis and postnatal diagnosis was not significant. Conclusions Selected fetal characteristics are significantly associated with the perinatal risk of death from omphalocele. Our findings suggest that improving pregnancy and delivery care, as well as management for omphalocele are important.
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Affiliation(s)
| | | | | | | | | | | | - Jun Zhu
- National Center for Birth Defects monitoring of China, West China Second University Hospital, Sichuan University, 17, Section3, Ren Min South Road, Chengdu, China.
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Goetzinger KR, Tuuli MG, Longman RE, Huster KM, Odibo AO, Cahill AG. Sonographic predictors of postnatal bowel atresia in fetal gastroschisis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 43:420-425. [PMID: 23893619 PMCID: PMC3968234 DOI: 10.1002/uog.12568] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 06/26/2013] [Accepted: 07/17/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To estimate the association between antenatal bowel dilation and postnatal small-bowel atresia in fetal gastroschisis and to establish a threshold at which the risk of adverse neonatal outcome increases. METHODS This was a retrospective cohort study of singleton gestations with an antenatal diagnosis of gastroschisis seen in our ultrasound unit from 2001 to 2010. We reviewed stored images from the last ultrasound examination before delivery, blinded to postnatal diagnoses and outcomes. Fetal intra- and extra-abdominal bowel dilation (IABD and EABD, respectively) and bowel-wall thickness were measured. Previously published definitions of bowel dilation, including > 6, > 10, > 14 and > 18 mm, were evaluated for association with the primary outcome of bowel atresia. The optimal threshold to define fetal bowel dilation was determined by evaluating the significance of association as well as test performance characteristics. RESULTS Of 109 consecutive patients with fetal gastroschisis, there were four cases of intrauterine fetal demise and three neonatal deaths. Of the 94 live births with complete outcome data, 39 (41.5%) had measurable IABD. There were 14 (14.9%) cases of bowel atresia. Using a threshold of > 14 mm, IABD was significantly associated with an increased risk for bowel atresia (relative risk, 3.1 (95% CI, 1.2-8.2)) with a sensitivity of 57.1%, specificity of 75.0%, positive predictive value of 28.6% and negative predictive value of 90.9%. IABD > 14 mm was also associated with a significantly longer stay in neonatal intensive care unit. There was no significant association between EABD and bowel atresia at any of the thresholds evaluated. CONCLUSION IABD > 14 mm is associated with an increased risk for postnatal bowel atresia in fetal gastroschisis. This finding may be useful in counseling patients regarding the anticipated postnatal course for their neonate.
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Affiliation(s)
- K R Goetzinger
- Department of Obstetrics & Gynecology, Washington University School of Medicine, St Louis, MO, USA
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Wood SJ, Samangaya RA, Gillham JC, Morabito A. Gastroschisis and the risk of short bowel syndrome: outcomes and counselling. Neonatology 2014; 105:5-8. [PMID: 24193105 DOI: 10.1159/000351038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 03/21/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Gastroschisis can be associated with short bowel syndrome (SBS). We present 4 cases with significant bowel shortening with very different ante- and postnatal presentations. CASES Three of the cases demonstrated 'vanishing' gastroschisis with progressively worsening antenatal intra-abdominal bowel dilatation with no defect present at birth. The fourth case followed an uneventful course antenatally but developed SBS considered secondary to gastroschisis-related atresia and necrosis. All 4 cases were classified as having SBS and were enrolled within the paediatric Intestinal Rehabilitation Programme. This involves autologous gastrointestinal reconstruction following a period of bowel expansion with concomitant parenteral and enteral nutrition. DISCUSSION These cases demonstrate that the serious complication of significant bowel loss cannot always be anticipated. Early multidisciplinary discussion with the parents enables a shared understanding of potential outcomes. It can aid the recognition of 'vanishing' gastroschisis enabling expedient investigations and early intervention, minimising morbidity and maximising bowel length.
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Affiliation(s)
- Sarah J Wood
- Royal Manchester Children's Hospital, Manchester, UK
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Tsai HF, Cheng YC, Ko HC, Kang L, Tsai PY, Yu CH, Chang CH, Chang FM. Prenatal diagnosis of fetal gastroschisis using three-dimensional ultrasound: comparison between the 20th and 21st centuries. Taiwan J Obstet Gynecol 2013; 52:192-6. [PMID: 23915850 DOI: 10.1016/j.tjog.2013.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2013] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE In order to compare the trends and improvements of prenatal diagnosis of gastroschisis, we herein retrospectively reviewed our cases of fetal gastroschisis detected by three-dimensional ultrasound (3D US) between the two centuries. MATERIALS AND METHODS We reviewed our computer database of prenatal diagnosis on gastroschisis in National Cheng Kung University Hospital from October 1994 to November 2011. All the fetuses were initially scanned by two-dimensional (2D) US to locate the region of interest (ROI). Then, the 3D probe was used to scan all the ROI systematically and mechanically, and all the images were stored on laser discs for further 3D visualization and reconstruction. To compare the characteristics at prenatal diagnosis of gastroschisis between the 20th and 21st centuries in our hospital, the Chi-square test and Student t test were used. The p values less than 0.05 and 0.1 were considered statistically significant. RESULTS In total, 26 fetuses with gastroschisis were depicted by 3D US in utero (10 cases were diagnosed in the 20th century and 16 cases in the 21st century). The ranges of gestational age at prenatal diagnosis of gastroschisis by 3D US in the 20th century were between 14 and 34 weeks (mean: 21.6 weeks) and between 14 and 33 weeks (mean: 21.9 weeks) in the 21st century. Moreover, seven cases (70%) were diagnosed before the third trimester in the 20th century, whereas 13 cases (81%) were diagnosed before the third trimester in the 21st century. CONCLUSION Although without statistical significance, higher prenatal diagnosis rate before the third trimester in the 21st century was noted. The improvement of 3D US has remarkable advantages in adding novel visual depiction of a 3D lesion of a 3D fetus in 3D US after reconstruction and thus assists substantially in prenatal diagnosis, genetic consultation, and perinatal management of gastroschisis.
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Affiliation(s)
- Hsing-Fen Tsai
- Department of Obstetrics and Gynecology, National Cheng Kung University College of Medicine and National Cheng Kung University Hospital, Tainan, Taiwan
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Abstract
A routine pregnancy ultrasound examination of a 30-yr-old, multiparous, common bottlenose dolphin, Tursiops truncatus, detected an approximately 16-wk (gestational age) fetus with an omphalocele, an abdominal wall defect at the base of the umbilical cord. Throughout the pregnancy, ultrasound allowed for identification of the omphalocele contents, which included a portion of the liver and intestinal loops. The maximum diameter of the omphalocele was 11.4 cm at an estimated 51-wk gestation. Color Doppler was utilized to study the blood flow within the omphalocele as well as diagnose an associated anomaly of the umbilical cord, which contained three vessels instead of four. Gross necropsy and histopathology confirmed the ultrasound diagnoses. This is the first report of an omphalocele in a T. truncatus fetus, and the first report of a fetal and umbilical cord anomaly diagnosed with ultrasound in a cetacean.
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Roelofs LAJ, Geutjes PJ, Hulsbergen-van de Kaa CA, Eggink AJ, van Kuppevelt TH, Daamen WF, Crevels AJ, van den Berg PP, Feitz WFJ, Wijnen RMH. Prenatal coverage of experimental gastroschisis with a collagen scaffold to protect the bowel. J Pediatr Surg 2013; 48:516-24. [PMID: 23480905 DOI: 10.1016/j.jpedsurg.2012.07.056] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Revised: 06/30/2012] [Accepted: 07/20/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND/PURPOSE In fetuses with gastroschisis, toxic products in the amniotic fluid and constriction at the defect of the abdominal wall are considered causative of damage to the eviscerated bowel. The aim of this study was to cover the eviscerated bowel in gastroschisis with a collagen scaffold to protect the bowel and induce cell growth into the scaffold, which could lead to skin or abdominal wall formation replacing the scaffold. METHODS In 12 fetal lambs gastroschisis was surgically created at 79 days gestation. A dual-layer type I collagen scaffold was sutured into the skin of the abdominal wall around the defect covering the eviscerated bowel. Lambs were examined after caesarean section at 140 days' gestation. RESULTS Survival was 67%. In 7 of 8 surviving lambs the bowel was found to be covered after birth. One scaffold had ruptured. The bowel was found repositioned in the abdominal cavity in 5 lambs. In 2 lambs it was still partially outside. Only minor adherence of bowel loops and no fibrous peel formation were seen. Connective tissue and skin tissue replaced the scaffold. CONCLUSIONS Prenatal coverage of the bowel in experimental gastroschisis with a collagen scaffold is feasible in fetal lambs, significantly diminished damage to the bowel wall, and skin and connective tissue replaced the scaffold. This technique may be promising in the care of fetuses with this congenital anomaly.
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Affiliation(s)
- Luc A J Roelofs
- Department of Urology, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
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Wilson MS, Carroll MA, Braun SA, Walsh WF, Pietsch JB, Bennett KA. Is preterm delivery indicated in fetuses with gastroschisis and antenatally detected bowel dilation? Fetal Diagn Ther 2012; 32:262-6. [PMID: 22813923 DOI: 10.1159/000338925] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 04/18/2012] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Due to the controversy surrounding diagnostic ultrasound evaluations and elective preterm delivery of fetuses with gastroschisis, we sought to calculate the predictive value of bowel dilation in fetuses with gastroschisis and evaluate the effect of preterm delivery on neonatal outcomes. MATERIALS AND METHODS Ultrasounds and medical records of 103 mother-infant pairs with fetal gastroschisis were reviewed. Eighty-nine pairs met the criteria. Intestinal complications, gestational age at delivery, birth weight, and number of abdominal surgeries were documented. RESULTS Forty-eight fetuses (54%) had bowel dilation and 41 (46%) did not. The positive predictive value of bowel dilation for complicated gastroschisis was 21%. There were 50 (56%) preterm and 39 (44%) term deliveries. The mean birth weight was 2,114 g (SD = 507) and 2,659 g (SD = 687), p = 0.001. For infants delivered preterm, the mean number of postnatal abdominal surgeries was 2.1 (SD = 1.1) as compared to 1.3 (SD = 0.5) surgical procedures for those infants delivered at term gestation. This was not statistically significant. With respect to hospital stay for each group, the mean length of neonatal intensive care unit admission was 48 days (SD = 33) in the preterm group and 35 days (SD = 50) in the term group, which was not statistically significant. DISCUSSION Ultrasound-detected bowel dilation was not predictive of important intestinal complications. Our data did not substantiate any benefit for elective preterm delivery of neonates with gastroschisis.
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Affiliation(s)
- Megan S Wilson
- Junior League Center for Advanced Maternal Fetal Care, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
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Na Q, Liu C, Cui H, Zhang Z, Yin S, Li Q. Immediate Repair Compared with Delayed Repair of Congenital Omphalocele: Short-Term Neonatal Outcomes in China. J Int Med Res 2011; 39:2344-51. [PMID: 22289553 DOI: 10.1177/147323001103900634] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This prospective study evaluated the short-term outcomes of 16 neonates undergoing single congenital omphalocele repair. Parents made informed choices for their baby to receive either immediate repair (IR group, n = 8) or repair ≥ 3 h after delivery (control group, n = 8). All babies were delivered by elective caesarian section. Babies in the two groups were matched one-to-one according to their birth weight, bulging volume and gestational age. Short-term outcomes included the incidence of infection and the lengths of stay in the neonatal intensive care unit (NICU) and in the hospital. Compared with the control group, the IR group showed a significantly lower incidence of infection, shorter surgical duration, shorter NICU stay, less time on total parenteral nutrition, less time to total enteral nutrition and shorter length of hospital stay. Immediate repair significantly improved the short-term neonatal outcomes of congenital omphalocele in China.
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Affiliation(s)
- Q Na
- Department of Obstetrics and Gynaecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - C Liu
- Department of Obstetrics and Gynaecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - H Cui
- Department of Obstetrics and Gynaecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Z Zhang
- Department of Obstetrics and Gynaecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - S Yin
- Department of Obstetrics and Gynaecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Q Li
- Department of Obstetrics and Gynaecology, Shengjing Hospital of China Medical University, Shenyang, China
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Juhasz-Böss I, Goelz R, Solomayer EF, Fuchs J, Meyberg-Solomayer G. Fetal and neonatal outcome in patients with anterior abdominal wall defects (gastroschisis and omphalocele). J Perinat Med 2011; 40:85-90. [PMID: 22085153 DOI: 10.1515/jpm.2011.107] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 08/11/2011] [Indexed: 11/15/2022]
Abstract
Fetuses with gastroschisis and omphalocele frequently show intrauterine growth restriction (IUGR). The aim of our study was to evaluate the intrauterine course of IUGR and the neonatal outcome in a large patient collective. We retrospectively included all euploid fetuses with gastroschisis and omphalocele between 2001 and 2009 in a single tertiary center. Patients' characteristics, serial ultrasound examinations and neonatal outcomes were evaluated. From 39 fetuses (28 gastroschisis, 11 omphalocele) 61.5% had IUGR <5th percentile and 15.4% had IUGR<10th percentile. The rate of IUGR did not differ significantly between the two groups during pregnancy. Newborns with gastroschisis showed an average weight of 2386 g, and those with omphalocele showed an average weight of 3148 g (P<0.001). Nevertheless, newborns with omphalocele were more frequently eutrophic than those with gastroschisis (88.8% vs. 52.2%, P=0.079). On average, only one surgical intervention was necessary for the definitive repair of the defect (65.5% of the newborns). Children with gastroschisis remained hospitalized nearly twice as long as children with an omphalocele (38 vs. 20 days). IUGR rates during pregnancy did not differ significantly between fetuses with gastroschisis and omphalocele although patients with defects of omphalocele were more frequently eutrophic at birth. Most newborns needed only one operation for definitive surgical treatment. The mean hospitalization time after this intervention was 4 weeks.
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Affiliation(s)
- Ingolf Juhasz-Böss
- Department of Obstetrics and Gynecology, University of Saarland, Homburg/Saar, Germany.
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Kuleva M, Khen-Dunlop N, Dumez Y, Ville Y, Salomon LJ. Is complex gastroschisis predictable by prenatal ultrasound? BJOG 2011; 119:102-9. [PMID: 22017923 DOI: 10.1111/j.1471-0528.2011.03183.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To establish a correlation between prenatal ultrasound findings and postnatal outcome in neonates with gastroschisis (GS). DESIGN Retrospective case-control study. SETTING Prenatal ultrasound reports, labour and neonatal intensive care unit notes, and paediatric surgical clinic records were reviewed. POPULATION Neonates with an antenatal diagnosis of isolated GS. METHODS The neonates were divided into two groups: one with associated bowel complications including intestinal atresia, perforation, necrosis or volvulus ('complex' GS), and the second without bowel complication ('simple' GS). Prenatal ultrasound markers: small-for-gestational-age, intra-abdominal and extra-abdominal bowel dilatation (>6 mm), thickened intestinal wall and stomach dilatation were correlated with outcome. MAIN OUTCOME MEASURES Fetal or neonatal death in complex versus simple GS. Time on parenteral nutrition and duration of hospital stay were also noted. RESULTS In all, 105 cases were eligible for analysis. Survival rate was 101/105 (96.2%). None of the ultrasound markers was predictive of fetal or neonatal death. Fourteen of 103 live-born babies (14.6%) had complex GS, which was associated with longer time on parenteral nutrition [8.0 (51.5-390) versus 33.5 (25.3-53.3) days, P<0.001] and longer duration of hospital stay [85.3 (55.5-210) versus 41.5 (33.0-64.8) days, P<0.001]. Infants with complex GS were more likely to require bowel resection and stoma placement (P<0.05). Intra-abdominal bowel dilatation was the only predictive ultrasound marker of complex GS (odds ratio 4.13, 95% CI 1.32-12.90; P=0.018). Receiver operating characteristic curve for observed/expected bowel diameter yielded 6 as the cutoff value for predicting complex GS (odds ratio 7.9, 95% CI 2.3-27.3; P=0.001) with 54% and 88% for sensibility and specificity, respectively. CONCLUSIONS Intra-abdominal bowel dilatation is the only ultrasound marker predictive of complex GS but it is a strong marker.
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Affiliation(s)
- M Kuleva
- Department of Obstetrics, Hôpital Necker Enfants Malades, Assistance Publique, Hôpitaux de Paris, Université Paris Descartes Société Française pour l'Amélioration des Pratiques Echographiques, Paris, France
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Wonkam A, Extermann P, Birraux J, Fokstuen S. Are abdominal wall defects and external genitalia anomalies randomly expressed in some families? Congenit Anom (Kyoto) 2011; 51:96-9. [PMID: 20727000 DOI: 10.1111/j.1741-4520.2010.00291.x] [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: 11/27/2022]
Abstract
Familial cases of isolated abdominal wall defects with variable expressivity in more than one generation have rarely been observed. We report four affected individuals within a small three-generation family with either variable non-syndromic abdominal wall defects or external genital anomalies. We discuss the possible transmission of non-syndromic abdominal wall defects. It could be hypothesized that similar developmental defects may result in anomalies like hypospadias in males or developmental anomalies of the labia minora or labia majora in females.
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Affiliation(s)
- Ambroise Wonkam
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
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Alfaraj MA, Ryan G, Langer JC, Windrim R, Seaward PGR, Kingdom J. Does gastric dilation predict adverse perinatal or surgical outcome in fetuses with gastroschisis? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 37:202-206. [PMID: 21264982 DOI: 10.1002/uog.8868] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/07/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To compare perinatal and infant surgical outcomes in fetuses with gastroschisis with and without gastric dilation in a single-center cohort. METHODS This was a retrospective study of all singleton pregnancies with a prenatal diagnosis of gastroschisis managed at University of Toronto perinatal centers between January 2001 and February 2010. Digital prenatal ultrasound images were reviewed to determine fetal gastric size within 2 weeks of delivery. Perinatal and surgical outcomes were compared in fetuses with and without gastric dilation including: gestational age at delivery, mode of delivery, indication for Cesarean section, meconium-stained amniotic fluid, birth weight percentile, Apgar scores at 1 and 5 min, umbilical artery pH, time to full enteral feeding, length of hospital stay, bowel atresia or necrosis and need for bowel resection. RESULTS Ninety-eight fetuses with prenatally diagnosed gastroschisis managed at our center were included in the study, of which 32 (32.7%) were found to have gastric dilation. Gastric dilation predicted meconium-stained amniotic fluid at delivery (53% vs. 24%; P = 0.017), but no other adverse perinatal outcome. Surgical morbidity rates (bowel atresia, bowel necrosis, perforation diagnosed postnatally, need for bowel resection, total time to full enteral feeding and length of hospital stay) were unaffected by gastric dilation. CONCLUSIONS In gastroschisis, fetal gastric dilation is associated with meconium-stained amniotic fluid at delivery, but is not predictive of any serious perinatal or postnatal complications. Fetal growth and well-being should be serially evaluated on ultrasound using biophysical and Doppler assessment to decide on the optimal timing and mode of delivery.
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Affiliation(s)
- M A Alfaraj
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Canada
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Ozawa K, Ishikawa H, Maruyama Y, Nagata T, Nagase H, Itani Y, Kurosawa K, Yamanaka M. Congenital Omphalocele and Polyhydramnios: A Study of 52 Cases. Fetal Diagn Ther 2011; 30:184-8. [DOI: 10.1159/000327542] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Accepted: 03/17/2011] [Indexed: 11/19/2022]
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Abstract
Gastroschisis (GS) continues to increase in frequency, with several studies now reported an incidence of between 4 and 5 per 10,000 live births. The main risk factor would seem to be young maternal age, and it is in this group that the greatest increase has occurred. Whilst various geographical regions confer a higher risk, the impact of several other putative risk factors, including smoking and illicit drug use, may be less important than when first identified in early epidemiological studies. Over 90% of cases of GS will now be diagnosed on antenatal ultrasound, but its value in determining the need for early delivery remains unclear. There would appear no clear evidence for either routine early delivery or elective caesarean section for infants with antenatally diagnosed GS. Delivery at a centre with paediatric surgical facilities reduces the risk of subsequent morbidity and should represent the standard of care. The relative roles of primary closure, staged closure and ward reduction, with or without general anaesthesia, appear less clear with considerable variation between centres in both the use of these techniques and subsequent surgical outcomes. Survival rates continue to improve, with rates well in excess of 90% now routine. The limited long-term developmental data available would suggest that normal or near-normal outcomes may be expected although there remains a need for further studies.
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Garcia L, Brizot M, Liao A, Silva MM, Tannuri AC, Zugaib M. Bowel dilation as a predictor of adverse outcome in isolated fetal gastroschisis. Prenat Diagn 2010; 30:964-9. [DOI: 10.1002/pd.2596] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Grapin-Dagorno C, Noche ME, Boubnova J. [Surgical treatment of omphalocele and gastroschisis: prognostic factors]. Arch Pediatr 2010; 17:820-1. [PMID: 20654910 DOI: 10.1016/s0929-693x(10)70128-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Contro E, Fratelli N, Okoye B, Papageorghiou A, Thilaganathan B, Bhide A. Prenatal ultrasound in the prediction of bowel obstruction in infants with gastroschisis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 35:702-707. [PMID: 20069663 DOI: 10.1002/uog.7514] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To assess the value of prenatal ultrasound in predicting bowel obstruction requiring surgery in fetuses with prenatal diagnosis of gastroschisis. METHODS The database of our center was searched for cases with an antenatal diagnosis of gastroschisis. The ultrasound images were reviewed blindly to assess the presence of intra- or extra-abdominal bowel dilatation. Details of surgical procedures were noted and the discharge letters were obtained. Pediatric follow-up was also obtained from pediatric surgeons, general practitioners or parents. RESULTS In the 10-year period between November 1998 and September 2008 there were 62 cases with a prenatal diagnosis of gastroschisis. Postnatal outcome was not available for five cases, four pregnancies underwent termination and intrauterine fetal demise occurred in five cases. A final population of 48 liveborn infants was available for analysis. Intra-abdominal bowel dilatation was identified in 14 of these 48 fetuses (29.2%) and extra-abdominal bowel dilatation in 30 (62.5%) fetuses on prenatal ultrasound images. Eight fetuses (16.7%) had bowel obstruction. The relative risk of bowel obstruction with intra-abdominal bowel dilatation was 4.05 (95% CI, 1.12-14.70). On the other hand, the relative risk of bowel obstruction with extra-abdominal bowel dilatation was 1.0 (95% CI, 0.37-3.70). Four babies died, two of whom had intra- and one had extra-abdominal bowel dilatation. CONCLUSIONS Intra-abdominal dilatation of the bowel on prenatal ultrasound examination appears to predict postnatal bowel obstruction and the need for surgical resection. Extra-abdominal bowel dilatation is observed frequently on prenatal ultrasound scans, but is not predictive of bowel obstruction.
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Affiliation(s)
- E Contro
- Academic Department of Obstetrics and Gynaecology, St George's Hospital Medical School, London, UK
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Prenatal intraabdominal bowel dilation is associated with postnatal gastrointestinal complications in fetuses with gastroschisis. Am J Obstet Gynecol 2010; 202:396.e1-6. [PMID: 20044065 DOI: 10.1016/j.ajog.2009.10.888] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Revised: 08/13/2009] [Accepted: 10/29/2009] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether prenatal intraabdominal bowel dilation (IBD) is associated with increased postnatal complications in fetuses with gastroschisis. STUDY DESIGN A retrospective review was performed on all maternal-fetus pairs with prenatally diagnosed gastroschisis that was treated at the University of California San Francisco from 2002-2008. Postnatal outcomes were compared between fetuses with and without IBD. RESULTS Forty-three of 61 maternal-fetal pairs met the criteria for inclusion. Sixteen fetuses (37%) had evidence of IBD. Fetuses with IBD were significantly more likely to have postnatal bowel complications (38% vs 7%; P = .037). The presence of multiple loops of IBD (n = 6) as opposed to a single loop (n = 10) was associated highly with bowel complications and increased time to full enteral feeding and length of hospital stay (100% vs 0% [P = .001]; 44 vs 23 days [P = .034]; 69 vs 27 days [P = .001], respectively). CONCLUSION IBD is associated with increased postnatal complications in infants with prenatally diagnosed gastroschisis; however, this association seems to be limited to those with multiple loops of dilated intraabdominal bowel.
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Abstract
Abstract
Diagnostic ultrasound in the field of obstetrics is used to evaluate fetal anomalies and well-being. These images are used to develop a differential diagnosis that can later be correlated with postnatal outcomes. The following cases are a small sample of recent challenging fetal anomalies at our institution that were detected on prenatal ultrasound.
Objectives
Interpret ultrasound images of fetal anomalies
Assimilate the interpretation of images into a differential diagnosis
Correlate prenatal imaging with postnatal outcomes
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Gonçalves FLL, da Silva R, Schmidt AF, de Oliveira MG, Sbragia L. Hydrogel protection: a novel approach to reduce bowel inflammation in experimental gastroschisis. Eur J Obstet Gynecol Reprod Biol 2010; 148:35-9. [DOI: 10.1016/j.ejogrb.2009.10.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Revised: 09/14/2009] [Accepted: 10/05/2009] [Indexed: 11/30/2022]
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