Gastroschisis with Fetal Chromosomal Abnormality: A Case Report

A clinical-pathogenetic approach on associated anomalies and chromosomal defects supports novel candidate critical regions and genes for gastroschisis

BACKGROUND

Gastroschisis has been assumed to have a low rate of syndromic and primary malformations. We aimed to systematically review and explore the frequency and type of malformations/chromosomal syndromes and to identify significant biological/genetic roles in gastroschisis.

METHODS

Population-based, gastroschisis-associated anomalies/chromosomal defects published 1950-2018 (PubMed/MEDLINE) were independently searched by two reviewers. Associated anomalies/chromosomal defects and selected clinical characteristics were subdivided and pooled by race, system/region, isolated, and associated cases (descriptive analysis and chi-square test were performed). Critical regions/genes from representative chromosomal syndromes including an enrichment analysis using Gene Ontology Consortium/Panther Classification System databases were explored. Fisher's exact test with False Discovery Rate multiple test correction was performed.

RESULTS

Sixty-eight articles and 18525 cases as a base were identified (prevalence of 17.9 and 3% for associated anomalies/chromosomal defects, respectively). There were 3596 associated anomalies, prevailing those cardiovascular (23.3%) and digestive (20.3%). Co-occurring anomalies were associated with male, female, American Indian, Caucasian, prenatally diagnosed, chromosomal defects, and mortality (P < 0.00001). Gene clusters on 21q22.11 and 21q22.3 (KRTAP), 18q21.33 (SERPINB), 18q22.1 (CDH7, CDH19), 13q12.3 (FLT1), 13q22.1 (KLF5), 13q22.3 (EDNRB), and 13q34 (COL4A1, COL4A2, F7, F10) were significantly related to biological processes: blood pressure regulation and/or vessel integrity, angiogenesis, coagulation, cell-cell and/or cell-matrix adhesion, dermis integrity, and wound healing (P < 0.05).

CONCLUSIONS

Our findings suggest that gastroschisis may result from the interaction of several chromosomal regions in an additive manner as a pool of candidate genes were identified from critical regions supporting a role for vascular disruption, thrombosis, and mesodermal deficiency in the pathogenesis of gastroschisis.

Associated malformations and the "hidden mortality" of gastroschisis

BACKGROUND

Little is known about associated anomalies in fetuses with gastroschisis (GS) who experience an "atypical perinatal event," defined as spontaneous abortion, stillbirth, termination, or death within 24 hours of birth.

PURPOSE

This study aims to compare associated malformation rates in an atypical perinatal event cohort vs newborns with GS surviving longer than 24 hours.

METHODS

A national prospective GS database was analyzed for cases with an atypical perinatal event. Associated anomaly rates were compared between this cohort and babies surviving longer than 24 hours.

RESULTS

Twenty-three atypical perinatal events (2 spontaneous abortions, 7 stillbirths, 11 terminations, and 3 deaths within 24 hours) were identified from 529 total GS cases. Autopsies in 14 (61%) of 23 identified at least 1 anomaly (excluding intestinal, patent ductus arteriosus, and undescended testicle) in 11 (78.6%) and a "lethal" anomaly in 4 (36%). The associated anomaly rate in newborns surviving longer than 24 hours was 7.3% (37/506; P < .0001). The anomalies in the atypical perinatal event cohort were musculoskeletal (35%), cardiac, central nervous system, pulmonary, and genitourinary (12% each). Among survivors, the most common anomalies were cardiac (38%), genitourinary (32%), musculoskeletal (16%), and central nervous system (8%).

CONCLUSION

Rates of associated anomalies are significantly higher in fetuses experiencing atypical perinatal events and may represent the "hidden mortality" of GS.

Clinical features of newborns with gastroschisis and outcomes of different initial interventions: primary closure versus staged repair

BACKGROUND

Gastroschisis requires surgical management soon after birth. Few publications have reached conclusion regarding the differences of outcomes between primary closure (PC) and a staged repair with silo pouch reduction (SR); as the initial management of gastroschisis.

METHODS

A retrospective review was conducted in 44 newborns with gastroschisis between 1996 and 2007 at Chang Gung Children's Hospital. We recorded and analyzed basic demographic data, including birth body weight, gestational age, size of the wall defect, initial operative procedure, outcomes, and mortality.

RESULTS

The male-to-female ratio was 21:23. Patients had a low birth body weight (2263 ± 539g, mean ± SD) and were borderline premature (gestational age = 36.3 ± 1.86 weeks). Thirty-two patients received PC and 12 received SR as the initial treatment. Seven of the newborn infants died because of delayed initial surgical intervention (n = 2), operation-related complications (n = 4), or underlying multiple congenital anomalies (n = 1). The mortality rate was 16%. When comparing PC and SR (excluding "complicated" gastroschisis), there were no significant differences in survival, days of ventilator use, days to reach full enteral feeding, and hospitalization.

CONCLUSION

PC and SR are comparable as initial treatment modalities for gastroschisis. In addition to underlying gastrointestinal anomalies, the factors that led to significant morbidity in our study were bowel gangrene or perforation resulting from postponed surgical management and the development of abdominal compartment syndrome.

Clinical care outcomes in abdominal wall defects

PURPOSE OF REVIEW

Abdominal wall defects comprising both gastroschisis and omphalocele remain a source of significant morbidity and mortality, despite the advances in neonatal and pediatric surgical care. Survival has improved over the past few decades, especially with parenteral nutrition and surgical repair. Yet, still, many questions remain regarding the outcome of these anomalies.

RECENT FINDINGS

Outcomes of abdominal wall defects have been discussed more often in the recent publications, with analysis of databases and evaluation of prenatal series. There have been a number of new prenatal interventions in gastroschisis, and a better understanding of gestational outcomes from omphalocele. Papers have discussed the optimal surgical management of these defects as well.

SUMMARY

This review helps to bring together the most recent findings regarding outcomes and interventions for abdominal wall defects. It also illustrates the pressing need for a large prospective database to better understand these anomalies and provide better care.