1
|
Luton D, Mitanchez D, Winer N, Muller F, Gallot D, Perrotin F, Jouannic JM, Bretelle F, de Lagausie P, Ville Y, Guibourdenche J, Oury JF, Alberti C, Benachi A. A randomised controlled trial of amnioexchange for fetal gastroschisis. BJOG 2019; 126:1233-1241. [PMID: 31033140 DOI: 10.1111/1471-0528.15804] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Morbidity in fetuses affected by gastroschisis is mainly the result of bowel ischaemic and inflammatory processes. Experimental studies on animal models show that clearing amniotic fluid from the digestive secretions by amnioexchange procedures reduces the inflammatory process. We evaluated the benefit of the amnioexchange procedure for fetal gastroschisis in humans. DESIGN Prospective, interventional, randomised study. SETTING Eight referral centres for fetal medicine. POPULATION Pregnant women carrying a fetus with gastroschisis. METHODS We compared, in utero, amnioexchange with a sham procedure. The protocol included, in both arms, steroid injections at 30 weeks of gestation and the use of postnatal minimal enteral feeding. MAIN OUTCOME MEASURES The primary outcome was a composite variable based on the duration of ventilation and parenteral nutrition. Secondary outcomes were the effectiveness and safety of the amnioexchange procedure, including the rate of perinatal death, time to full enteral feeding, primary closure, and late feeding disorders. RESULTS Sixty-four patients were randomised. There was no difference in the composite criteria between the amnioexchange and control groups. Based on an intention-to-treat analysis, there were no significant between-group differences in pregnancy outcome or complications. When studying the relationship between digestive compounds and amniotic fluid inflammatory markers, a clear correlation was found between bile acid and both ferritin and interleukin 1β (IL1β). CONCLUSIONS In humans, amnioexchange, as described in our protocol, is not an option for fetal care; however, we provide supplementary proof of the involvement of inflammation in the pathogenicity of gastroschisis and suggest that future research should aim at reducing inflammation. ClinicalTrials.gov: NCT00127946. TWEETABLE ABSTRACT A prospective, interventional, randomised study shows no benefit of amnioexchange for fetal gastroschisis in humans.
Collapse
Affiliation(s)
- D Luton
- Department of Obstetrics and Gynaecology, AP-HP, Bichat Hospital, Paris, France.,DHU Risks in Pregnancy, Paris, France.,Department of Obstetrics and Gynaecology, AP-HP, Bichat-Claude Bernard Hospital, Paris, France.,Université Paris VII, Paris Diderot, Sorbonne Paris Cité, Paris, France.,INSERM U1141, Robert-Debré Hospital, Paris, France
| | - D Mitanchez
- Department of Neonatal Pediatrics, AP-HP, GHUEP, Armand Trousseau Hospital, Paris, France.,Faculty of Medicine, Sorbonne University, Paris, France
| | - N Winer
- Department of Obstetrics and Gynaecology, University Hospital of Nantes, CIC Mère enfant Nantes, UMR 1280 INRA Physiologie des Adaptations Nutritionnelles, Nantes, France
| | - F Muller
- INSERM U1141, Robert-Debré Hospital, Paris, France.,Department of Biochemistry and Hormonology, AP-HP, Robert Debré Hospital, Paris, France
| | - D Gallot
- Department of Obstetrics and Gynaecology, CHU de Clermont-Ferrand - Hôpital d'Estaing, Auvergne University, Clermont-Ferrand, France
| | - F Perrotin
- Department of Obstetrics and Gynaecology, CHRU de Tours, François Rabelais University, Tours, France
| | - J-M Jouannic
- Department of Obstetrics and Gynaecology, Faculty of Medicine, AP-HP, Armand Trousseau Hospital, Sorbonne University, Paris, France
| | - F Bretelle
- Department of Obstetrics and Gynaecology, CHU de Marseille, APHM, Aix Marseille University, Marseille, France
| | - P de Lagausie
- INSERM U1141, Robert-Debré Hospital, Paris, France.,Department of Paediatrics Surgery, AP-HP, Robert Debré Hospital, Paris, France
| | - Y Ville
- Department of Obstetrics and Gynaecology, AP-HP, Necker-Enfants Malades, Paris Descartes University, Paris, France
| | - J Guibourdenche
- Department of Biochemistry and Hormonology, AP-HP, Robert Debré Hospital, Paris, France
| | - J-F Oury
- Department of Obstetrics and Gynaecology, AP-HP, Robert Debré Hospital, Paris, France
| | - C Alberti
- INSERM U1141, Robert-Debré Hospital, Paris, France.,AP-HP, Inserm, Univ. Paris Diderot, Univ. Sorbonne Paris Cité, Robert Debré Hospital, CIC 1426, UMR-S 1123, Paris, France
| | - A Benachi
- Department of Obstetrics and Gynaecology, AP-HP, Antoine Béclère Hospital, Paris-Sud University, Clamart, France
| |
Collapse
|
2
|
Kirollos DW, Abdel-Latif ME. Mode of delivery and outcomes of infants with gastroschisis: a meta-analysis of observational studies. Arch Dis Child Fetal Neonatal Ed 2018; 103:F355-F363. [PMID: 28970315 DOI: 10.1136/archdischild-2016-312394] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 07/29/2017] [Accepted: 08/01/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND There is controversy among the literature for electing caesarean section (CS) delivery for infants with gastroschisis in an attempt to reduce mortality and morbidity. OBJECTIVE This meta-analysis investigates whether there is enough evidence to support CS delivery over vaginal delivery. DATA SOURCES We conducted our search in April 2017. We searched Cochrane, Medline, Premedline, Embase, CINAHL, GoogleScholar and Web of Science. We also searched conferences for abstracts online. Additional studies were retrieved by reviewing reference lists. STUDY SELECTION Observational studies, excluding case series, were eligible if data compared relevant outcomes of infants with gastroschisis in relation to mode of delivery. DATA EXTRACTION Relevant information were extracted and assessed the methodological quality of the retrieved records. RESULTS Thirty-eight studies were included. Evidence suggested that mode of delivery is not significantly associated with overall mortality (OR 0.82, 95% CI 0.57 to 1.18), primary repair (OR 0.82, 95% CI 0.57 to 1.18), neonatal mortality (OR 1.08, 95% CI 0.54 to 2.15), necrotising enterocolitis, secondary repair, sepsis, short gut syndrome, duration until enteral feeding and duration of hospital stay. Furthermore, sensitivity analyses based on economic status and quality of study showed no significant difference between the impact of mode of delivery for all investigated outcomes. LIMITATIONS Due to uncontrolled variables between and within studies, particularly regarding characteristics of delivery and postdelivery care, it is difficult to extract meaningful results from the literature. CONCLUSIONS There is insufficient evidence to advocate the use of CS over vaginal delivery for infants with gastroschisis.
Collapse
Affiliation(s)
- Dina W Kirollos
- Medical School, College of Medicine, Biology & Environment, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Mohamed E Abdel-Latif
- Medical School, College of Medicine, Biology & Environment, Australian National University, Canberra, Australian Capital Territory, Australia.,Department of Neonatology, Centenary Hospital for Women and Children, Canberra Hospital, Woden, Australian Capital Territory, Australia
| |
Collapse
|
3
|
Walker K, Badawi N, Holland AJ, Halliday R. Developmental outcomes following major surgery: what does the literature say? J Paediatr Child Health 2011; 47:766-70. [PMID: 21040073 DOI: 10.1111/j.1440-1754.2010.01867.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Relative to the wealth of information in the medical literature regarding developmental outcome for infants who have had cardiac surgery available, few studies specifically detail how those who have undergone major surgery grow and develop. The few published studies tend to be disease specific, making their results difficult to translate to a more general setting. As mortality for most infants who require surgery in infancy continues to decrease, the focus for researchers and clinicians should be on how these children will grow and develop. As parents realise that their infant will survive, this becomes their next major concern. The most common conditions requiring early major surgery have been reviewed in relation to data on infant developmental outcomes.
Collapse
Affiliation(s)
- Karen Walker
- Grace Centre for Newborn Care, The Children's Hospital at Westmead, Australia.
| | | | | | | |
Collapse
|
4
|
Ramadan G, Rex D, Okoye B, Kennea NL. Early high C-reactive protein in infants with open abdominal wall defects does not predict sepsis or adverse outcome. Acta Paediatr 2010; 99:126-30. [PMID: 19735496 DOI: 10.1111/j.1651-2227.2009.01501.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To study CRP values and relate it to outcome in infants with antenatal diagnosis of gastroschisis, exomphalos and other surgical conditions. METHODS Over five years, infants admitted to our neonatal unit with gastroschisis, exomphalos and other surgical diagnoses were identified. Serum CRP measurements in first 5 days were studied. Group one included 33 gastroschisis patients, group two, 18 exomphalos patients, and group three, 38 patients with other surgical diagnoses. Outcome measures included TPN days, time to full feeds and duration of hospitalization. RESULTS Infants with gastroschisis were more premature (36.9 vs 38.1 weeks) with lower birth weights (2515 vs 3078 g), than infants with exomphalos. CRP values on admission in gastroschisis group were significantly higher than exomphalos and other diagnoses groups (33.7 +/- 6.4 vs 8.8 +/- 6.0 vs 5.7 +/- 2.0, respectively, p < 0.05). All blood cultures were sterile. There was no relationship between high CRP and death or adverse outcome (TPN days, time to full feeds or duration of hospitalization) in the gastroschisis group. CONCLUSION Infants with gastroschisis exhibit high early CRP, which may not indicate sepsis or adverse outcome. This increase can complicate the assessment of these infants. Clinicians should be aware of this finding as it could inform management decisions in this group.
Collapse
Affiliation(s)
- G Ramadan
- Regional Neonatal Intensive Care Unit, St George's Hospital, London, UK
| | | | | | | |
Collapse
|
5
|
Rosenberg J, Amaral JG, Sklar CM, Connolly BL, Temple MJ, John P, Chait PG. Gastrostomy and gastrojejunostomy tube placements: outcomes in children with gastroschisis, omphalocele, and congenital diaphragmatic hernia. Radiology 2008; 248:247-53. [PMID: 18458240 DOI: 10.1148/radiol.2481061193] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To retrospectively evaluate the technical success, safety, and outcomes of radiologically guided retrograde percutaneous gastrostomy and gastrojejunostomy tube placements in terms of weight gain and growth in children with gastroschisis, omphalocele, and/or congenital diaphragmatic hernia (CDH). MATERIALS AND METHODS Research ethics board approval, with waived informed patient consent, was obtained for review of the data of 37 children (17 male, 20 female; age range, 1-20 months; mean age, 4.3 months) in whom gastrostomy or gastrojejunostomy tubes were inserted between 1995 and 2004. Twenty-two patients had CDH, eight had gastroschisis, five had omphalocele, and two had both CDH and omphalocele. The technical success and complications of the procedures were recorded. Tube maintenance problems were analyzed separately from postprocedural complications. Initial and final patient growth percentiles were compared by using a one-sided paired Student t test. RESULTS Thirty-six of the 38 procedures performed in the 37 patients were successful. There were three intraprocedural complications (two cases of access difficulty, one case of bleeding) and three major complications (one skin and prosthetic material infection, one track loss during tube replacement, one delayed gastrostomy track closure necessitating surgery). Sixteen patients had at least one minor complication (cellulitis, feeding intolerance, skin-site bleeding, intussusception). Twenty-two patients had at least one tube maintenance problem. All patients gained weight (mean weight gain, 4.7 kg) after the procedure, with a significant increase in growth percentile (average increase, 6.5%; P = .029). CONCLUSION Radiologically guided percutaneous gastrostomy and gastrojejunostomy tube placements in children with gastroschisis, omphalocele, and/or CDH are associated with high success rates and low major complication rates. Although tube maintenance problems and minor complications are common, use of gastrostomy and gastrojejunostomy tubes effectively improves nutritional support.
Collapse
Affiliation(s)
- Jodine Rosenberg
- Department of Diagnostic Imaging, Division of Image Guided Therapy, the Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada
| | | | | | | | | | | | | |
Collapse
|