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OBJECTIVES AND INTRODUCTION: Gastroschisis is a congenital abdominal wall defect with increasing occurrence worldwide over the past 20-30 years. Our aim was to analyze the morbidity of newborns after gastroschisis closure, with emphasis on metabolic and hydroelectrolyte disturbances in patients at three tertiary university centers.
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Background: Gastroschisis is associated with less than 4% mortality in high-income countries and over 90% mortality in many tertiary paediatric surgery centres across sub-Saharan Africa (SSA). The aim of this trial is to develop, implement and prospectively evaluate an interventional bundle to reduce mortality from gastroschisis in seven tertiary p...
Die Fortschritte in der pränatalen Diagnostik, neonatologischen Intensivmedizin und kinderchirurgischen Technik haben die Prognose von Kindern mit Gastroschisis und Omphalocele stark beeinflusst. Die Betrachtung der Ergebnisse und Entwicklungen der letzten 3 Jahrzehnte soll den aktuellen Stand in der Behandlung dieser Fehlbildungen dokumentieren.
V...
Myelomeningocele and gastroschisis, on their own, are both relatively common entities encountered in pediatric surgical care. Coexistence of these pathologies, however, is exceedingly rare. The authors report on 2 patients who presented with myelomeningocele and gastroschisis at birth. They obtained blood for whole-exome analysis for one of the pat...
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Gastroschisis and omphalocele are the most common malformation of the anterior abdominal wall.The aim of the study was to determine the abdominal wall defect frequencies, survival, and mortalities in Ahvaz, Khuzestan province of Iran.Materiał and methods. All cases born with omphalocele or gastroschisis whom born in Imam Khomeini hospi...
Citations
... (13,14) Long-term outcomes of non-complex cases include abdominal pain and the need for additional surgery, (14) and overall mortality rates can reach 9-25% depending on the center. (2,(15)(16)(17) Furthermore, recent evidence has shown that survivors may have subtle abnormal neurodevelopment. (14,18,19) Previous studies have found that children with gastroschisis may be particularly at risk for executive functioning difficulties despite an intelligence quotient (IQ) that is within normal limits. ...
We report the long-term outcomes of a case of prenatal gastroschisis repair using a fully percutaneous fetoscopic approach with partial carbon dioxide insufflation. Surgery was performed as an experimental procedure before the scheduled elective birth. The fetal intestines were successfully returned to the abdominal cavity without any fetal or maternal complications. Ultrasonography performed 24 hours later revealed bowel peristalsis and no signs of fetal distress. After 48 hours, partial extrusion of the small bowel was observed, and the fetus was delivered. Gastroschisis repair was immediately performed upon delivery using the EXIT-like procedure as per our institutional protocol. The newborn did not require assisted mechanical ventilation, was discharged at 14 days of age and was then exclusively breastfed. At 3-year follow-up, the patient had no associated gastroschisis-related complications. This is the first case of prenatal repair of gastroschisis, which provides baseline knowledge for future researchers on the potential hurdles and management of prenatal repair.
Gastroschisis; Abdominal wall; Fetoscopy; Fetal therapies; Fetus; Infant, newborn; Carbon dioxide; Insufflation; Fetal distress
... This study presents two extremely important aspects that have not yet been addressed in the literature. The first is to analyze a cohort of gastroschisis composed only of preterm newborns, because published studies on gastroschisis cohorts analyze premature and term infants together (16,17) . The second is to describe the growth of these preterm infants, because there are few studies that analyze growth and not only with preterm newborns (9) . ...
Background:
Gastroschisis, especially complex type, prematurity and low birth weight are associated with a worse clinical outcome with higher mortality, higher incidence of sepsis and catheter-related infection, cholestasis, short bowel syndrome, greater number of days to achieve full diet, longer time of parenteral nutrition and longer hospitalization time.
Objective:
To evaluate the growth of preterm newborns with gastroschisis during their hospitalization in the neonatal intensive care unit.
Methods:
Descriptive study, based on a retrospective cohort (January 2012 to December 2018), including preterm newborns (gestational age less than 37 weeks) with simple and complex gastroschisis admitted in a tertiary neonatal intensive care unit. The following parameters were analyzed: maternal age, parity, type of delivery, birth weight, gender, gestational age, nutritional adequacy, type of gastroschisis, fasting time, parenteral nutrition time, time until achieving full enteral nutrition, hospitalization time, weight gain and outcome. The results were expressed in percentage, average, and median.
Results:
A total of 101 newborns with gastroschisis were admitted, of which 59.4% were premature (80.7% of late preterm infants). From the maternal data, the mean age was 21.2 years and 68.3% were primiparous. Regarding childbirth: 80% were cesarean sections. From newborns: the average birth weight was 2137 g, 56.6% were female, the average gestational age was 34.8 weeks, the average weight gain was 20.8 g/day during hospitalization and 83.3% were discharged from the hospital.
Conclusion:
The growth analysis by weight gain (grams/day) during hospitalization in the intensive care unit showed that more than 90% of the sample presented acceptable or adequate weight gain.
... This chain of events could explain the increase in ventilation time observed in newborns with hyponatremia and hypoalbuminemia. 21 In this study rate of complex gastroschisis was similar in both groups. This data was similar to that found in a study carried out in a high-income country. ...
Objective
To characterize the influence of birthplace on outcomes of patients with gastroschisis admitted to three hospitals in a state in Brazil’s southeastern region, according to condition inborn (born in a reference center) or outborn (born outside the reference center).
Methods
Retrospective multicenter cohort study of patients with gastroschisis. The sample size utilized was of patients admitted in three hospitals with a diagnosis of gastroschisis ICD 10 Q79.3 between January 2000 to December 2018. Patients were divided into two groups, inborn and outborn. Characteristics of prenatal, perinatal and postoperative were compared using statistical tests. The level of significance adopted was P-value < 0.05.
Results
In total, 144 cases of gastroschisis were investigated. The outborn patients group had higher rates of absence of antenatal diagnosis (p = 0.001), vaginal delivery (p = 0.001), longer time between birth and abdominal wall closure surgery (p = 0.001), to silo removal (p = 0.001), to first enteral feeding (p = 0.008), for weaning from mechanical ventilation (p = 0.034), used less peripherally inserted central catheter (PICC) and required more venous dissections (p = 0.001), and lower mean of serum sodium (p = 0.015). There were no differences in mortality rates and length of hospital stay between the inborn and outborn groups.
Conclusion
Although outborn patients with gastroschisis were less likely to have an antenatal diagnosis and were more prone to a longer time to undergo surgical and feeding procedures, and to spend more time in mechanical ventilation, these disadvantages seemed not to reflect on the death rate and the length of hospital stay of patients from this group.
... GS patients have been reported to be at risk for nosocomial infections [5,31], which are usually associated with a significant proportion of deaths and a prolonged length of hospital stay. Our results showed a high incidence of wound infection and proven sepsis, usually central line-associated bloodstream infections, when compared with results in the international literature [6,31]; however, our results are similar to those of other Brazilian studies [8,32]. We speculate that our high levels of infections were because of the manipulation and poor quality of the central venous line catheter. ...
Background/Purpose.
Gastroschisis is increasing in incidence and has low mortality and high morbidity. We describe the clinical and surgical characteristics of gastroschisis patients in a Brazilian referral center.
Methods
Single-center prospective case series of gastroschisis patients. The following two groups were formed depending on the intestinal characteristics: simple and complex patients.
Results
In total, 79 patients were enrolled, 89% of whom were classified as simple and 11% as complex. The baseline characteristics were similar between the groups, with the exception of the illness severity score. The complex group had a significantly smaller defect size, more reoperations and worse clinical outcomes than the simple group, with the initiation of feeding taking 1.5 times longer, the duration of total parenteral nutrition taking twice as long, and the length of hospitalization being 2.5 times longer; the complex group also included all the deaths that occurred. Overall, the survival rate was 96%. Patients who underwent the sutureless technique had significantly fewer wound infections and a decreased duration of mechanical ventilation than sutured patients.
Conclusions
This study provides a comprehensive picture of gastroschisis during the neonatal period in a Brazilian referral center, emphasizing the significantly higher risk for morbidity and mortality among complex patients than among simple patients and the few advantages of the sutureless technique over the sutured technique in terms of closing the defect.
Type of study.
Prognostic.
Level of evidence.
IV
... In São Paulo, the Brazilian state with the most plentiful financial resources, three tertiary university centers reported a survival rate of 85.9%, approaching that of developed countries. [5] However, a more recent report from an academic medical center in Sao Paulo again demonstrated an overall survival rate of 75%, when accounting for all deaths [6]. ...
... There is also a hidden mortality from gastroschisis represented in patients who may never seek medical care or be referred to a tertiary care center due to the perceived dismal outcomes in certain countries [4]. The Brazilian experience reported here, as well as other small series previously reported from Brazil, show overall survival from gastroschisis in the 50-80% range, outcomes which lie closer to those of high income than low income countries [5,6,10]. This supports a direct relationship between a country's neonatal care resources and gastroschisis outcomes, and strongly supports the potential use of gastroschisis as a bellwether condition for neonatal surgery capacity as recently proposed [4]. ...
... Sepsis seems to be the common denominator for the high mortality experienced in LMICs. [4][5][6][7][8][9][10] It has also emerged as the highest independent risk factor for prolonged hospital stay in patients with simple gastroschisis treated in high resource settings [13]. ...
Background:
Survival of newborns with gastroschisis is significantly higher in high-income versus low and middle-income countries. We reviewed treatment and outcomes of gastroschisis in a middle-income country setting with increasing protocolized management.
Methods:
All newborns with gastroschisis treated during the period 1989-2013 at a single Brazilian academic surgical service were studied retrospectively. Protocolized diagnosis, delivery, nutrition, medical interventions, and surgical interventions were introduced in 2002. Outcomes before and after protocol introduction were studied using univariate and multivariate analysis.
Results:
One hundred fifty-six newborns were treated for gastroschisis: 35 (22.4%) and 121 (77.6%) before and after 2002, respectively. When compared to the earlier cohort, patients treated after 2002 had higher rates of prenatal diagnosis (90.9% vs. 60.0%, p < 0.001), delivery at a tertiary center (90.9% vs. 62.9%, p < 0.001), early closure (65.3% vs. 33.3%, p = 0.001), primary repair (55.4% vs. 31.4%, p = 0.013), monitoring of bladder pressure (62.0% vs. 2.9%, p = 0.001), PICC placement (71.1% vs. 25.7%, p < 0.001), early initiation of enteral feeding (54.5% vs. 20.0%, p < 0.001), and lower rates of electrolyte disturbances (53.7% vs. 85.7%, p = 0.001). Mortality decreased from 34.3% before 2002 to 24.8% (p = .27) after 2002 despite an increase in the complex gastroschisis rate from 11.4% to 15.7% during the same period.
Conclusions:
Gastroschisis outcomes in a middle-income country can be gradually improved through targeted interventions and management protocols.
Type of study:
Therapeutic.
Level of evidence:
III.
... Gastroschisis survival is well over 95%, in developed countries, where mortality is not even considered any more as an outcome measure [4,5]. However, in Latin American countries, mortality is frequently higher than 15% often due to infectious complications [6,7]. ...
Objective
Gastroschisis incidence is rising. Survival in developed countries is over 95%. However, in underdeveloped countries, mortality is higher than 15% often due to sepsis. The aim of this study was to evaluate the effect on morbidity and mortality of a Quality Improvement Protocol for out-born gastroschisis patients.
Methods
The protocol consisted in facilitating transport, primary or staged reduction at the bedside and sutureless closure, without anesthesia, PICC lines and early feeding. Data was prospectively collected for the Protocol Group (PG) treated between June 2014 through March 2016 and compared to the last consecutive patients Historical Group (HG). Primary outcome was mortality. Secondary outcomes: need for and duration of mechanical ventilation (MV), time to first feed (TFF) after closure, parenteral nutrition (TPN), length of stay (LOS) and sepsis. Data were analyzed using χ2 and Mann–Whitney U tests.
Results
92 patients were included (46 HG and 46 PG). Demographic data were homogeneous. Mortality decreased from 22% to 2% (p = 0.007). Mechanical ventilation use decreased from 100% to 57% (p = < 0.001), ventilator days from 14 to 3 median days (p = < 0.0001), TPN days: 27 to 21 median days (p = 0.026), sepsis decreased from 70% to 37% (p = 0.003) and anesthesia from a 100% to 15% (p = < 0.001), respectively. No difference was found in NPO or LOS.
Conclusion
A major improvement in the morbidity and mortality rates was achieved, with outcomes comparable to those reported in developed countries. It was suitable for all patients with gastroschisis. We believe this protocol can be implemented in other centers to reduce morbidity and mortality.
Level of evidence
III.
... Tannuri et al. indicated that reduction in serum albumin level was observed in critically ill patients. When serum albumin < 30.3 g/l, the risk of mechanical ventilation will double, the stay will be longer, and the mortality will be higher as compared with that of the patients with normal albumin levels [24]. In contrast, the remedy success rate will double as the serum albumin level increase by every 5 g/l. ...
Early and accurate assessment of severity in acute pancreatitis (AP) is of great importance to provide effective disease management and prevent mortality. In this study, we aim to evaluate early indicators that predict the mortality of AP. We retrospectively analyzed 24-hour clinical characteristics and laboratory data in 166 AP patients recruited between January 2014 and November 2015 in Baotou Central Hospital. In total, 18 patients did not survive the disease. Multivariate logistic regression showed that red cell distribution (RDW) (OR = 2.965, P=0.001 ) and creatinine (OR = 1.025, P=0.005 ) were early independent risk factors of AP mortality while albumin (OR = 0.920, P=0.032 ) levels reduced AP mortality. The corresponding optimal cut-off values were 14.45, 125.5, and 34.95, respectively. The positive predictive values of the AP mortality were 80.1%, 54.5%, and 69.5%. In combined measurement, the area under the curve of RDW, creatinine, and albumin was 0.964 (95% CI: 0.924 to 1.000, P<0.001 ). RDW ≥ 14.45%, creatinine ≥ 125.5 μ mol/l, and albumin ≤ 34.95 g/l indicated a good predictive value for mortality in AP patients with a sensitivity of 100% and specificity of 64.2%. RDW, creatinine, and albumin may serve as early indicators for AP mortality which warrants further clinical investigation.
... However, in the groups of newborns treated with Silo placement, mechanical ventilation was required for a shorter period, (13)(14)(15) which can also be correlated with lower risk of hyponatremia and hypoalbunemia. (19) The technique presented in our study is based on primary closure of the defect; however, without air inside bowel loops, that is, at "zero minute". We believe this may be the main reason for the better postnatal parameters studied. ...
Objective:
To describe our initial experience with a novel approach to follow-up and treat gastroschisis in "zero minute" using the EXITlike procedure.
Methods:
Eleven fetuses with prenatal diagnosis of gastroschisis were evaluated. The Svetliza Reductibility Index was used to prospectively evaluate five cases, and six cases were used as historical controls. The Svetliza Reductibility Index consisted in dividing the real abdominal wall defect diameter by the larger intestinal loop to be fitted in such space. The EXIT-like procedure consists in planned cesarean section, fetal analgesia and return of the herniated viscera to the abdominal cavity before the baby can fill the intestines with air. No general anesthesia or uterine relaxation is needed. Exteriorized viscera reduction is performed while umbilical cord circulation is maintained.
Results:
Four of the five cases were performed with the EXIT-like procedure. Successful complete closure was achieved in three infants. The other cases were planned deliveries at term and treated by construction of a Silo. The average time to return the viscera in EXIT-like Group was 5.0 minutes, and, in all cases, oximetry was maintained within normal ranges. In the perinatal period, there were significant statistical differences in ventilation days required (p = 0.0169), duration of parenteral nutrition (p=0.0104) and duration of enteral feed (p=0.0294).
Conclusion:
The Svetliza Reductibility Index and EXIT-like procedure could be new options to follow and treat gastroschisis, with significantly improved neonatal outcome in our unit. Further randomized studies are needed to evaluate this novel approach.
... PPN in these children is a challenge, not only due to the diffi culties associated with hydroelectrolytic and glucose control, but also due to the association between prolonged fasting and frequent episodes of bacterial sepsis, causing almost always a cholestasis associated to parenteral nutrition (CANP) framework, characterised by increased direct bilirubin and liver enzymes. The severity and progression of this case often affects the maintenance of PPN or even makes it unfeasible since the proposed treatment is a reduction of amino acids and lipid emulsion, resulting in an unsatisfactory supply of nutrients for proper growth 19,20 . ...
... The recent introduction of a 20% lipid emulsion with fi sh oil (omega-3) brought a better outlook in the control of CANP 19 . The replacement of the 20% lipid emulsion (20% Lipid® SMOF), consisting of fi sh and olive oils as well as long chain triglycerides (TCM/TCL) increased direct bilirubin and liver enzymes. ...
... The replacement of the 20% lipid emulsion (20% Lipid® SMOF), consisting of fi sh and olive oils as well as long chain triglycerides (TCM/TCL) increased direct bilirubin and liver enzymes. A decrease in these indicators allows for the maintenance of adequate protein-calorie offering PPN and satisfactory weight gain [19][20][21] . ...
Introduction: Congenital malformations are major diseases observed at birth. They are the second most common cause of death in the neonatal population, the first one being prematurity. Objective: To characterise the clinical outcome of newborns with gastroschisis (GS) in a neonatal intensive care unit. Methods: A retrospective observational clinical study in 50 infants with GS using the association of intestinal abnormalities, impossibility of primary closure of the abdominal defect and reoperation necessity as classification criteria for the disease. The significance level was p < 0.05. Results: The hospitalisation to primary surgery occurred with a median age of 2 hours. Fourteen percent of children were subjected to a primary silo interposition and 24% had associated intestinal malformation. Nineteen newborns (NB) required more than one surgery. The median length of stay was 33 days, higher in patients with complex GS (56 days). All NB recovered from urine output 48 hours after surgery and 40% had hyponatraemia and oligoanuria in this period. There was no difference between the natraemia and fasting time (p = 0.79). Weight gain was similar in both groups with total parenteral nutrition and became significantly higher in patients with simple GS after enteral feeding (p = 0.0046). These NB evolved 2.4 times less cholestasis. Late-onset sepsis occurred in 58% of patients and was related to the infection of the central venous catheter in 37.9% of cases. Mortality was higher in infants infected with complex GS and the overall mortality rate was 14%. Conclusion: Clinical characterisation of newborns with gastroschisis depends on the complexity and the knowledge and conduct of morbidities to reduce mortality.
... Se ha referido que la causa de la hipoalbuminemia es por la pérdida de líquidos de la cavidad amniótica secundaria al defecto abdominal y exposición de asas intestinales. Sin embargo, la necrosis hepática que la paciente desarrolló al final también contribuyó a agravar esta hipoalbuminemia por falta de síntesis 7,8 . ...
