Are babies with gastroschisis small for gestational age?

Trends in prevalence of gastroschisis in Brazil from 2007 to 2020: A national population-based cross-sectional study

BACKGROUND

Gastroschisis is a congenital abnormality of the abdominal wall which worldwide prevalence is increasing with time. Up to now, young maternal age is the main factor associated with gastroschisis. Brazil has a great proportion of adolescent mothers.

OBJECTIVES

To estimate prevalence of gastroschisis in Brazil, explore the effect of very young maternal age, and analyze regional distribution and time trends.

METHODS

Cross-sectional population-based study using data from official national information systems from 2007 to 2020, covering 9,831 gastroschisis cases. Low maternal age was assessed as risk factor through odds ratio. Prevalence time trends by maternal age and geographic area were analyzed using joinpoint regression.

RESULTS

Overall prevalence of gastroschisis in Brazil was 2.47 per 10,000 births. From first to last biennium, there was a 23% relative increase. Last biennium prevalence was higher in the Central-west region and lower in the Northeast. Compared to mothers of 20-34 years old (YO), the odds-ratio for prevalence and 95% confidence intervals for gastroschisis were, as follows: (a) 10-14 YO-4.9 (4.3,5.5); (b) 15-19 YO-3.6 (3.5,3.8); and (c) 35-49 YO-0.3 (95% CI 0.3, 0.4).

CONCLUSIONS

Prevalence of gastroschisis in Brazil relatively increased 23% from 2007 to 2020. This happened in all maternal age groups. Differences between regions may be associated to data quality. Young mothers had a higher prevalence of gastroschisis and still higher for those under 15 YO. Mother age over 34 YO was a protective factor.

Long-term core outcomes of patients with simple gastroschisis

PURPOSE

To report the long-term core outcome set of patients with simple gastroschisis.

METHODS

This was a retrospective chart review of all patients with simple gastroschisis managed at our hospital between August 2008 and July 2016. We collected all data included in the core outcome set developed for the standardization of gastroschisis outcomes reporting. We conducted a phone survey of the patients' parents using the PedsQL™ Pediatric Quality of Life Inventory, Cognitive Functioning Scale, and Gastrointestinal Symptoms Scale (GSS). Additionally, parents reported their subjective evaluation of the patients' cosmetic result and overall quality of life.

RESULTS

There were 124 patients included in the study. The majority (76.5%) was born prematurely at a median gestational age of 36 (range 27.6-38) weeks. At neonatal discharge (median 36 days [18-150] days) most patients were below the 10th percentile for height (81.4%) and weight (87%). Their growth, however, normalized during early childhood. Seven patients (5.6%) required at some point an operation for acute abdominal complications. One-third of patients required long-term treatment for constipation and one-third of patients required long-term treatment for gastroesophageal reflux disease (GERD). Thirty-five parents participated in the phone survey. Mean parent-reported quality of life score was better than healthy controls (87.5% vs. 82.3%, p = 0.049). Cognitive functions and gastrointestinal symptoms scores were similar to healthy controls. All patients are alive.

CONCLUSION

Growth restriction in patients with simple gastroschisis is common at birth and during the neonatal period, but it improves during the first three years of life. Abdominal operations are rarely needed in patients with simple gastroschisis. GERD and constipation, on the other hand, are common and often require long-term medical management. The overall parent-reported quality of life of patients with simple gastroschisis is excellent.

LEVEL OF EVIDENCE

Level II.

A retrospective review of gastroschisis epidemiology and referral patterns in northern Ghana

PURPOSE

To describe the epidemiology and referral patterns of gastroschisis patients in northern Ghana.

METHODS

A hospital-based retrospective review was undertaken at Tamale Teaching Hospital (TTH) Neonatal Intensive Care Unit (NICU) between 2014 and 2019. Data from gastroschisis patients were compared to patients with other surgical diagnoses. Descriptive and inferential statistics were performed with SAS. Referral flow maps were made with ArcGIS.

RESULTS

From a total of 360 neonates admitted with surgical conditions, 12 (3%) were diagnosed with gastroschisis. Around 91% (n = 10) of gastroschisis patients were referred from other hospitals, traveling 4 h, on average. Referral patterns showed gastroschisis patients were admitted from three regions, whereas patients with other surgical diagnoses were admitted from eight regions. Only 6% (12/201) of expected gastroschisis cases were reported during the 6-year period in all regions. All gastroschisis deaths occurred within the first week of life.

CONCLUSIONS

Improving access to surgical care and reducing neonatal mortality related to gastroschisis in northern Ghana is critical. This study provides a baseline to inform future gastroschisis interventions at TTH. Priority areas may include special management of low birth weight newborns, better referral systems, empowerment of community health workers, and increasing access to timely, affordable, and safe neonatal transport.

The long-term neurodevelopmental and psychological outcomes of gastroschisis: A cohort study

OBJECTIVES

Previous gastroschisis specific neurodevelopmental studies have focused on the first 3years of life. The aim of this study was to assess the intellectual, behavioral and neurological outcomes of older children and adolescents born with gastroschisis.

STUDY DESIGN

Of 99 gastroschisis survivors born in Western Australia, 1992 to 2005, and who were at least 5years old, 42 agreed to take part in this study. The study assessed: intellectual ability, with age appropriate Wechsler intelligence scales; neurological status; hearing; vision; behavioral status with the Strengths and Difficulties Questionnaire (SDQ); and parenting style with the Parenting Relationship Questionnaire (PRQ). All results were compared to normative means.

RESULTS

Median age at follow-up was 10years (range 5-17). No child had evidence of cerebral palsy or hearing loss; 1 child had amblyopia. Psychometric tests were completed in 39 children: mean full scale IQ was 98.2 (standard deviation [SD] 10.7); the working memory index was the only subscale to show a significant decrease from the normative mean (mean 95.5, SD 12.4, p=0.038). The mean SDQ behavioral scores were significantly lower for 3 of 5 domains and the Total Difficulties score. PRQ scores were significantly abnormal for 4 of 7 domains: Communication, Discipline, Satisfaction with School and Relational Frustration.

CONCLUSIONS

Overall intellectual abilities were within a normal range. The decrease in working memory index and the behavioral and parenting relationship impairments could be an effect of perinatal factors, gastroschisis management and complications or the complexity of the socio-economic environment.

The role of gut-liver axis in the restriction of intrauterine growth in a model of experimental gastroschisis

PURPOSE

To evaluate the intrauterine growth restriction (IUGR) by the expression of IR-β, IRS-1, IRS-2, IGF-IRβ and Ikappaβ in experimental model of gastroschisis.

METHODS

Pregnant rats at 18.5 days of gestation were submitted to surgery to create experimental fetal gastroschisis (term = 22 days) were divided in three groups: gastroschisis (G), control (C) and sham (S). Fetuses were evaluated for body weight (BW), intestinal (IW), liver (LW) and their relations IW/BW and LW/BW. IR-β and IGF-IRβ receptors, IRS-1 and IRS-2 substrates and Ikappaβ protein were analyzed by western blotting.

RESULTS

BW was lower in G, the IW and IW / BW were greater than C and S (p<0.05) groups. The liver showed no differences between groups. In fetuses with gastroschisis, compared with control fetuses, the expression of IGF-IRβ (p<0.001) and Ikappaβ (p<0.001) increased in the liver and intestine, as well as IR-β (p<0.001) which decreased in both. In contrast to the intestine, IRS-1 (p<0.001) increased in the liver and IRS-2 decreased (p<0.01).

CONCLUSION

The axis of the intestine liver has an important role in inflammation, with consequent changes in the metabolic pathway of glucose can contribute to the IUGR in fetuses with gastroschisis.

Clinical presentation of children with gastroschisis and small for gestational age

BACKGROUND

Gastroschisis (GS) is defined as a full-thickness paraumbilical abdominal wall defect associated with evisceration of fetal abdominal organ. Although the concomitant nongastrointestinal anomalies and aneuploidy are rarely presented, fetal growth restriction is common. The aim of this study is to compare the primary and secondary outcomes of GS between infants small for gestational age (SGA) and those appropriate for gestational age as well as term and late preterm infants.

METHODS

Chart records of neonates born with gestational age at or more than 34 weeks were reviewed. All babies received repair procedure immediately after birth. SGA was defined as birth weight for gestational age below the 10th percentile. The primary outcomes were the length of hospital stay, duration of total parental nutrition used, and the surgical complications. The secondary outcome was the percentile of body weight at 6 months old.

RESULTS

There were 21 babies diagnosed with GS from January 1990 to January 2010 at Kaohsiung Chang Gung Memorial Hospital. Four (19%) babies expired soon after operation. Nine (53%) of the 17 surviving babies had SGA. Length of hospital stay, surgical complications, and the percentile of body weight at 6 months old were significantly poorer for the SGA compared with appropriate for gestational age group (p = 0.005, 0.050, and 0.035). Furthermore, preterm neonates in SGA group had lower Apgar scores at 1 minute and 5 minutes than did term neonates (p = 0.045 and 0.031).

CONCLUSION

SGA commonly occurred in GS cases and it was associated with longer hospital stay, more operative complications, and less body weight gain. Our conclusion may provide informative data to parents of GS fetuses during prenatal consultation, and reminds us that long-term follow-up of these cases could be necessary.

Characteristics and perinatal course of prenatally diagnosed fetal abdominal wall defects managed in a tertiary center in Japan

AIMS

To identify the clinical characteristics of fetal abdominal wall defects managed at a single institution and to provide information regarding the most likely clinical course of the affected fetuses.

METHODS

A retrospective review was conducted of 44 fetuses prenatally diagnosed with abdominal wall defects at Kyushu University Hospital between 1990 and 2006.

RESULTS

A total of 11 cases of gastroschisis and 33 cases of omphalocele were found. Preterm delivery was observed in eight of 11 fetuses (72.7%) with gastroschisis and in 14 of 27 fetuses (51.9%) with omphalocele who were not artificially aborted. Intrauterine growth restriction (IUGR) was identified in four of 11 fetuses (36.4%) with gastroschisis and in 13 of 27 fetuses (48.1%) with omphalocele who were not aborted artificially. There was a high rate of associated structural anomalies with omphalocele (26/33). Karyotypic abnormalities were observed in eight of 29 tested fetuses with omphalocele (27.6%). The prognosis for a chromosomally normal fetus with omphalocele appeared to largely depend on the associated structural abnormalities and the gestational age at delivery. Despite the frequent presence of IUGR, the outcome of neonates with gastroschisis was good.

CONCLUSIONS

The possibility of preterm delivery and IUGR should be considered during the management of both omphalocele and gastroschisis. For the management of omphaloceles, chromosomal abnormalities and respiratory insufficiency after birth must also be considered. Timely prenatal diagnosis and the subsequent identification of associated anomalies will improve patient care and will enable clinicians to provide appropriate counseling about the expected course.

Scheduled preterm delivery for gastroschisis improves postoperative outcome

There are some evidence to suggest that careful antenatal monitoring, scheduled preterm delivery and immediate abdominal wall closure may reduce gastroschisis morbidity. We hypothesised that the advantages of a scheduled preterm delivery balance possible complications related to prematurity. A retrospective study was performed including all cases of gastroschisis born between 1990 and 2004 (n = 69). Cases were categorised in two groups. Group 1 contained gastroschisis cases born between 1990 and 1997. Group 2 contained cases occurring since 1997, when a new management pathway for gastroschisis was established: weekly evaluation of the foetal gut by ultrasound (>28 weeks), corticosteroids, and delivery by scheduled caesarean section at 35 weeks (before if evidence of bowel compromise was present). The primary endpoints of this study were the initiation of oral feeding and the number of re-operation for intestinal obstruction. There was a significantly faster initiation of oral feeding (P < 0.0001), however, duration of parenteral nutrition (34 vs. 38 days) and hospital discharge (53 vs. 58.5 days) was not reduced. There was no complication due to prematurity in group 2. Postoperative outcome was improved with less need for muscular stretching or prosthetic patch and less re-operation for intestinal obstruction (P < 0.05). Scheduled and elective preterm delivery facilitates surgical procedure and shortens the time to first feeding. A delivery at 35 weeks (preferring vaginal delivery) seems to be a good compromise between risks related to prematurity and complications related to intestinal peel.

Antenatal fetal surveillance in pregnancies complicated by fetal gastroschisis

OBJECTIVE

The purpose of this study was to determine if antenatal fetal surveillance should be considered in pregnancies complicated by fetal gastroschisis, and if so, what gestational age should testing begin.

STUDY DESIGN

During an 18-year period, all pregnancies delivered of a newborn that had gastroschisis were identified. Numerous data parameters were collected, including gestational age at delivery, birthweight, indication for delivery, antenatal testing results if performed, and neonatal outcome. Fetal compromise was defined as stillbirth or moderate to severe arterial cord blood gas acidosis at the time of delivery (pH < 7.10).

RESULTS

During the study period, 84 pregnancies complicated by fetal gastroschisis were delivered from 117,564 gestations. Antenatal testing was performed in 58 cases (69%). Of the 26 (31%) without antenatal testing, 17 had an antenatal diagnosis of gastroschisis and in 9, the diagnosis was made on the day of delivery. In the 17 with an antenatal diagnosis, there were 2 stillbirths (29(4/7) and 31(3/7) weeks' gestation) and 1 was delivered with a moderate to severe arterial cord blood gas acidosis at 29(5/7) weeks' gestation. An additional case of moderate to severe arterial cord blood gas acidosis occurred in the 9 cases where the diagnosis was made on the day of delivery. Of the 58 pregnancies with antenatal surveillance, there were no stillbirths and no cases with a moderate to severe arterial cord blood gas acidosis. Of these 58 cases, 22 (38%) were delivered based on an abnormal testing result. Of the 84 total cases, 32 (38%) had birthweights < 10th percentile, and of these, 16 (19%) had birthweights < 3rd percentile.

CONCLUSION

Based on these data, antenatal fetal surveillance may be warranted in pregnancies complicated by fetal gastroschisis beginning at a gestational age of 28 to 29 weeks. Fetal testing between the thresholds of viability up to 28 weeks' gestation would be controversial.

Aminiotic Fluid and Intrauterine Growth Restriction in a Gastroschisis Fetal Rat Model

Fetuses with digestive anomalies such as gastroschisis may present intrauterine growth restriction (IUGR) and shortened intestines.

OBJECTIVE

The aim of this study was to assess the influence caused by amniotic fluid (AF) in intestinal length and somatic growth in an experimental gastroschisis fetal model at two distinct gestational ages.

MATERIAL AND METHOD

Fetal rats were operated according to Correia-Pinto on 2 different days of gestation: day 18.5 (group I) and day 19.5 (group II). Each group was divided into three sub-groups: fetuses with gastroschisis (G), control (C) and sham(S). Body measurements and histological analysis were done.

RESULT

Body measurement analysis showed: average body weight (g) in group I was G = 5.32, C = 5.68, S = 5.86; group II was G = 5.32, C = 5.80, S = 5.66. Average intestine weight (g) in group I was G = 0.283, C = 0.238, S = 0.231; group II was G = 0.272, C = 0.231, S = 0.233. Average intestine length (mm) in group I was G = 125, C = 216, S = 209; group II was G = 148, C = 226, S = 226. Histological analysis showed a decrease in the number and size of the intestinal microvillae and a light edema of serosa.

CONCLUSION

Gastroschisis had a direct correlation with IUGR and the time of exposure of the fetuses to AF had no influence on body weight in gastroschisis fetuses but did interfere with intestinal length.

Abdominal wall and umbilical cord anomalies

This article begins with a presentation of the embryology of the anterior abdominal wall and umbilical cord. Abnormal embryology and resulting anomalies are presented in tabular form and later reviewed in chronologic order of embryologic development. Techniques involved in the prenatal diagnosis of these abnormalities are also described.