1
|
Suntharalingam H, Briatico D, Carey N, McBryde A, Skarsgard E, Huisman E, Livingston MH. Feeding practices for infants with gastroschisis: A survey of neonatal intensive care units in Canada. J Neonatal Perinatal Med 2025:19345798251327370. [PMID: 40096853 DOI: 10.1177/19345798251327370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2025]
Abstract
BackgroundFeeding practices for infants with gastroschisis are often based on institutional protocols, clinician judgement, and usual practice. The purpose of this study was to describe the range of feeding practices used in neonatal intensive care units across Canada.MethodsWe developed an 18-item survey with open-ended questions focused on feeding and nutrition among infants with gastroschisis. Clinicians from neonatal intensive care units that manage infants with gastroschisis were invited to participate. Interviews were completed via virtual meeting or email. Data were analyzed using descriptive statistics.ResultsSemi-structured interviews were conducted with 14 of 17 centers (82% response rate). Participants included neonatologists (12/14 centers) and dieticians (10/14 centers). Pediatric surgeons from 3/14 centers participated at the request of neonatologists. None of the centers reported using a gastroschisis feeding protocol routinely, although two centers noted occasional use of a protocol from another hospital, and another indicated that a gastroschisis feeding protocol is in development. All centers reported that patients with gastroschisis qualify for donor human milk if maternal breast milk is unavailable. Routine use of sham feeding, contrast studies, rectal irrigations, or motility agents was not reported. There was variation between centers regarding feeding advancement, type of formula used if breast milk is unavailable, use of probiotics, and strategies to introduce breastfeeding.ConclusionThere is variation in some but not all aspects of enteral feeding among infants with gastroschisis at neonatal intensive care units in Canada. The development of institutional feeding protocols and clinical practice guidelines may help standardize practice.
Collapse
Affiliation(s)
- Hareshan Suntharalingam
- McMaster Pediatric Surgery Research Collaborative, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Daniel Briatico
- McMaster Pediatric Surgery Research Collaborative, Hamilton, ON, Canada
- Division of Pediatric Surgery, McMaster University, Hamilton, ON, Canada
| | - Nathalie Carey
- McMaster Pediatric Surgery Research Collaborative, Hamilton, ON, Canada
- Division of Pediatric Surgery, McMaster University, Hamilton, ON, Canada
| | - Ali McBryde
- Neonatal Intensive Care Unit, McMaster Children's Hospital, Hamilton, ON, Canada
| | - Erik Skarsgard
- Division of Pediatric Surgery, University of British Columbia, Vancouver, BC, Canada
- Canadian Pediatric Surgery Network (CAPSNet), Vancouver, BC, Canada
| | - Esther Huisman
- Neonatal Intensive Care Unit, McMaster Children's Hospital, Hamilton, ON, Canada
- Division of Neonatology, McMaster University, Hamilton, ON, Canada
| | - Michael H Livingston
- McMaster Pediatric Surgery Research Collaborative, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Division of Pediatric Surgery, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
2
|
Baerg J, McAteer J, Miniati D, Somme S, Slidell M. Improving outcomes for uncomplicated gastroschisis: clinical practice guidelines from the American Pediatric Surgical Association Outcomes and Evidence-based Practice Committee. Pediatr Surg Int 2024; 40:246. [PMID: 39222260 DOI: 10.1007/s00383-024-05819-5] [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] [Accepted: 08/10/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND The authors sought better outcomes for uncomplicated gastroschisis through development of clinical practice guidelines. METHODS The authors and the American Pediatric Surgical Association Outcomes and Evidenced-based Practice Committee used an iterative process and chose two questions to develop clinical practice guidelines regarding (1) standardized nutrition protocols and (2) postnatal management strategies. An English language search of PubMed, MEDLINE, OVID, SCOPUS, and the Cochrane Library Database identified literature published between January 1, 1970, and December 31, 2019, with snowballing to 2022. The Appraisal of Guideline, Research and Evaluation reporting checklist was followed. RESULTS Thirty-three studies were included with a Level of Evidence that ranged from 2 to 5 and recommendation Grades B-D. Nine evaluated standardized nutrition protocols and 24 examined postnatal management strategies. The adherence to gastroschisis-specific nutrition protocols promotes intestinal feeding and reduces TPN administration. The implementation of a standardized postnatal clinical management protocol is often significantly associated with shorter hospital stays, less mechanical ventilation use, and fewer infections. CONCLUSIONS There is a lack of comparative studies to guide practice changes that improve uncomplicated gastroschisis outcomes. The implementation of gastroschisis-specific feeding and clinical care protocols is recommended. Feeding protocols often significantly reduce TPN administration, although the length of hospital stay may not consistently decrease.
Collapse
Affiliation(s)
- Joanne Baerg
- Division of Pediatric Surgery, Presbyterian Healthcare Services, Albuquerque, NM, USA.
| | - Jarod McAteer
- Division of Pediatric Surgery, Providence Sacred Heart Children's Hospital, Spokane, WA, USA
| | - Doug Miniati
- Division of Pediatric Surgery, Kaiser Permanente Northern California, Roseville, CA, USA
| | - Stig Somme
- Division of Pediatric Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Mark Slidell
- Division of Pediatric Surgery, Johns Hopkins Children's Center, Baltimore, MD, USA
| |
Collapse
|
3
|
Burgos CM, Irvine W, Vivanti A, Conner P, Machtejeviene E, Peters N, Sabria J, Torres AS, Tognon C, Sgró A, Kouvisalo A, Langeveld-Benders H, Sfeir R, Miserez M, Qvist N, Lokosiute-Urboniene A, Zahn K, Brendel J, Prat J, Eaton S, Benachi A. European reference network for rare inherited congenital anomalies (ERNICA) evidence based guideline on the management of gastroschisis. Orphanet J Rare Dis 2024; 19:60. [PMID: 38347519 PMCID: PMC10860293 DOI: 10.1186/s13023-024-03062-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 02/03/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND The European Reference Network for rare Inherited Congenital Anomalies, ERNICA, guidelines for gastroschisis cover perinatal period to help teams to improve care. METHOD A systematic literature search including 136 publications was conducted. Research findings were assessed following the GRADE methodology. The evidence to decision framework was used to determine the strength and direction of recommendations. RESULTS The mode or timing of delivery do not impact neonatal mortality, risk of NEC or time on parenteral nutrition (PN). Intra or extra abdominal bowel dilatation predict complex gastroschisis and longer length of hospital stay but not increased perinatal mortality. Outcomes after Bianchi procedure and primary fascia closure under anesthesia are similar. Sutureless closure decreases the rate of surgical site infections and duration of ventilation compared to surgical closure. Silo-staged closure with or without intubation results in similar outcomes. Outcomes of complex gastroschisis (CG) undergoing early or delayed surgical repair are similar. Early enteral feeds starting within 14 days is associated with lower risk of surgical site infection. RECOMMENDATIONS The panel suggests vaginal birth between 37 and 39 w in cases of uncomplicated gastroschisis. Bianchi's approach is an option in simple gastroschisis. Sutureless closure is suggested when general anesthesia can be avoided, sutured closure. If anesthesia is required. Silo treatment without ventilation and general anesthesia can be considered. In CG with atresia primary intestinal repair can be attempted if the condition of patient and intestine allows. Enteral feeds for simple gastroschisis should start within 14 days.
Collapse
Affiliation(s)
- Carmen Mesas Burgos
- Department of Pediatric Surgery, Karolinska University Hospital, Eugeniavägen 23, C11:33, 17176, Stockholm, Sweden.
| | - Willemijn Irvine
- Department of Evidence Based Medicine and Methodology, Qualicura Healthcare Support Agency, Breda, The Netherlands
| | - Alexandre Vivanti
- Department of Obstetrics and Gynecology, Antoine Béclère Hospital, Paris Saclay University, Clamart, France
| | - Peter Conner
- Center for Maternal and Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Egle Machtejeviene
- Department of Gynecology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania
| | - Nina Peters
- Department of Gynecology and Obstetrics, Erasmus MC, Rotterdam, The Netherlands
| | - Joan Sabria
- Center for Maternal and Fetal Medicine, Hospital St Joan de Dieu, Barcelona, Spain
| | | | - Costanza Tognon
- Department of Neonatology, University of Padua, Padua, Italy
| | - Alberto Sgró
- Department of Pediatric Surgery, University of Padua, Padua, Italy
| | - Antti Kouvisalo
- Department of Pediatric Surgery, Helsinki University Hospital, Helsinki, Finland
| | | | - Rony Sfeir
- Department of Pediatric Surgery, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Marc Miserez
- Department of Surgery, UZ Leuven, Louvain, Belgium
| | - Nils Qvist
- Department of Pediatric Surgery, Odense University Hospital, Odense, Denmark
| | - Ausra Lokosiute-Urboniene
- Department of Pediatric Surgery, Lithuanian University of Health Sciences Kauno Klinikos, Kaunas, Lithuania
| | - Katrin Zahn
- Department of Pediatric Surgery, Mannheim, Germany
| | - Julia Brendel
- Department of Pediatric Surgery, Hannover Medical University, Hanover, Denmark
| | - Jordi Prat
- Department of Pediatric Surgery, Hospital S Joan de Diu, Barcelona, Spain
| | - Simon Eaton
- Department of Pediatric Surgery, Erasmus MC, Rotterdam, The Netherlands
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Alexandra Benachi
- Department of Obstetrics and Gynecology, Antoine Béclère Hospital, Paris Saclay University, Clamart, France
| |
Collapse
|
4
|
Merritt RJ. Gastroschisis: Progress and Challenges. J Pediatr 2022; 243:8-11. [PMID: 34958830 DOI: 10.1016/j.jpeds.2021.12.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/21/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Russell J Merritt
- Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California.
| |
Collapse
|
5
|
Raduma OS, Jehangir S, Karpelowsky J. The effect of standardized feeding protocol on early outcome following gastroschisis repair: A systematic review and meta-analysis. J Pediatr Surg 2021; 56:1776-1784. [PMID: 34193345 DOI: 10.1016/j.jpedsurg.2021.05.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 04/27/2021] [Accepted: 05/25/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Improved post-operative outcomes following gastroschisis repair are attributed to advancement in perioperative and post-operative care and early enteral feeding. This study evaluates the role of standardized postoperative feeding protocols in gastroschisis. STUDY DESIGN A systematic review and meta-analysis of studies published from January 2000 to April 2019 in MEDLINE, EMBASE, Cochrane Library databases and Google Scholar was conducted. Primary outcomes were duration to full enteral feeding and cessation of parenteral nutrition. Secondary outcomes included days to first enteral feeding, length of stay, compliance, complication and mortality rates. Meta-analysis was done using the RevMan Analysis Statistical Package in Review Manager (Version 5.3) using a random effects model and reported as pooled Risk Ratio and Mean Difference. p-value < 0.05 was considered statistically significant. RESULTS Eight observational cohort studies were identified and their data analyzed. Significant heterogeneity was noted for some outcomes. Standardized feeding protocols resulted in fewer days to first enteral feeding by 3.19 days (95% CI: -4.73, -1.66, p < 0.0001) than non-protocolized feeding, less complication rates, reduced mortality and better compliance to care. The duration of parenteral nutrition and time to full enteral feeding were not significantly affected. CONCLUSION Protocolized feeding post-gastroschisis repair is associated with early initiation of enteral feeding. There is a likelihood of reduced rates of sepsis; shorter duration of parenteral nutrition, length of hospital stay and time to full enteral feeding. However, the latter trends are not statistically significant and will require further studies best accomplished with a prospective randomized trial or more cohort studies.
Collapse
Affiliation(s)
- Ochieng Sephenia Raduma
- Department of Surgery, Defence Forces Memorial Hospital, Nairobi, Kenya; Division of Surgery, University of Sydney, NSW, Australia; Division of Child and Adolescent Health, Sydney Medical School, University of Sydney, NSW, Australia
| | - Susan Jehangir
- Department of Paediatric Surgery, The Children's hospital at Westmead, NSW, Australia; Christian Medical College, Vellore, Tamil Nadu, India
| | - Jonathan Karpelowsky
- Division of Surgery, University of Sydney, NSW, Australia; Department of Paediatric Surgery, The Children's hospital at Westmead, NSW, Australia; Division of Child and Adolescent Health, Sydney Medical School, University of Sydney, NSW, Australia.
| |
Collapse
|
6
|
Hamad D, Yousef Y, Caminsky NG, Guadagno E, Tran VA, Laberge JM, Emil S, Poenaru D. Defining the critical pediatric surgical workforce density for improving surgical outcomes: a global study. J Pediatr Surg 2020; 55:493-512. [PMID: 31839371 DOI: 10.1016/j.jpedsurg.2019.11.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 11/02/2019] [Accepted: 11/05/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE Low- and middle-income countries (LMICs) have only 19% of the global surgical workforce yet see 80% of worldwide deaths from noncommunicable diseases. We aimed to interrogate the correlation between pediatric surgical workforce density (PSWD) and survival from pediatric surgical conditions worldwide. METHODS A systematic review of online databases identified outcome studies for key pediatric surgical conditions (gastroschisis, esophageal atresia, intestinal atresia, and typhoid perforation) as well as PSWD data across low-income (LICs), middle-income (MICs), and high-income countries (HICs). PSWD was expressed as the number of PSs/million children under 15 years of age and we correlated this to surgical outcomes for our case series. RESULTS PSWD ranged between zero (Burundi, The Gambia, and Mauritania) and 125.2 (Poland) across 86 countries. Outcomes for at least one condition were obtained in 61 countries: 50 outcomes in HICs, 52 in MICs and 8 in LICs. The mean survival in our case series was 42.3%, 69.4% and 91.6% for LICs, MICs, and HICs, respectively. A PSWD ≥4 PSs/million children under 15 years of age significantly correlated to odds of survival ≥80% (OR 16.8, p < 0.0001, 95% CI 5.66-49.88). Specifically in the studied LICs and MICs, increasing the PSWD to 4 would require training 1427 additional surgeons. CONCLUSION Using a novel approach, we have established a benchmark for the scale-up of pediatric surgical workforce, which may support broader efforts to reduce childhood deaths from congenital disease. LEVELS OF EVIDENCE 2c - Outcomes Research.
Collapse
Affiliation(s)
- Doulia Hamad
- Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Yasmine Yousef
- Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Natasha G Caminsky
- Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Elena Guadagno
- Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Viet Anh Tran
- Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jean-Martin Laberge
- Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sherif Emil
- Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Dan Poenaru
- Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
| |
Collapse
|
7
|
Pomare C, Long JC, Churruca K, Ellis LA, Braithwaite J. Interprofessional collaboration in hospitals: a critical, broad-based review of the literature. J Interprof Care 2020; 34:509-519. [PMID: 31928245 DOI: 10.1080/13561820.2019.1702515] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Interprofessional collaboration (IPC) is a common term applied in the healthcare literature, with suggestions it contributes to improved quality and safety of patient care across the globe. Despite worldwide implementation of models of IPC, past systematic or meta-reviews on this topic have concluded that the evidence is mixed. However, these reviews are yet to adequately consider the qualitative and mixed-methods literature on this topic. In this critical review, we synthesize the outcomes and key findings of IPC in hospitals, taking a broader approach by including diverse study designs. A total of 4,776 abstracts were screened from three major databases (Medline, CINAHL, Embase). Thirty-four studies fulfilled inclusion criteria. Although outcomes and key findings (e.g., staff turnover, error rates) were mostly positive, there were inconsistencies in the results. The included studies reflected a variety of study designs and different methodological approaches. Overall, our review revealed moderate evidence that IPC can positively influence patient, staff and organizational factors in hospitals, and that inconsistent findings may be due to variation in context (e.g., the cohort of patients). Recommendations from the review are to incorporate qualitative- and mixed-methods approaches to studying IPC in healthcare and tailor evaluations of IPC outcomes specific to the context.
Collapse
Affiliation(s)
- Chiara Pomare
- Australian Institute of Health Innovation, Macquarie University , Sydney, Australia
| | - Janet C Long
- Australian Institute of Health Innovation, Macquarie University , Sydney, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University , Sydney, Australia
| | - Louise A Ellis
- Australian Institute of Health Innovation, Macquarie University , Sydney, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University , Sydney, Australia
| |
Collapse
|
8
|
Mansfield SA, Ryshen G, Dail J, Gossard M, McClead R, Aldrink JH. Use of quality improvement (QI) methodology to decrease length of stay (LOS) for newborns with uncomplicated gastroschisis. J Pediatr Surg 2018; 53:1578-1583. [PMID: 29291893 DOI: 10.1016/j.jpedsurg.2017.11.061] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 10/26/2017] [Accepted: 11/30/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE Gastroschisis is a congenital defect of the abdominal wall leading to considerable morbidity and long hospitalizations. The purpose of this study was to use quality improvement methodology to standardize care in the management of gastroschisis that may contribute to length of stay (LOS). METHODS A gastroschisis quality improvement team established a best-practice protocol in order to decrease LOS in infants with uncomplicated gastroschisis. The specific aim was to decrease median LOS from a baseline of 34days. We used statistical process control charts including rational subgroup analysis to monitor LOS. RESULTS From December 2008 to December 2016, 119 patients with uncomplicated gastroschisis were evaluated. Retrospective data were obtained on 25 patients prior to protocol implementation. Ninety-four patients with uncomplicated gastroschisis comprised the prospective process stage. The median LOS for this retrospective cohort was 34days (IQR: 30.5-50.5), while the median LOS for the prospective cohort following implementation of the protocol decreased to 29days (IQR: 23-43). CONCLUSIONS With the use of quality improvement methodology, including standardization of care and a change in surgical approach, the median LOS for newborns with uncomplicated gastroschisis at our institution decreased from 34days to 29days. LEVEL OF EVIDENCE 3.
Collapse
Affiliation(s)
- Sara A Mansfield
- Department of General Surgery, The Ohio State University College of Medicine, Columbus, OH
| | - Gregory Ryshen
- Quality Improvement Services, Nationwide Children's Hospital, Columbus, OH
| | - James Dail
- Quality Improvement Services, Nationwide Children's Hospital, Columbus, OH
| | - Mary Gossard
- Division of Neonatology, Nationwide Children's Hospital, Columbus, OH
| | - Richard McClead
- Department of Pediatrics, Division of Neonatology, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH
| | - Jennifer H Aldrink
- Department of Surgery, Division of Pediatric Surgery, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH.
| |
Collapse
|
9
|
Assessing quality of life in pediatric gastroschisis patients using the Pediatric Quality of Life Inventory survey: An institutional study. J Pediatr Surg 2016; 51:726-9. [PMID: 26932251 DOI: 10.1016/j.jpedsurg.2016.02.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 02/07/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND The purpose of this study was to quantify quality of life (QOL) outcomes in gastroschisis children using a validated QOL inventory survey. METHODS A chart review and prospective survey (2012 Pediatric Quality of Life Inventory™ (PedsQL™)) were performed for gastroschisis patients from 2005 to 2011. Demographics and scores were compared between patents with simple versus complicated gastroschisis and patients with and without bowel resection. RESULTS One hundred nineteen patients (>2years of age) were identified. Twenty-eight families participated in the prospective survey with an average patient age of 5.8±2.3years. There were 11 complicated and 17 simple cases. Children with simple gastroschisis had lower rates of reoperation (0.06% versus 90%, p<0.001) and bowel resection (12% and 64%, p=0.004) than complicated patients. Average QOL scores for children with simple and complicated gastroschisis were 81.69/100±19.50 and 78.7/100±20.14 (p=0.70), respectively. Scores were also similar in children with and without bowel resection (74.72/100±19.94 and 83.29/100±19.10, p=0.171). Cronbach's alpha correlation was 0.912 for the overall survey. DISCUSSION Despite increased need for reoperation and bowel resection, at >2years of age, PedsQL™ scores were similar between patients with simple and complicated gastroschisis. This study provides preliminary data on QOL outcomes for antenatal counseling of gastroschisis families.
Collapse
|