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Hodgson E, Briatico D, Klapman S, Skarsgard E, Beltempo M, Shah PS, Huisman E, Walton JM, Livingston MH. Association of Exclusive Breast Milk Intake and Outcomes in Infants With Uncomplicated Gastroschisis: A National Cohort Study. J Pediatr Surg 2024; 59:863-868. [PMID: 38413262 DOI: 10.1016/j.jpedsurg.2024.01.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 01/22/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Enteral feeding is an essential part of the management of infants with gastroschisis. We hypothesized that exclusive breast milk is associated with improved neonatal outcomes. METHODS We conducted a retrospective review of infants with uncomplicated gastroschisis through the Canadian Pediatric Surgery Network (CAPSNet) and Canadian Neonatal Network (CNN). The primary outcome was time to full enteral feeds. RESULTS We identified 411 infants with gastroschisis treated at CAPSNet centres from 2014 to 2022. 144 patients were excluded due to gestational age <32 weeks, birth weight <1500 g, other congenital anomalies, or complicated gastroschisis. Of the remaining 267 participants, 78% (n = 209) received exclusive breast milk diet in the first 28 days of life, whereas 22% (n = 58) received supplemental or exclusive formula. Infants who received exclusive breast milk experienced higher time to reach full enteral feeding (median 24 vs 22 days, p = 0.047) but were more likely to have undergone delayed abdominal closure (32% vs 17%, p = 0.03). After adjustment, there were no significant differences between groups in time to reach full enteral feeds, duration of parenteral nutrition, or length of stay. Infants who received supplemental or exclusive formula had a similar risk of necrotizing enterocolitis (4% vs 3%) but were less likely to transition to exclusive breast milk at discharge (73% vs 11%, p < 0.001). CONCLUSION Early use of exclusive breast milk in infants with uncomplicated gastroschisis is associated with similar outcomes compared to supplemental or exclusive formula. Patients who received supplemental or exclusive formula were unlikely to transition to exclusive breastfeeding by discharge. LEVEL OF EVIDENCE Level IIb (Individual Cohort Study).
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Affiliation(s)
- Emily Hodgson
- Division of General Surgery, McMaster University, Hamilton, Canada
| | - Daniel Briatico
- McMaster Pediatric Surgery Research Collaborative, McMaster University, Hamilton, Canada; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Sarah Klapman
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Erik Skarsgard
- Division of Pediatric Surgery, University of British Columbia, Vancouver, Canada
| | - Marc Beltempo
- Division of Neonatology, McGill University Health Centre, Montreal, Canada
| | - Prakesh S Shah
- Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Canada
| | - Esther Huisman
- Division of Neonatology, McMaster University, Hamilton, Canada
| | - J Mark Walton
- McMaster Pediatric Surgery Research Collaborative, McMaster University, Hamilton, Canada; Division of Pediatric Surgery, McMaster University, Hamilton, Canada
| | - Michael H Livingston
- McMaster Pediatric Surgery Research Collaborative, McMaster University, Hamilton, Canada; Division of Pediatric Surgery, McMaster University, Hamilton, Canada.
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Wu D, Van Oerle R, Martinez A, Piper HG. Risk Factors for Infection in Neonates With Intestinal Failure. J Pediatr Surg 2024; 59:854-857. [PMID: 38365474 DOI: 10.1016/j.jpedsurg.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 01/18/2024] [Indexed: 02/18/2024]
Abstract
PURPOSE Neonates with intestinal failure (IF) are at risk for infection due to central venous access, and intestinal surgery. Infection can cause systemic inflammation and sepsis, potentially affecting growth. The purpose of this study was to identify risk factors for, and the potential impact of infection to help with preventative strategies. METHODS A retrospective review of infants with IF, at a single centre from 2018 to 2022 was conducted. Clinical characteristics, intestinal pathology, nutritional intake, and growth were compared among infants with bloodstream infection (BSI), other infection (OI) (urinary, respiratory, or wound), or no infection (NI) within 2 months of diagnosis. Mann-Whitney and Kruskal-Wallis tests were used for comparisons with p-values <0.05 considered significant. RESULTS Eighty-six infants were included, with gastroschisis (41%) and necrotizing enterocolitis (26%) the most common diagnoses. Fifty-nine % of infants developed infection (22% BSI and 37% OI). Those with BSI or OI had a lower gestational age and birthweight, and were more likely to have a stoma. All infants with complex gastroschisis developed infection compared to 38% of infants with simple gastroschisis. Median daily weight gain was suboptimal across all groups and did not differ over 6 weeks following infection. CONCLUSION Most infants with IF develop infection shortly after diagnosis. Risk factors include prematurity, complex gastroschisis, and the presence of a stoma. Growth was suboptimal but did not differ among infants with or without infection. TYPE OF STUDY Retrospective Review. LEVEL OF EVIDENCE Level III Retrospective Comparative Study.
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Affiliation(s)
- Dana Wu
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Rhonda Van Oerle
- Division of Neonatology, University of British Columbia/BC Women's Hospital and Health Center, Vancouver, BC, Canada
| | - Andrea Martinez
- Division of Gastroenterology, University of British Columbia/BC Children's Hospital, Vancouver, BC, Canada
| | - Hannah G Piper
- Division of Pediatric Surgery, University of British Columbia/BC Children's Hospital, Vancouver, BC, Canada.
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Cozzi DA, Ceccanti S. Letter to the Editor in response to: Immediate Versus Delayed Surgical Management of Cryptorchidism in Newborns With Gastroschisis. J Pediatr Surg 2024; 59:1016. [PMID: 38360450 DOI: 10.1016/j.jpedsurg.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 01/11/2024] [Indexed: 02/17/2024]
Affiliation(s)
- Denis A Cozzi
- Pediatric Surgery Unit, Azienda Ospedaliero Universitaria Policlinico Umberto I, and Department of Maternal Infantile and Urological Sciences, "Sapienza" University of Rome, RM 00161, Italy.
| | - Silvia Ceccanti
- Pediatric Surgery Unit, Azienda Ospedaliero Universitaria Policlinico Umberto I, and Department of Maternal Infantile and Urological Sciences, "Sapienza" University of Rome, RM 00161, Italy
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Schmidt CN, Wen T, Friedman AM, D'Alton ME, Andrikopoulou M. Trends in Attempted Vaginal Delivery among Pregnancies Complicated by Gastroschisis, 2014 to 2020. Am J Perinatol 2024; 41:543-547. [PMID: 36452974 DOI: 10.1055/a-1990-8668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVE Gastroschisis is a full-thickness congenital defect of the abdominal wall through which intestines and other organs may herniate. In a prior analysis, attempted vaginal delivery with fetal gastroschisis appeared to increase through 2013, although cesarean delivery remained common. The objective of this analysis was to update current trends in attempted vaginal birth among pregnancies complicated by gastroschisis. STUDY DESIGN We performed an updated cross-sectional analysis of live births from 2014 and 2020 using data from the U.S. National Vital Statistics System and evaluated trends in attempted vaginal deliveries among births with gastroschisis. Trends were evaluated using joinpoint regression. We constructed logistic regression models to evaluate the association between demographic and clinical variables and attempted vaginal delivery in the setting of gastroschisis. RESULTS Among 5,355 deliveries with gastroschisis meeting inclusion criteria, attempted vaginal delivery increased significantly from 68.9% to 75.1%, an average annual percent change of 1.7% (95% confidence interval [CI], 0.8-2.5). Among gastroschisis-complicated pregnancies, patients 35 to 39 years old (adjusted odds ratio [aOR], 0.53; 95% CI, 0.37-0.79) and Hispanic race/ethnicity (aOR, 0.69; 95% CI, 0.58-0.62) were at lower likelihood of attempted vaginal delivery in adjusted analyses. CONCLUSION These findings suggest that vaginal delivery continues to increase in the setting of gastroschisis. Further reduction of surgical delivery for this fetal defect may be possible. KEY POINTS · Vaginal deliveries increased among gastroschisis pregnancies.. · Hispanic patients were less likely to attempt vaginal delivery.. · Some gastroschisis pregnancies still deliver surgically..
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Affiliation(s)
| | - Timothy Wen
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California
| | - Alexander M Friedman
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Mary E D'Alton
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Maria Andrikopoulou
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Nimanya SA, Stephens CQ, Yap A, Kisa P, Kakembo N, Wesonga A, Okello I, Naluyimbazi R, Mbwali F, Kayima P, Ssewanyana Y, Naik-Mathuria B, Ozgediz D, Sekabira J. Impact of Bowel Coverage and Resuscitation Protocol on Gastroschisis Mortality in Low-Income Countries: Experience and Lessons From Uganda. J Pediatr Surg 2024; 59:151-157. [PMID: 37838617 DOI: 10.1016/j.jpedsurg.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/06/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Gastroschisis causes near complete mortality in low-income countries (LICs). This study seeks to understand the impact of bedside bowel reduction and silo placement, and protocolized resuscitation on gastroschisis outcomes in LICs. METHODS We conducted a retrospective cohort study of gastroschisis patients at a tertiary referral center in Kampala, Uganda. Multiple approaches for bedside application of bowel coverage devices and delayed closure were used: sutured urine bags (2017-2018), improvised silos using wound protectors (2020-2021), and spring-loaded silos (2022). Total parental nutrition (TPN) was not available; however, with the use of improvised silos, a protocol was implemented to include protocolized resuscitation and early enteral feeding. Risk ratios (RR) for mortality were calculated in comparison to historic controls from 2014. RESULTS 368 patients were included: 42 historic controls, 7 primary closures, 81 sutured urine bags, 133 improvised silos and 105 spring-loaded silos. No differences were found in sex (p = 0.31), days to presentation (p = 0.84), and distance traveled to the tertiary hospital (p = 0.16). Following the introduction of bowel coverage methods, the proportion of infants that survived to discharge increased from 2% to 16-29%. In comparison to historic controls, the risk of mortality significantly decreased: sutured urine bags 0.65 (95%CI: 0.52-0.80), improvised silo 0.76 (0.66-0.87), and spring-loaded silo 0.65 (0.56-0.76). CONCLUSION Bedside application of bowel coverage and protocolization decreases the risk of death for infants with gastroschisis, even in the absence of TPN. Further efforts to expand supply of low-cost silos in LICs would significantly decrease the mortality associated with gastroschisis in this setting. TYPE OF STUDY Treatment Study. LEVEL OF EVIDENCE III (Retrospective Comparative Study).
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Affiliation(s)
| | - Caroline Q Stephens
- UCSF Center for Health Equity and Anesthesia, University of California-San Francisco, San Francisco, CA, USA.
| | - Ava Yap
- UCSF Center for Health Equity and Anesthesia, University of California-San Francisco, San Francisco, CA, USA
| | - Phyllis Kisa
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Nasser Kakembo
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Anne Wesonga
- Mulago National Referral Hospital, Kampala, Uganda
| | | | | | - Fiona Mbwali
- Mulago National Referral Hospital, Kampala, Uganda
| | - Peter Kayima
- Mulago National Referral Hospital, Kampala, Uganda
| | | | | | - Doruk Ozgediz
- UCSF Center for Health Equity and Anesthesia, University of California-San Francisco, San Francisco, CA, USA
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Lotakis DM, Parekh B, Kim AG, Speck KE. Management of Complex Gastroschisis: Early Primary Anastomoses at the Time of Abdominal Wall Closure. Am Surg 2023; 89:6293-6295. [PMID: 36794527 DOI: 10.1177/00031348231157413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- Dimitra M Lotakis
- Section of Pediatric Surgery, Department of Surgery, Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Bela Parekh
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Aimee G Kim
- Section of Pediatric Surgery, Department of Surgery, Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - K Elizabeth Speck
- Section of Pediatric Surgery, Department of Surgery, Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
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Barry M, Gozali A, Vu L. Impact of Social Vulnerability on Long-Term Growth Outcomes in Sutureless Versus Sutured Repair of Gastroschisis. Eur J Pediatr Surg 2023; 33:477-484. [PMID: 36720245 DOI: 10.1055/s-0043-1761921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The purpose of this study is to describe the long-term growth and nutrition outcomes of sutureless versus sutured gastroschisis repair. We hypothesized that weight z-score at 1 year would be affected by social determinants of health measured by the U.S. Centers for Disease Control Social Vulnerability Index (SVI). MATERIALS AND METHODS We conducted a single-center retrospective review of patients who underwent gastroschisis repair (n = 97) from 2007 to 2018. Growth z-scores collected through 5 years of age and long-term clinical outcomes were compared based on the closure method and the type of gastroschisis (simple vs. complicated). Multiple regression analysis was performed to identify the impact of SVI themes and other covariates on weight for age z-score at 1 year. RESULTS In total, 46 patients underwent sutureless repair and 51 underwent sutured repair with median follow-up duration of 2.5 and 1.9 years, respectively. Weight and length z-scores decreased after birth but normalized within the first year of life. Growth and long-term clinical outcomes were similar regardless of the closure method, while patients with complicated gastroschisis had higher rates of hospitalizations, small bowel obstructions, and additional abdominal surgeries. Using multiple regression, both low discharge weight and high SVI in the "minority status and language" theme were associated with lower weight for age z-scores at 1 year (p = 0.003 and p = 0.03). CONCLUSION Sutureless and sutured gastroschisis repairs result in similar growth and long-term outcomes. Patients living in areas with greater social vulnerability may be at increased risk of poor weight gain. Patients should be followed at least through their first year to ensure appropriate growth.
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Affiliation(s)
- Mark Barry
- Department of Surgery, University of California San Francisco, San Francisco, California, United States
| | - Aileen Gozali
- School of Medicine, University of California San Francisco, San Francisco, California, United States
| | - Lan Vu
- Division of Pediatric Surgery, University of California San Francisco, San Francisco, California, United States
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Goto H, Iwatani S, Ikuta T, Yoshimoto S. Hypoalbuminemia in newborns with gastroschisis. Congenit Anom (Kyoto) 2023; 63:214-216. [PMID: 37574591 DOI: 10.1111/cga.12537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 06/09/2023] [Accepted: 07/22/2023] [Indexed: 08/15/2023]
Affiliation(s)
- Hiroki Goto
- Department of Neonatology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Hyogo, Japan
| | - Sota Iwatani
- Department of Neonatology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Hyogo, Japan
| | - Toshihiko Ikuta
- Department of Neonatology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Hyogo, Japan
| | - Seiji Yoshimoto
- Department of Neonatology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Hyogo, Japan
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Salaün JP, Beaufils R, Chagnot A, Alexandre C, Petit T, Hanouz JL, Orliaguet G. Evaluation of quality of care in neonatal anesthesia using a bundle of intraoperative parameters. Paediatr Anaesth 2023; 33:823-828. [PMID: 37422704 DOI: 10.1111/pan.14719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Maintenance of physiological homeostasis is key in the safe conduct of pediatric anesthesia. Achieving this goal is especially difficult in neonatal surgery. AIMS The first aim was to document the absolute number of seven intraoperative parameters monitored during anesthesia in neonates undergoing gastroschisis surgery. The second aims were to determine the frequency of monitoring of each of these intraoperative parameters as well as the proportion of cases in which each parameter was both monitored and maintained within a pre-defined range. METHODS This retrospective observational analysis includes data from 53 gastroschisis surgeries performed at Caen University Hospital (2009-2020). Seven intraoperative parameters were analyzed. First, we assessed if the intraoperative parameters were monitored or not. Second, when monitored, we assessed if these parameters were maintained within a pre-defined range, based on the current literature and on local agreement. RESULTS The median [first-third Q], range (min-max) number of intraoperative parameters monitored during the 53 gastroschisis surgeries was 6 [5-6], range (4-7). There were no missing data for the automatically recorded ones such as arterial blood pressure, heart rate, end-tidal CO2, and oxygen saturation. Temperature was monitored in 38% of the patients, glycemia in 66%, and natremia in 68% of the cases. Oxygen saturation and heart rate were maintained within the pre-defined range in 96% and 81% of the cases respectively. The blood pressure (28%) and temperature (30%) were instead the least often maintained within the pre-defined range. CONCLUSION Although a median of six out of the seven selected intraoperative parameters were monitored during gastroschisis repair, only two of them (oxygen saturation and heart rate) were maintained within the pre-defined range more than 80% of the time. It might be of interest to extend physiologic age- and procedure-based approach to the development of specific preoperative anesthetic planning.
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Affiliation(s)
- Jean-Philippe Salaün
- Department of Anesthesiology and Critical Care Medicine, CHU Caen Normandie, Caen University Hospital, 14000 Caen, France
- Normandie Univ, UNICAEN, INSERM UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), Institut Blood and Brain @ Caen-Normandie (BB@C), GIP Cyceron, Caen, France
| | - Roxane Beaufils
- Department of Anesthesiology and Critical Care Medicine, CHU Caen Normandie, Caen University Hospital, 14000 Caen, France
| | - Audrey Chagnot
- Normandie Univ, UNICAEN, INSERM UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), Institut Blood and Brain @ Caen-Normandie (BB@C), GIP Cyceron, Caen, France
| | - Cénéric Alexandre
- Department of Neonatology, CHU Caen Normandie, Caen University Hospital, 14000 Caen, France
| | - Thierry Petit
- Department of Pediatric surgery, CHU Caen Normandie, Caen University Hospital, 14000 Caen, France
| | - Jean-Luc Hanouz
- Department of Anesthesiology and Critical Care Medicine, CHU Caen Normandie, Caen University Hospital, 14000 Caen, France
- EA 4650, Caen Normandy University, UNICAEN, Caen, France
| | - Gilles Orliaguet
- Department of Pediatric Anesthesia and Intensive Care, Necker-Enfants Malades University Hospital, AP-HP, Centre-Université de Paris, Paris, France
- Pharmacologie et Évaluation des Thérapeutiques Chez l'enfant et la Femme Enceinte EA 7323, Université de Paris, Paris, France
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Fatona O, Opashola K, Faleye A, Adeyanju T, Adekanmbi A, Etiubon E, Jesuyajolu D, Zubair A. Gastroschisis in Sub-Saharan Africa: a scoping review of the prevalence, management practices, and associated outcomes. Pediatr Surg Int 2023; 39:246. [PMID: 37584727 DOI: 10.1007/s00383-023-05531-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 08/17/2023]
Abstract
Gastroschisis is a congenital defect of the anterior abdominal wall characterized by a periumbilical abdominal wall defect with associated bowel protrusion. Limitations in the diagnosis and management of gastroschisis in Sub-Saharan African countries contribute to the high mortality rate. Few studies have been published despite its significant contribution to neonatal mortality in Sub-Saharan Africa. This review study explores the prevalence of gastroschisis, likewise the management and clinical outcomes. Full-text articles reporting the prevalence, management, and associated outcomes of gastroschisis in Sub-Saharan Africa were included. Data were extracted from databases such as PubMed, Google Scholar, and Ajol following a systematic search. The study was reported following the PRISMA-ScR guideline. A total of ten articles which included studies conducted from 1999 to 2022 fulfilled the criteria. The prevalence of gastroschisis varied widely, ranging from 0.026 to 1.75 with an overall mortality rate of 62.48%. Young maternal age is strongly associated with the incidence of gastroschisis. The study showed a slight male preponderance with a M: F ratio of 1.12:1. Staged closure with silos is the preferred method of management, it is explicitly linked to improved clinical outcomes. The prevalence rate and associated mortality of gastroschisis remain alarmingly high in most of the studies. There is a need for advanced diagnostic and management practices as well as increased awareness of gastroschisis to reduce mortality and improve survival outcomes.
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Affiliation(s)
- Omobolanle Fatona
- Paediatric Surgery Department, Surgery Interest Group of Africa, Lagos, Nigeria.
| | - Kehinde Opashola
- Paediatric Surgery Department, Surgery Interest Group of Africa, Lagos, Nigeria
| | - Abidemi Faleye
- Paediatric Surgery Department, Surgery Interest Group of Africa, Lagos, Nigeria
| | - Toluwanimi Adeyanju
- Paediatric Surgery Department, Surgery Interest Group of Africa, Lagos, Nigeria
| | - Azeezat Adekanmbi
- Paediatric Surgery Department, Surgery Interest Group of Africa, Lagos, Nigeria
| | - Etimbuk Etiubon
- Paediatric Surgery Department, Surgery Interest Group of Africa, Lagos, Nigeria
| | - Damilola Jesuyajolu
- Paediatric Surgery Department, Surgery Interest Group of Africa, Lagos, Nigeria
| | - Abdulahi Zubair
- Paediatric Surgery Department, Surgery Interest Group of Africa, Lagos, Nigeria
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Nezafat Maldonado B, Singhal G, Chow L, Hargreaves D, Gale C, Battersby C. Association between birth location and short-term outcomes for babies with gastroschisis, congenital diaphragmatic hernia and oesophageal fistula: a systematic review. BMJ Paediatr Open 2023; 7:e002007. [PMID: 37474200 PMCID: PMC10357737 DOI: 10.1136/bmjpo-2023-002007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/13/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Neonatal care is commonly regionalised, meaning specialist services are only available at certain units. Consequently, infants with surgical conditions needing specialist care who are born in non-surgical centres require postnatal transfer. Best practice models advocate for colocated maternity and surgical services as the place of birth for infants with antenatally diagnosed congenital conditions to avoid postnatal transfers. We conducted a systematic review to explore the association between location of birth and short-term outcomes of babies with gastroschisis, congenital diaphragmatic hernia (CDH) and oesophageal atresia with or without tracheo-oesophageal fistula (TOF/OA). METHODS We searched MEDLINE, CINAHL, Web of Science and SCOPUS databases for studies from high income countries comparing outcomes for infants with gastroschisis, CDH or TOF/OA based on their place of delivery. Outcomes of interest included mortality, length of stay, age at first feed, comorbidities and duration of parenteral nutrition. We assessed study quality using the Newcastle-Ottawa Scale. We present a narrative synthesis of our findings. RESULTS Nineteen cohort studies compared outcomes of babies with one of gastroschisis, CDH or TOF/OA. Heterogeneity across the studies precluded meta-analysis. Eight studies carried out case-mix adjustments. Overall, we found conflicting evidence. There is limited evidence to suggest that birth in a maternity unit with a colocated surgical centre was associated with a reduction in mortality for CDH and decreased length of stay for gastroschisis. CONCLUSIONS There is little evidence to suggest that delivery in colocated maternity-surgical services may be associated with shortened length of stay and reduced mortality. Our findings are limited by significant heterogeneity, potential for bias and paucity of strong evidence. This supports the need for further research to investigate the impact of birth location on outcomes for babies with congenital surgical conditions and inform future design of neonatal care systems. PROSPERO REGISTRATION NUMBER CRD42022329090.
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Affiliation(s)
| | | | - LiYan Chow
- Neonatal Medicine Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Chris Gale
- Neonatal Medicine, Chelsea and Westminster Hospital Campus, Imperial College London, London, UK
| | - Cheryl Battersby
- Neonatal Medicine, Chelsea and Westminster Hospital Campus, Imperial College London, London, UK
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13
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Tambo FFM, Badjang GT, Kamga GF, Sadjo SA, Tsala INK, Ondobo GA, Sosso MA. Bedside reduction of gastroschisis: A preliminary experience in yaounde-cameroon. Afr J Paediatr Surg 2023; 20:229-232. [PMID: 37470561 PMCID: PMC10450105 DOI: 10.4103/ajps.ajps_2_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 04/28/2020] [Indexed: 11/04/2022] Open
Abstract
Background Gastroschisis denotes a congenital or sporadic malformation of the anterior abdominal wall, which is rarely associated with other anomalies. The mortality in African countries is still high almost 100%. Objective The aim was to determine the feasibility and safety of bedside reduction of gastroschisis and factors affecting the outcome in low-income setting. Methodology This was a retrospective, descriptive and analytic study over a period of 6 years conducted in the Pediatric Surgery Service of the Yaoundé Gyneco-Obstetric and Pediatric Hospital. Only neonates with gastroschisis seen within 6 h of life without bowel necrosis and in whom bedside reduction was attempted in the neonatology unit under sedation (with 0.5 mg/kg of diazepam intra-rectally and 0.5-1 mg of atropine intravenously) were included in this study. Ethical clearance was obtained for the Ethical Committee of the Yaoundé Gyneco-Obstetric and Pediatric Hospital and a signed consent form was required from the parents of the children prior to the procedure. Results Twelve neonates with a mean age of 16.8 h (0 and 24 h) and mean birth weight of 2245 g (1860-3600 g) were enrolled. The mean time to presentation at hospital was 3.5 h (2-9 h). Bedside closure was successful in 10 patients. Two patients underwent primary closure in the theatre after failure of bedside reduction due to the volume of contents of gastroschisis. Mortality rate in our study was 33.3% and the morbidity was dominated by compartment syndrome and malnutrition. Conclusion Bedside reduction of gastroschisis under sedation in Yaoundé seems to be way to reduce the mortality.
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Affiliation(s)
- Faustin Felicien Mouafo Tambo
- Pediatric Surgery Department, Yaoundé Gyneco Obstetric and Pediatric Hospital, Yaoundé, Cameroon
- Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Gaelle Therese Badjang
- Pediatric Surgery Department, Yaoundé Gyneco Obstetric and Pediatric Hospital, Yaoundé, Cameroon
| | - Gacelle Fossi Kamga
- Pediatric Surgery Department, Yaoundé Gyneco Obstetric and Pediatric Hospital, Yaoundé, Cameroon
| | - Salihou Aminou Sadjo
- Pediatric Surgery Department, Yaoundé Gyneco Obstetric and Pediatric Hospital, Yaoundé, Cameroon
| | - Irene Nadine Kouna Tsala
- Pediatric Surgery Department, Yaoundé Gyneco Obstetric and Pediatric Hospital, Yaoundé, Cameroon
| | - Gervais Andze Ondobo
- Pediatric Surgery Department, Yaoundé Gyneco Obstetric and Pediatric Hospital, Yaoundé, Cameroon
- Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Maurice Aurélien Sosso
- Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
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14
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Martínez Villamandos A, Díaz Diñeiro M, Gallego Fernández ÁJ, García Soldevila N. New methods in the delayed closure of gastroschisis. An Pediatr (Barc) 2023; 98:234-235. [PMID: 36813616 DOI: 10.1016/j.anpede.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/05/2022] [Indexed: 02/22/2023] Open
Affiliation(s)
| | - María Díaz Diñeiro
- Servicio de Cirugía Pediátrica, Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | - Nuria García Soldevila
- Servicio de Cirugía Pediátrica, Hospital Regional Universitario de Málaga, Málaga, Spain
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15
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Leraas HJ, Biswas A, Eze A, Zadey S, Wilson P, Theriot BS, Surana NK, Ssekitoleko R, Mugaga J, Salzman C, Hall A, Wesonga A, Saterbak A, Fitzgerald TN. Low Cost Gastroschisis Silo for Sub-Saharan Africa: Testing in a Porcine Model. World J Surg 2023; 47:545-551. [PMID: 36329222 DOI: 10.1007/s00268-022-06797-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Gastroschisis mortality in sub-Saharan Africa (SSA) remains high at 59-100%. Silo inaccessibility contributes to this disparity. Standard of care (SOC) silos cost $240, while median monthly incomes in SSA are < $200. Our multidisciplinary American and Ugandan team designed and bench-tested a low-cost (LC) silo that costs < $2 and is constructed from locally available materials. Here we describe in vivo LC silo testing. METHODS A piglet gastroschisis model was achieved by eviscerating intestines through a midline incision. Eight piglets were randomized to LC or SOC silos. Bowel was placed into the LC or SOC silo, maintained for 1-h, and reduced. Procedure times for placement, intestinal reduction, and silo removal were recorded. Tissue injury of the abdominal wall and intestine was assessed. Bacterial and fungal growth on silos was also compared. RESULTS There were no gross injuries to abdominal wall or intestine in either group or difference in minor bleeding. Times for silo application, bowel reduction, and silo removal between groups were not statistically or clinically different, indicating similar ease of use. Microbiologic analysis revealed growth on all samples, but density was below the standard peritoneal inoculum of 105 CFU/g for both silos. There was no significant difference in bacterial or fungal growth between LC and SOC silos. CONCLUSION LC silos designed for manufacturing and clinical use in SSA demonstrated similar ease of use, absence of tissue injury, and acceptable microbiology profile, similar to SOC silos. The findings will allow our team to proceed with a pilot study in Uganda.
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Affiliation(s)
- Harold J Leraas
- Department of Surgery, Duke University School of Medicine, DUMC, Box 3815, Durham, NC, 27710, USA.
| | - Arushi Biswas
- Pratt School of Engineering, Duke University, Durham, NC, USA
| | - Anthony Eze
- Department of Surgery, Duke University School of Medicine, DUMC, Box 3815, Durham, NC, 27710, USA
| | - Siddesh Zadey
- Department of Surgery, Duke University School of Medicine, DUMC, Box 3815, Durham, NC, 27710, USA
- Duke Global Health Institute, Durham, NC, USA
| | - Patrick Wilson
- Pratt School of Engineering, Duke University, Durham, NC, USA
| | | | | | | | | | | | - Allison Hall
- Department of Pathology, Duke University, Durham, NC, USA
| | | | - Ann Saterbak
- Pratt School of Engineering, Duke University, Durham, NC, USA
| | - Tamara N Fitzgerald
- Department of Surgery, Duke University School of Medicine, DUMC, Box 3815, Durham, NC, 27710, USA
- Duke Global Health Institute, Durham, NC, USA
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16
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Mowrer AR, DeUgarte DA, Wagner AJ. Abdominal Wall Defects: A Review of Current Practice Guidelines. Clin Perinatol 2022; 49:943-953. [PMID: 36328609 DOI: 10.1016/j.clp.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The 2 most common congenital abdominal wall defects are gastroschisis and omphalocele. Gastroschisis is a defect in the abdominal wall with exposed abdominal contents. Mortality rates are low but lengths of stay are often prolonged by bowel dysmotility and other intestinal abnormalities in complicated cases. Omphalocele is a defect through the umbilical cord with herniated abdominal contents covered by a sac. It is associated with other genetic abnormalities and other anomalies that can lead to significant morbidity and mortality. Prenatal diagnosis in both conditions allows for improved prenatal consultation and coordinated perinatal care to improve clinical outcomes.
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Affiliation(s)
- Alyssa R Mowrer
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Children's Wisconsin, Administration Office, 999 North 92nd Street Suite 320, Milwaukee, WI 53226, USA.
| | - Daniel A DeUgarte
- UCLA Division of Pediatric Surgery, Westwood Clinic Location, 200 UCLA Medical Plaza, Suite 265, Los Angeles, CA 90095, USA
| | - Amy J Wagner
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Children's Wisconsin, Administration Office, 999 North 92nd Street Suite 320, Milwaukee, WI 53226, USA
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17
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Segal RM, Wong A, Zaldana-Flynn M, Englar K, Ewing E, Lance SH, Gosman AA. Tissue Expander-Assisted Component Separation for Pediatric Abdominal Wall Reconstruction. Ann Plast Surg 2022; 88:S320-S324. [PMID: 37740465 DOI: 10.1097/sap.0000000000003138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
BACKGROUND Tissue expander-assisted component separation can be used to increase the amount of skin, muscle, and fascial components available for repair of congenital abdominal wall defects via a staged approach without the need for flap reconstruction. We present the largest case series to date using a tissue expander-assisted component separation technique for treatment of congenital abdominal wall defects in a pediatric patient population. METHODS A retrospective chart review of 9 patients with large congenital abdominal wall defects not initially amenable to primary repair between 2009 and 2020 was performed. Patients first underwent placement of tissue expanders, followed by removal once they had reached a sufficient expander volume. Component separation, with and without mesh placement, was performed to achieve abdominal wall closure. RESULTS The average age of patients at primary repair was 3.2 years (SD ±1.7 years). Eight patients (88.8%) had congenital omphalocele, and 1 patient (11.1%) had gastroschisis; none were amenable to primary repair. The average size of the defects before closure was 87.6 cm2 (SD = 33.6 cm2). Eighteen tissue expanders were placed in 9 patients, 72.2% of which were placed in the plane between the external and internal oblique muscles. Patients were seen in clinic an average of 6.8 times (SD, ±3.3 visits) for volume expansion into the tissue expander, receiving an average of 32.0 mL in each per visit. An average of 4.3 months (SD, ±1.8 months) elapsed between placement and removal of the expanders. At the time of tissue expander removal and abdominal wall closure, the defects ranged from 30 to 132 cm2 (mean, 54 cm2). All defects were successfully repaired using a component separation and bilateral fasciocutaneous flap advancement. Two patients (18.2%) experienced infection of the surgical site and seroma, both of which required debridement. One patient (9.1%) experienced partial thickness skin necrosis that was managed nonsurgically. The overall complication rate was 36.4%. CONCLUSIONS Omphalocele and gastroschisis can produce abdominal wall defects that are not amenable to primary repair. Staged reconstruction using tissue expander-assisted component separation is a safe and effective method of obtaining adequate local soft tissue to achieve primary closure.
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Affiliation(s)
- Rachel Marie Segal
- From the Department of Surgery, UC San Diego School of Medicine, San Diego, CA
| | - Alvin Wong
- Division of Plastic Surgery, Department of Surgery, UC San Diego San Diego, CA
| | | | - Kevin Englar
- Division of Plastic Surgery, Department of Surgery, UC San Diego San Diego, CA
| | - Emily Ewing
- Department of Surgery, Rady Children's Hospital, San Diego, CA
| | - Samuel H Lance
- Division of Plastic Surgery, Department of Surgery, UC San Diego San Diego, CA
| | - Amanda A Gosman
- Division of Plastic Surgery, Department of Surgery, UC San Diego San Diego, CA
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18
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Szydłowska-Pawlak P, Barszczewska O, Sołtysiak I, Librowska B, Kozlowski R, Engleseth P, Marczak M, Kilańska D. Nursing Care Plan for a Newborn with the Defect of Congenital Gastroschisis in the Postoperative Period Using ICNP TM and the Dedicated Software. Int J Environ Res Public Health 2022; 19:ijerph19063498. [PMID: 35329185 PMCID: PMC8952406 DOI: 10.3390/ijerph19063498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/11/2022] [Accepted: 03/12/2022] [Indexed: 12/25/2022]
Abstract
Background: Congenital defect gastroschisis manifests as a defect in the sheath in the intestine of the newborn, which is not covered by the hernia sac. In this case, the priority task of the neonatal nurse is to diagnose patient care problems quickly and accurately. Choosing the correct care plan elements has a significant impact on shortening the duration of hospitalization, reducing the number and severity of complications, and preventing their recurrence. The purpose of this study was to formulate a care plan for a newborn with diagnosed congenital defect gastroschisis in the postoperative period, using the International Classification for Nursing Practice (ICNPTM) within the nursing documentation and decision support system, the “ADPIECare Dorothea” software. Methods: After a review of the relevant literature and nursing documentation, a case study of a newborn with the congenital defect gastroschisis was described. A care plan was prepared using ICNP and the “ADPIECare” software. Results: It was possible to organize and standardize care plans to provide consistent and comprehensive professional nursing care. The system supporting nursing decisions suggested interventions personalized for the nursing diagnoses and to the patient needs. Conclusions: Our findings can help to optimize the nurse’s work organization to improve health care quality, outcomes, and effectiveness.
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Affiliation(s)
- Paulina Szydłowska-Pawlak
- Department of Coordinated Care, Medical University of Lodz, Kościuszki Street 4, 90-131 Lodz, Poland; (P.S.-P.); (I.S.); (B.L.); (D.K.)
| | - Olga Barszczewska
- Department of Management and Logistics in Healthcare, Medical University of Lodz, Lindleya Street 6, 90-131 Lodz, Poland;
- Correspondence:
| | - Izabela Sołtysiak
- Department of Coordinated Care, Medical University of Lodz, Kościuszki Street 4, 90-131 Lodz, Poland; (P.S.-P.); (I.S.); (B.L.); (D.K.)
| | - Barbara Librowska
- Department of Coordinated Care, Medical University of Lodz, Kościuszki Street 4, 90-131 Lodz, Poland; (P.S.-P.); (I.S.); (B.L.); (D.K.)
| | - Remigiusz Kozlowski
- Center of Security Technologies in Logistics, Faculty of Management, University of Lodz, Matejki Street 22/26, 90-237 Lodz, Poland;
| | - Per Engleseth
- Narvik Campus, Tromsø School of Business and Economics, University of Tromsø, 8505 Narvik, Norway;
| | - Michał Marczak
- Department of Management and Logistics in Healthcare, Medical University of Lodz, Lindleya Street 6, 90-131 Lodz, Poland;
| | - Dorota Kilańska
- Department of Coordinated Care, Medical University of Lodz, Kościuszki Street 4, 90-131 Lodz, Poland; (P.S.-P.); (I.S.); (B.L.); (D.K.)
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Abstract
ABSTRACT Infants born with congenital gastroschisis are at risk for intrauterine growth restriction, small for gestational size at birth, and growth failure during the newborn period despite advanced care. Body composition provides a more complete picture of proportional growth than weight and length alone. Fat-free mass (FFM) represents organ growth, and in preterm infants without gastroschisis, improved FFM deposition is associated with improved neurodevelopmental outcomes. There is limited literature regarding the body composition of infants with gastroschisis. This case series describes the body composition of 10 infants with gastroschisis.
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Affiliation(s)
- Kera McNelis
- Division of Neonatology, Cincinnati Children's Hospital Medical Center
- College of Medicine, University of Cincinnati
| | | | - Gillian Goddard
- Division of Pediatric and General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Surgery, Boston Medical Center, Boston, MA
| | - Stefanie Riddle
- Division of Neonatology, Cincinnati Children's Hospital Medical Center
- College of Medicine, University of Cincinnati
| | - Jacqueline Wessel
- Division of Pediatric and General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Michael Helmrath
- College of Medicine, University of Cincinnati
- Division of Pediatric and General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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20
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Redondo Pertuz EJ, González Rührnschopf C, D'Alessandro P, Boglione M, Reusmann A, Barrenechea M. Gastroschisis: deferred closure with releasing incisions. A case report. Cir Pediatr 2022; 35:42-45. [PMID: 35037440 DOI: 10.54847/cp.2022.01.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Primary defect closure is the surgical treatment of choice in gastroschisis. When this is not feasible, a silo is required to progressively reduce the organs and perform a deferred closure of the wall. We present the case of a newborn with gastroschisis that required the use of a silo. Once the silo had been created, the distance between borders did not allow the defect to be closed, so decision was made to conduct releasing aponeurotic incisions for mobilization purposes.Progression was uneventful, and enteral nutrition was initiated at 24 days of life. Total enteral total nutrition was achieved at 40 days of life. He received parenteral nutrition for 36 days. He was discharged at 59 days of life. Abdominal wall treatment through releasing incisions allows prostheses to be avoided and represents an alternative for these patients.
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Affiliation(s)
- E J Redondo Pertuz
- Prof. Dr. Juan P. Garrahan. S.A.M.I.C. Pediatric Hospital. Buenos Aires (Argentina)
| | | | - P D'Alessandro
- Prof. Dr. Juan P. Garrahan. S.A.M.I.C. Pediatric Hospital. Buenos Aires (Argentina)
| | - M Boglione
- Prof. Dr. Juan P. Garrahan. S.A.M.I.C. Pediatric Hospital. Buenos Aires (Argentina)
| | - A Reusmann
- Prof. Dr. Juan P. Garrahan. S.A.M.I.C. Pediatric Hospital. Buenos Aires (Argentina)
| | - M Barrenechea
- Prof. Dr. Juan P. Garrahan. S.A.M.I.C. Pediatric Hospital. Buenos Aires (Argentina)
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21
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Joyeux L, Belfort MA, De Coppi P, Basurto D, Valenzuela I, King A, De Catte L, Shamshirsaz AA, Deprest J, Keswani SG. Complex gastroschisis: a new indication for fetal surgery? Ultrasound Obstet Gynecol 2021; 58:804-812. [PMID: 34468062 DOI: 10.1002/uog.24759] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/16/2021] [Accepted: 08/19/2021] [Indexed: 06/13/2023]
Abstract
Gastroschisis (GS) is a congenital abdominal wall defect, in which the bowel eviscerates from the abdominal cavity. It is a non-lethal isolated anomaly and its pathogenesis is hypothesized to occur as a result of two hits: primary rupture of the 'physiological' umbilical hernia (congenital anomaly) followed by progressive damage of the eviscerated bowel (secondary injury). The second hit is thought to be caused by a combination of mesenteric ischemia from constriction in the abdominal wall defect and prolonged amniotic fluid exposure with resultant inflammatory damage, which eventually leads to bowel dysfunction and complications. GS can be classified as either simple or complex, with the latter being complicated by a combination of intestinal atresia, stenosis, perforation, volvulus and/or necrosis. Complex GS requires multiple neonatal surgeries and is associated with significantly greater postnatal morbidity and mortality than is simple GS. The intrauterine reduction of the eviscerated bowel before irreversible damage occurs and subsequent defect closure may diminish or potentially prevent the bowel damage and other fetal and neonatal complications associated with this condition. Serial prenatal amnioexchange has been studied in cases with GS as a potential intervention but never adopted because of its unproven benefit in terms of survival and bowel and lung function. We believe that recent advances in prenatal diagnosis and fetoscopic surgery justify reconsideration of the antenatal management of complex GS under the rubric of the criteria for fetal surgery established by the International Fetal Medicine and Surgery Society (IFMSS). Herein, we discuss how conditions for fetoscopic repair of complex GS might be favorable according to the IFMSS criteria, including an established natural history, an accurate prenatal diagnosis, absence of fully effective perinatal treatment due to prolonged need for neonatal intensive care, experimental evidence for fetoscopic repair and maternal and fetal safety of fetoscopy in expert fetal centers. Finally, we propose a research agenda that will help overcome barriers to progress and provide a pathway toward clinical implementation. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- L Joyeux
- MyFetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, Division Woman and Child, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
- Department of Pediatric Surgery, Queen Fabiola Children's University Hospital, Brussels, Belgium
- Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - M A Belfort
- Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- Department of Obstetrics and Gynecology, Division Maternal-Fetal Medicine, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- Texas Children's Fetal Center, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - P De Coppi
- MyFetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, Division Woman and Child, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
- Specialist Neonatal and Paediatric Surgery Unit and NIHR Biomedical Research Center, Great Ormond Street Hospital, and Great Ormond Street Institute of Child Health, University College London, London, UK
| | - D Basurto
- MyFetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, Division Woman and Child, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
| | - I Valenzuela
- MyFetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - A King
- Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- Texas Children's Fetal Center, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- Department of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - L De Catte
- Department of Obstetrics and Gynecology, Division Woman and Child, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
| | - A A Shamshirsaz
- Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- Department of Obstetrics and Gynecology, Division Maternal-Fetal Medicine, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- Texas Children's Fetal Center, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - J Deprest
- MyFetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, Division Woman and Child, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
- Institute of Women's Health, University College London Hospitals, London, UK
| | - S G Keswani
- Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- Texas Children's Fetal Center, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- Department of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
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22
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Sivaraj J, Boam T, Gozzini S. Gastroschisis or exomphalos? An unusual abdominal defect. BMJ Case Rep 2021; 14:e242904. [PMID: 34497054 PMCID: PMC8438738 DOI: 10.1136/bcr-2021-242904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2021] [Indexed: 11/04/2022] Open
Abstract
A baby with an antenatal diagnosis of exomphalos was born at term. The abnormality had a highly unusual appearance, a right-sided paraumbilical defect, similar to gastroschisis, but with a sac typical of exomphalos containing both abdominal contents and over 1 L of serosanguinous fluid. The sac was drained and suspended from the top of the incubator in silo fashion. Definitive closure was achieved at day 3 of life, and the patient had a non-eventful recovery. Despite exomphalos and gastroschisis normally being discrete entities, ambiguity in the presentation this case necessitated a composite management approach.
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Affiliation(s)
- Jayaram Sivaraj
- Department of General Surgery, North Middlesex University Hospital NHS Trust, London, UK
- Department of Paediatric Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Tristan Boam
- Department of Paediatric Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Department of Paediatric Surgery, Leicester Royal Infirmary, Leicester, UK
| | - Sara Gozzini
- Department of Paediatric Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Department of Paediatric Surgery, King's College Hospital, London, UK
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Thanh Tri T, Minh Duc N, Phi Duy H, Thanh Thien N, Nguyen An Thuan L, Tan Lien Bang M. A case series describing vacuum-assisted closure for complex congenital abdominal wall defects. Clin Ter 2021; 172:273-277. [PMID: 34247210 DOI: 10.7417/ct.2021.2331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
ABSTRACT Giant omphalocele and large gastroschisis remain challenging issues faced by pediatric surgeons and neonatal intensivists. In this report, we presented 3 neonatal cases with complex congenital abdo-minal wall defects that were successfully treated with vacuum-assisted closure (VAC). Case 1 had a ruptured giant omphalocele and was treated with VAC for 24 days. She was successfully discharged at 78 days old. Case 2 had large gastroschisis that was unretractable using silo reduction. She was treated with VAC for 19 days and was succes-sfully discharged at 69 days old. Case 3 had large gastroschisis, and his defect had been closed using Gore-tex after silo reduction. VAC was applied for 14 days, and the baby was discharged at 67 days old. The VAC system can be effectively used to assist with visceral reduction, promote granulation tissue development, and skin epithelialization. This method represents a life-saving treatment for neonates with giant omphalocele and large gastroschisis.
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Affiliation(s)
- T Thanh Tri
- Department of General surgery, Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - N Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam
- Department of Radiology, Children's Hospital 2, Ho Chi Minh City, Viet Nam
| | - H Phi Duy
- Department of General surgery, Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - N Thanh Thien
- Department of Neonatal Intensive Care, Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - L Nguyen An Thuan
- Department of General surgery, Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - M Tan Lien Bang
- Department of Radiology, Children's Hospital 2, Ho Chi Minh City, Viet Nam
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Lemoine C, Larkin K, Brennan K, Zoller-Thompson C, Cohran V, Superina R. Repeat serial transverse enteroplasty procedure (reSTEP): Is it worth it? J Pediatr Surg 2021; 56:951-960. [PMID: 33455806 DOI: 10.1016/j.jpedsurg.2020.12.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 12/10/2020] [Accepted: 12/24/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The utility of repeat serial transverse enteroplasty (reSTEP) has been questioned after patients failed to achieve enteral autonomy. We compared the outcomes after reSTEP to one lifetime STEP (oneSTEP), and tried to identify patients at risk for reSTEP failure. METHODS All STEPs done at our institution were reviewed. Growth, enteral autonomy, bowel-derived bloodstream infection hospital admissions, complications, and need for bowel transplantation were evaluated (p<0.05 considered significant). RESULTS 24 patients underwent 32 STEP (16 oneSTEP, 8 reSTEP). reSTEP patients were younger at first surgery (1.01±1.05 vs. oneSTEP 3.06±4.73 years, p = 0.24). Median time to reSTEP was 1.1 year (0.6-5.7). Weight-for-length z-scores improved after reSTEP (0.02±1.40 to 0.22±1.42, p = 0.81). Bowel-derived bloodstream infections decreased after surgery (oneSTEP 1.50±2.25 to 0.94±1.73, p = 0.50; reSTEP 1.88±2.10 to 1.66±2.32, p = 0.52). 37.5% (9/24) patients achieved enteral autonomy at last follow-up: 7/16 oneSTEP, 2/8 reSTEP (p = 0.37). Two complications occurred after oneSTEP (staple line ulcer, leak), none following reSTEP. Three patients (oneSTEP 1/16, reSTEP 2/8, p = 0.19) underwent bowel transplantation (all gastroschisis). CONCLUSION Similar postoperative outcomes after reSTEP and single STEP (improved enteral tolerance, reduced rates of infections) support the use of reSTEP when clinically indicated, although reSTEP in young infants with a history of gastroschisis may need further evaluation.
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Affiliation(s)
- Caroline Lemoine
- Division of Transplant and Advanced Hepatobiliary Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kevin Larkin
- Division of Transplant and Advanced Hepatobiliary Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Katherine Brennan
- Division of Gastroenterology, Hepatology, and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Carmyn Zoller-Thompson
- Division of Gastroenterology, Hepatology, and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Valeria Cohran
- Division of Gastroenterology, Hepatology, and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Riccardo Superina
- Division of Transplant and Advanced Hepatobiliary Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Gordon ES, Wagner LA, Kennedy JM. Challenge of diagnosing splenic torsion in a paediatric patient with gastroschisis. BMJ Case Rep 2021; 14:14/4/e239520. [PMID: 33883109 PMCID: PMC8061818 DOI: 10.1136/bcr-2020-239520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Gastroschisis is an uncommon congenital defect of the abdominal wall resulting in intestinal prolapse, most commonly associated with short gut syndrome or bowel obstruction. Wandering spleen, movement of the spleen due to the underdevelopment of splenic ligaments, has a prevalence of 0.25% and is asymptomatic in 15% of paediatric cases. An 11-year-old patient, admitted with a history of gastroschisis repaired at birth, presents with 18 months of intermittent, worsening abdominal pain. Imaging demonstrated splenomegaly and tortuosity of the splenic vein with abnormal positioning of the superior mesenteric artery and vein. The patient was found to have a wandering spleen with subacute splenic infarct secondary to splenic torsion, necessitating emergent surgical intervention. This patient experienced an extremely rare complication of gastroschisis that has not previously been reported. This complication is caused by a lack of appropriate abdominal fixation points for the spleen.
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Affiliation(s)
- Elliott S Gordon
- Department of Pediatrics, Mercer University School of Medicine, Macon, Georgia, USA
- Department of Pediatrics, Atrium Health Navicent Beverly Knight Olson Children's Hospital, Macon, Georgia, USA
| | - Lauren A Wagner
- Department of Pediatrics, Mercer University School of Medicine, Macon, Georgia, USA
- Department of Pediatrics, Atrium Health Navicent Beverly Knight Olson Children's Hospital, Macon, Georgia, USA
| | - Joanne M Kennedy
- Department of Pediatrics, Mercer University School of Medicine, Macon, Georgia, USA
- Department of Pediatrics, Atrium Health Navicent Beverly Knight Olson Children's Hospital, Macon, Georgia, USA
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Elhosny A, Banieghbal B. Simplified preformed silo bag crafted from standard equipment in African Hospitals. Afr J Paediatr Surg 2021; 18:123-126. [PMID: 33642416 PMCID: PMC8232359 DOI: 10.4103/ajps.ajps_62_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/03/2020] [Accepted: 08/20/2020] [Indexed: 11/30/2022] Open
Abstract
Silo bags are synthetic, flexible silicone bags used to cover and protect the bowel of neonates born with gastroschisis. They are transparent, which enables clinicians to visualise bowel colour and allows for gentle reduction until closure. Silo bags are expensive, and different sizes are needed depending on the gastroschisis size. Currently, tertiary hospitals in low-income countries experience great difficulty in purchasing these bags. Therefore, in this article, we present a method for creating a preformed silo bag by utilising readily available disposable equipment in secondary or tertiary hospitals. The disposable equipment required includes a 200- or 500-ml saline or blood bag, 16- or 18-Fr silicone/latex Foley catheter, Opsite® and 2-0 silk suture. The saline bag is cut and opened transversely. The Foley catheter is cut corresponding to the diameter of the saline bag opening, and both ends of the catheter piece are connected to each other to create a 'circle', which is used as the base for the opening. The edge of the saline bag is turned inside out around the catheter and then securely closed with a continuous suture, which fixes the folded part of the bag to the catheter. These silo bags are cheap and easily and quickly prepared at any centre in Africa and very similar to manufactured silo bags, which are comparatively costly and difficult to procure in limited-resource environments.
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Affiliation(s)
- Ayman Elhosny
- Department of Paediatric Surgery, Tygerberg Children's Hospital, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Behrouz Banieghbal
- Department of Paediatric Surgery, Tygerberg Children's Hospital, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Martins BMR, Abreu I, Méio MDB, Moreira MEL. Gastroschisis in the neonatal period: A prospective case-series in a Brazilian referral center. J Pediatr Surg 2020; 55:1546-1551. [PMID: 32467036 DOI: 10.1016/j.jpedsurg.2020.04.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 04/19/2020] [Accepted: 04/20/2020] [Indexed: 12/28/2022]
Abstract
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.
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Affiliation(s)
- Bianca M R Martins
- Department of Surgery, Surgical NICU, Instituto Fernandes Figueira - Fundação Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil.
| | - Isabel Abreu
- Department of Surgery, Surgical NICU, Instituto Fernandes Figueira - Fundação Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil
| | - Maria Dalva B Méio
- Clinical Research Unit, Instituto Fernandes Figueira - Fundação Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil
| | - Maria Elisabeth L Moreira
- Clinical Research Unit, Instituto Fernandes Figueira - Fundação Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil
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Affiliation(s)
- Charlene Dekonenko
- Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, USA
| | - Jason D Fraser
- Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, USA; University of Missouri Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO 64108, USA.
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Abstract
PURPOSE Neonatal surgery for abdominal wall defects is not performed in a centralized manner in Germany. The aim of this study was to investigate whether treatment for abdominal wall defects in Germany is equally effective compared to international results despite the decentralized care. METHODS All newborn patients who were clients of the major statutory health insurance company in Germany between 2009 and 2013 and who had a diagnosis of gastroschisis or omphalocele were included. Mortality during the first year of life was analysed. RESULTS The 316 patients with gastroschisis were classified as simple (82%) or complex (18%) cases. The main associated anomalies in the 197 patients with omphalocele were trisomy 18/21 (8%), cardiac anomalies (32%) and anomalies of the urinary tract (10%). Overall mortality was 4% for gastroschisis and 16% for omphalocele. Significant factors for non-survival were birth weight below 1500 g for both groups, complex gastroschisis, volvulus and anomalies of the blood supply to the intestine in gastroschisis, and female gender, trisomy 18/21 and lung hypoplasia in omphalocele. CONCLUSIONS Despite the fact that paediatric surgical care is organized in a decentralized manner in Germany, the mortality rates for gastroschisis and omphalocele are equal to those reported in international data.
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Affiliation(s)
- Andrea Schmedding
- Department of Pediatric Surgery and Pediatric Urology, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
| | - Boris Wittekind
- Department of Neonatology, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Emilia Salzmann-Manrique
- Department of Pediatric Stem Cell Transplantation, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Rolf Schloesser
- Department of Neonatology, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Udo Rolle
- Department of Pediatric Surgery and Pediatric Urology, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
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Chalphin AV, Tracy SA, Kycia I, Chan C, Finkelstein A, Zurakowski D, Fauza DO. Donor mesenchymal stem cell kinetics after transamniotic stem cell therapy (TRASCET) in a rodent model of gastroschisis. J Pediatr Surg 2020; 55:482-485. [PMID: 31813581 DOI: 10.1016/j.jpedsurg.2019.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 11/06/2019] [Accepted: 11/14/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE We sought to comprehensively scrutinize donor mesenchymal stem cell kinetics following transamniotic stem cell therapy (TRASCET) in experimental gastroschisis. METHODS A gastroschisis was surgically created in 102 rat fetuses at gestation day 18 (term = 22 days), immediately followed by volume-matched amniotic injections of either amniotic fluid mesenchymal stem cells (afMSCs) labeled with a luciferase reporter gene (n = 58), or luciferase protein alone (n = 44). Samples from multiple anatomical sites from survivors were screened for luciferase activity via microplate luminometry at term. Statistical analysis included Mann-Whitney U-test, Wald test, and kappa coefficient (p < 0.05). RESULTS Overall survival was 42% (43/102), with no significant difference between the two groups (p = 0.82). When controlled by acellular luciferase, donor afMSCs were identified selectively in the placenta (p < 0.001) and bowel (p = 0.005), independently of the dams (respectively, p < 0.001 and p = 0.041). Bowel homing was documented exclusively in areas exposed to the amniotic cavity. There was no mutual correlation between placental and bowel homing (kappa = -0.02; p = 0.91). CONCLUSIONS Amniotic mesenchymal stem cells home to specific sites after TRASCET in the setting of gastroschisis. Placental homing and intestinal homing are central yet seemingly independent constituents of cell trafficking, suggesting that both direct amniotic seeding and hematogenous routing take place. LEVEL OF EVIDENCE N/A (animal and laboratory study).
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Affiliation(s)
- Alexander V Chalphin
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Sarah A Tracy
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Ina Kycia
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Christopher Chan
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Adam Finkelstein
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - David Zurakowski
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Dario O Fauza
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA.
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Mc Donald I, Doyle M, Murphy J. Gastroschisis: What can the Neonate and Parents Expect? Ir Med J 2019; 112:905. [PMID: 31124629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- I Mc Donald
- Department of Neonatology Temple St. Children’s University Hospital, Temple Street, Dublin 1
| | - M Doyle
- Department of Surgery Temple St. Children’s University Hospital, Dublin 1
| | - J Murphy
- Department of Neonatology Temple St. Children’s University Hospital, Temple Street, Dublin 1
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Abstract
Nutrition for the infant with gastroschisis is a complex topic and there is not a lot of uniformity in the literature to formulate evidence-based care. This article discusses more recent findings in the literature as we search for an effective method of feeding these infants. Issues with growth and development, illustrating the variety of outcomes, are also addressed.
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Abstract
BACKGROUND Gastroschisis is the most common congenital abdominal wall defect. Due to the exposure of midgut to amniotic fluid, the recovery of bowel function is often delayed. This study aimed to identify the factors associated with the successful early enteral feeding in gastroschisis and to develop further guidelines of treatment. METHODS A retrospective cohort study of gastroschisis babies from January 2006 to December 2015 was done. Exclusion criteria were incomplete data and death. Successful early enteral feeding was defined when full feeding was achieved within 21 days of life. RESULTS One hundred and five gastroschisis patients were divided into a successful early-feeding group (n = 56, 53%) and a non-successful early-feeding group (n = 49, 46%). In multivariable analysis, significant factors for successful feeding clustered by primary treatment were female (RR = 1.38, P value < 0.001), gestational age > 36 weeks (RR = 1.23, P value < 0.001), age at surgery less than 10 h (RR = 1.15, P value < 0.001), postoperative extubation time < 4 days (RR = 1.39, P value < 0.001), and age when feeding started less than 10 days (RR = 35.69, P value < 0.001). CONCLUSION Several factors were found to be associated with successful early enteral feeding. The modifiable factors found in this study were surgery within 10 h, early postoperative extubation within 4 days, and feeding started before 10 days of life. These will guide the management of gastroschisis to achieve successful early enteral feeding.
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Affiliation(s)
- Theerayuth Pratheeppanyapat
- Division of Pediatric Surgery, Department of Surgery, Chiang Mai University Hospital, 110 Intavaroros Road, Muang Chiang Mai District, Chiang Mai, 50200, Thailand
| | - Kanokkan Tepmalai
- Division of Pediatric Surgery, Department of Surgery, Chiang Mai University Hospital, 110 Intavaroros Road, Muang Chiang Mai District, Chiang Mai, 50200, Thailand
| | - Jesda Singhavejsakul
- Division of Pediatric Surgery, Department of Surgery, Chiang Mai University Hospital, 110 Intavaroros Road, Muang Chiang Mai District, Chiang Mai, 50200, Thailand
| | - Jiraporn Khorana
- Division of Pediatric Surgery, Department of Surgery, Chiang Mai University Hospital, 110 Intavaroros Road, Muang Chiang Mai District, Chiang Mai, 50200, Thailand.
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Sigalet DL, Lam V, Brindle M, Boctor D, Wallace L, de Heuval E, Hartmann B, Holst JJ. The glucagon like peptide-2 'axis': Capacity for production and response following intestinal resection or repair of gastroschisis in infants. J Pediatr Surg 2018. [PMID: 29523359 DOI: 10.1016/j.jpedsurg.2018.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE This study investigates the relationship between the enteric hormone glucagon-like peptide 2 (GLP-2) production, sensitivity, and intestinal adaptation in infants following resection or repair of gastroschisis. METHODS With IRB approval (UCalgary #10656), consent was obtained from families of infants undergoing surgery for prospective monitoring of nutritional status, GLP-2 levels, and where possible, tissue sampling. RESULTS Infants who adapted and weaned from parenteral nutrition (PN) had increased GLP-2 (86±32) n=24 vs. controls: 45±20 n=10 and vs. patients on prolonged PN: 42±6 pM, n=10). This was maintained to one year: weaned patients: 72±49 vs. non-weaned: 35±15 pM (p<0.05). Infants with gastroschisis (n=33) had decreased GLP-2 levels until enteral function was achieved and then became elevated: (21±15 with first feeding vs. 102±60 at full feeds and 60±19 pM at one year). There were no changes in the density or distribution of GLP-2 producing L-cells related to gestational age, nor in the expression of the GLP-2 receptor. CONCLUSION GLP-2 levels correlate with intestinal adaptation in infants, and with recovery of intestinal function in gastroschisis. GLP-2 productive capacity (L-cell expression) and GLP-2 receptor expression do not vary with maturity. The findings support a role for GLP-2 in regulating intestinal function. Further study is suggested.
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Affiliation(s)
- David L Sigalet
- Department of Pediatric Surgery, Sidra Medical and Research Center, Doha, Qatar; Children's Hospital Intestinal Rehabilitation Program, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada.
| | - Viona Lam
- Children's Hospital Intestinal Rehabilitation Program, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Mary Brindle
- Children's Hospital Intestinal Rehabilitation Program, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Dana Boctor
- Children's Hospital Intestinal Rehabilitation Program, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Laurie Wallace
- Department of Pediatric Surgery, Sidra Medical and Research Center, Doha, Qatar; Children's Hospital Intestinal Rehabilitation Program, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Elaine de Heuval
- Department of Pediatric Surgery, Sidra Medical and Research Center, Doha, Qatar; Children's Hospital Intestinal Rehabilitation Program, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Bollette Hartmann
- NNF Center for Basic Metabolic Research, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens J Holst
- NNF Center for Basic Metabolic Research, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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Chakhunashvili DG, Lomidze N, Karalashvili L, Kikalishvili L, Chakhunashvili K, Kakabadze Z. CHALLENGES AND MANAGEMENT OF CONGENITAL ABDOMINAL WALL DEFECTS (REVIEW). Georgian Med News 2018:24-33. [PMID: 29697377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Management of congenital abdominal wall malformations is still a challenge in paediatric surgery due to visceroabdominal disproportion, large defects of abdominal wall and immature abdominal cavity. Most of the patients treated with primary closure need artificial substitutes like patches or biomaterials for non-permanent abdominal wall closure. Patches represent the source of constant infections and complications like separation of prosthesis from fascia. Removal of these patches and ventral hernia repair is essential afterwards. As for component separation technique, this method helps to restore normal anatomy of anterior abdominal wall, results in good cosmetic appearance, requires only one-stage operation procedure, minimal skin flap advancement and is associated with lower infection risk. Although, while performing component separation technique, perforator branches of epigastric artery (periumbilical perforators) are damaged and puts the vascularization of the skin at the risk. Only pudendal artery branches and intercostal arteries are left to supply the skin with the blood, which from our point of view is insufficient. Accordingly, for successful treatment of congenital abdominal wall defects, further research in order to develop new operation techniques, as well as search for the ideal biomaterials for the closure of the large defects of anterior abdominal wall is essential. These biomaterials should possess unique biological properties that are important for tissue repair, including anti-inflammatory, antimicrobial, antifibrosis, antiscarring, as well as a reasonable cost and low immunogenicity.
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Affiliation(s)
| | - N Lomidze
- Tbilisi State Medical University, Georgia
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de Oliveira GH, Svetliza J, Vaz-Oliani DCM, Liedtke H, Oliani AH, Pedreira DAL. Novel multidisciplinary approach to monitor and treat fetuses with gastroschisis using the Svetliza Reducibility Index and the EXIT-like procedure. Einstein (Sao Paulo) 2017; 15:395-402. [PMID: 29364360 PMCID: PMC5875150 DOI: 10.1590/s1679-45082017ao3979] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 08/15/2017] [Indexed: 11/21/2022] Open
Abstract
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.
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Affiliation(s)
| | - Javier Svetliza
- Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | | | - Humberto Liedtke
- Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | - Antonio Helio Oliani
- Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
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Villamil V, Aranda García MJ, Sánchez Morote JM, Ruiz Pruneda R, Fernández Ibieta M, Sánchez Sánchez A, Martínez Castaño I, Rojas-Ticona J, Giménez Aleixandre MC, Ruiz Jiménez JI. [Management protocol in gastroschisis]. Cir Pediatr 2017; 30:39-45. [PMID: 28585789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
AIM There are two classical managements in gastroschisis: primary or delayed closure. From 2007 on, a multidisciplinary approach protocol based in preterm caesarean delivery at 34-35th gestational age (in order to minimize peel injury) plus primary closure is followed in our institution. Prior to this, term delivery, either by caesarean section or not, was the rule. METHODS Retrospective study of gastroschisis's patients before (1978-2006) and after (2007-2016) protocol approval. Complex gastroschisis frequency, peel's presence, primary or delayed closure, complications, re-interventions, neonatal intensive care unit (NICU) length of stay, age at onset of enteral nutrition, total parenteral nutrition's length and length of stay were compared. MAIN RESULTS Study groups: before (12 patients) and after (13 newborns) the protocol implantation (pre/post). Nine complex gastroschisis were observed in the pre-protocol period, compared to one in the post-protocol era (p= 0.001). The re-interventions also decreased: 58.33% in the pre-protocol vs. 15.38% in the post-protocol group (p= 0.025). Complications rate were 66.67% before protocol vs. 23.07% after protocol (p= 0.028). NICU length of stay decreased from 40 ± 32 to 17 ± 12 days (p= 0.025). Parenteral total nutrition length was 61 ± 36 in the pre-protocol vs. 15 ± 6 in the port-protocol eras, respectively (p= 0.043). The age at onset of enteral nutrition was 34 ± 26 vs. 9 ± 5 days (p= 0.004) and hospitalization length was 98 ± 81 days pre vs. 35 ± 15 days post protocol implantation (p= 0.011). CONCLUSIONS The protocol implantation has allowed primary closure, decreased hospitalization; reduced complications and mortality rate as well.
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Affiliation(s)
- V Villamil
- Servicio de Cirugía Pediátrica. Hospital Clínico Universitario Virgen de la Arrixaca. Murcia
| | - M J Aranda García
- Servicio de Cirugía Pediátrica. Hospital Clínico Universitario Virgen de la Arrixaca. Murcia
| | - J M Sánchez Morote
- Servicio de Cirugía Pediátrica. Hospital Clínico Universitario Virgen de la Arrixaca. Murcia
| | - R Ruiz Pruneda
- Servicio de Cirugía Pediátrica. Hospital Clínico Universitario Virgen de la Arrixaca. Murcia
| | - M Fernández Ibieta
- Servicio de Cirugía Pediátrica. Hospital Clínico Universitario Virgen de la Arrixaca. Murcia
| | - A Sánchez Sánchez
- Servicio de Cirugía Pediátrica. Hospital Clínico Universitario Virgen de la Arrixaca. Murcia
| | - I Martínez Castaño
- Servicio de Cirugía Pediátrica. Hospital Clínico Universitario Virgen de la Arrixaca. Murcia
| | - J Rojas-Ticona
- Servicio de Cirugía Pediátrica. Hospital Clínico Universitario Virgen de la Arrixaca. Murcia
| | - M C Giménez Aleixandre
- Servicio de Cirugía Pediátrica. Hospital Clínico Universitario Virgen de la Arrixaca. Murcia
| | - J I Ruiz Jiménez
- Servicio de Cirugía Pediátrica. Hospital Clínico Universitario Virgen de la Arrixaca. Murcia
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Lalani A, Benson Ham P, Wise LJ, Daniel JM, Walters KC, Pipkin WL, Stansfield B, Hatley RM, Bhatia J. Management of Patients with Gastroschisis Requiring Extracorporeal Membrane Oxygenation for Concurrent Respiratory Failure. Am Surg 2016; 82:768-772. [PMID: 27670556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Treatment of gastroschisis often requires multiple surgical procedures to re-establish abdominal domain, reduce abdominal contents, and eventually close the abdominal wall. In patients who have concomitant respiratory failure requiring extracorporeal membrane oxygenation (ECMO), this process becomes further complicated. This situation is rare and only five such cases have been reported in the ECMO registry database. Management of three of the five patients along with results and implications for future care of similar patients is discussed here. Two patients had respiratory failure due to meconium aspiration syndrome and one patient had persistent acidosis as well as worsening pulmonary hypertension leading to the decision of ECMO. The abdominal contents were placed in a spring-loaded silastic silo while on ECMO and primary closure was performed three to six days after the decannulation. All three patients survived and are developmentally appropriate. We recommend avoiding aggressively reducing the abdominal contents and using a silo to conservatively reducing the gastroschisis while the patient is on ECMO therapy. Keeping the intra-abdominal pressure below 20 mm Hg can possibly reduce ECMO days and ventilator time and has been shown to decrease morbidity and mortality. Patients with gastroschisis and respiratory failure requiring ECMO can have good outcomes despite the complexity of required care.
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Affiliation(s)
- Alykhan Lalani
- Medical College of Georgia, Georgia Regents University, Augusta, Georgia, USA
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Allin B, Ross A, Marven S, J Hall N, Knight M. Development of a core outcome set for use in determining the overall success of gastroschisis treatment. Trials 2016; 17:360. [PMID: 27465672 PMCID: PMC4964000 DOI: 10.1186/s13063-016-1453-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 06/01/2016] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Gastroschisis research is limited in quality by the presence of significant heterogeneity in outcome measure reporting (PloS One 10(1):e0116908, 2015). Using core outcome sets in research is one proposed method for addressing this problem (Trials 13:103, 2012; Clin Rheumatol 33(9):1313-1322, 2014; Health Serv Res Policy 17(1):1-2, 2012). Ultimately, standardising outcome measure reporting will improve research quality and translate into improvements in patient care. METHODS/DESIGN Candidate outcome measures have been identified through systematic reviews. These outcome measures will form the starting point for an online, three-phase Delphi process that will be carried out in parallel by three panels of experts. Panel 1 is a neonatal panel, panel 2 is a non-neonatal panel and panel 3 is a lay panel. In round 1, experts will be asked to score the previously identified outcome measures from 1-9 based on how important they think the measures are in determining the overall success of their/their child's/their patient's gastroschisis treatment. In round 2, experts will be presented with the same list of outcome measures and with graphical representations of how their panel scored that outcome in round 1. They will be asked to re-score the outcome measure taking into account how important other members of their panel felt it to be. In round 3, experts will again be asked to re-score each outcome measure, but this time they will receive a graphical representation of the distribution of scores from all three panels which they should take into account when re-scoring. Following round 3 of the Delphi process, 40 experts will be invited to attend a face-to-face consensus meeting. Participants will be invited in a purposive manner to obtain balance between the different panels. The results of the Delphi process will be discussed, and outcomes re-scored. Outcome measures where > 70 % of the participants at the meeting scored them as 7-9 and < 15 % scored them as 1-3 will form the core outcome set. DISCUSSION Development of a core outcome set will help to reduce the heterogeneity of the outcome measure reporting in gastroschisis. This will increase the quality of research taking place and ultimately improve care provided to infants with gastroschisis.
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Affiliation(s)
- Benjamin Allin
- National Perinatal Epidemiology Unit, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, England.
- Oxford University Hospitals NHS Trust, Headley Way, Headington, Oxford, OX3 9DU, England.
| | - Andrew Ross
- Oxford University Hospitals NHS Trust, Headley Way, Headington, Oxford, OX3 9DU, England
| | - Sean Marven
- Sheffield Children's Hospital, Western Bank, Sheffield, S10 2TH, England
| | - Nigel J Hall
- Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, England
| | - Marian Knight
- National Perinatal Epidemiology Unit, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, England
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Dore Reyes M, Triana Junco P, Barrena Delfa S, Encinas JL, Romo Muñoz M, Vilanova Sánchez A, Chocarro Amatriain G, Hernández Oliveros F, Martínez Martínez L, López-Santamaría M. [Primary versus secondary closure: ventilatory and nutritional differences in patients with gastrosquisis]. Cir Pediatr 2016; 29:49-53. [PMID: 28139102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
AIM OF THE STUDY Optimal surgical treatment of patients with gastroschisis remains controversial. Recent studies suggest better outcomes with secondary closure techniques (surgical or preformed silo). The purpose of the study is to identify differences in outcome of infants treated with traditional primary closure (PC) versus surgical silo (SS). PATIENTS AND METHODS Retrospective study of patients primarily treated of gastroschisis between 2004 and 2014. Patients were divided in PC and SS according to abdominal wall closure. Non-parametric statistical analysis was used with p< 0.05 regarded as significant. RESULTS Twenty-seven patients were included (14M/13F). Primary closure was performed on 17 and 10 underwent surgical silo placement with a median of 6 (5-26) days till secondary closure. Prenatal diagnosis was available in most patients (74%) by the 20th week of gestation. There were no significant differences regarding sex, gestational age or birthweight between groups. Fewer ventilation days were required in PC group compared to SS (4 vs 13, p< 0,05), however, there was no difference in type of ventilation or oxygen needs. Sedation and parenteral nutrition requirements were also lower in PC patients 4 vs 10 and 12 vs 20 days respectively (p< 0,05). Post-operative complications (5vs6) and median length of stay (36vs43 days) were also similar in PC and SS patients. One patient ultimately died due to catheter-related sepsis. Mean length of stay in hospital was 42 days (20-195). CONCLUSION Patients with gastroschisis who underwent primary closure showed shorter ventilator support and PN dependency than those treated with surgical silo. However, SS is as safe and effective technique as PC and led to similar outcome regarding digestive autonomy and hospital length of stay.
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Affiliation(s)
- M Dore Reyes
- Departamento de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | - P Triana Junco
- Departamento de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | - S Barrena Delfa
- Departamento de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | - J L Encinas
- Departamento de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | - M Romo Muñoz
- Departamento de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | - A Vilanova Sánchez
- Departamento de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | | | | | | | - M López-Santamaría
- Departamento de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
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Gulack BC, Laughon MM, Clark RH, Burgess T, Robinson S, Muhammad A, Zhang A, Davis A, Morton R, Chu VH, Arnold CJ, Hornik CP, Smith PB. Enteral Feeding with Human Milk Decreases Time to Discharge in Infants following Gastroschisis Repair. J Pediatr 2016; 170:85-9. [PMID: 26703875 PMCID: PMC4769929 DOI: 10.1016/j.jpeds.2015.11.046] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 10/26/2015] [Accepted: 11/16/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess the effect of enteral feeding with human milk on the time from initiation of feeds to discharge after gastroschisis repair through review of a multi-institutional database. STUDY DESIGN Infants who underwent gastroschisis repair between 1997 and 2012 with data recorded in the Pediatrix Medical Group Clinical Data Warehouse were categorized into 4 groups based on the percentage of days fed human milk out of the number of days fed enterally. Cox proportional hazards regression modeling was performed to determine the adjusted effect of human milk on the time from initiation of feeds to discharge. RESULTS Among 3082 infants, 659 (21%) were fed human milk on 0% of enteral feeding days, 766 (25%) were fed human milk on 1%-50% of enteral feeding days, 725 (24%) were fed human milk on 51%-99% of enteral feeding days, and 932 (30%) were fed human milk on 100% of enteral feeding days. Following adjustment, being fed human milk on 0% of enteral feeding days was associated with a significantly increased time to discharge compared with being fed human milk on 100% of enteral feeding days (hazard ratio [HR] for discharge per day, 0.46; 95% CI, 0.40-0.52). The same was found for infants fed human milk on 1%-50% of enteral feeding days (HR, 0.37; 95% CI, 0.32-0.41) and for infants fed human milk on 51%-99% of enteral feeding days (HR, 0.51; 95% CI, 0.46-0.57). CONCLUSION The use of human milk for enteral feeding of infants following repair of gastroschisis significantly reduces the time to discharge from initiation of feeds.
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Affiliation(s)
- Brian C Gulack
- Department of Surgery, Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Matthew M Laughon
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Terrance Burgess
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Sybil Robinson
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Abdurrauf Muhammad
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Angela Zhang
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Adrienne Davis
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Robert Morton
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Vivian H Chu
- Department of Medicine, Duke University Medical Center, Durham, NC
| | | | - Christoph P Hornik
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC; Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - P Brian Smith
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC; Department of Pediatrics, Duke University Medical Center, Durham, NC.
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Marinovic VM, Lukac ML, Mikovic Z, Grujic B, Stojanovic A, Sabbagh D, Samardzija G. Gastroschisis with gastric perforation and jejunal stenosis. A rare association of anomalies. Ann Ital Chir 2016; 87:S2239253X16024865. [PMID: 26996209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM Gastroschisis with prenatal gastric perforation and intestinal stenosis is a rare and serious anomaly. although there are several case reports, no case series exists to suggest the prognosis for these infants. MATERIAL AND METHODS In this report a case of gastroschisis with gastric perforation and jejunal stenosis in male newborn is presented with literature review. The stomach, small bowel and the part of the colon were herniated through the abdominal wall defect. A large perforation site at the anterior wall of fundus and a thin fibrous strip that causing stenosis of jejunum was found. RESULTS Gastrorraphy was performed. Stenosis of jejunum was resected and t-t anastomosis was performed, followed by primary fascial closure. DISCUSSION The prenatal sonographic finding of bowel or gastric perforation are variable. Antenatal bowel dilatation and in particular intraabdominal bowel dilatation is prognostically useful for detection of patients with worse outcome. The absence of bowel dilatation cannot fully exclude complex patients. Early restoration of bowel continuity using primary anastomosis and primary abdominal wall closure are not associated with prolonged time for full enteral feeding and length of hospital stay. CONCLUSIONS We have presented the first detailed report of surgical intervention and outcomes in case of gastroschisis with prenatal gastric perforation and congenital jejunal stenosis. Early restoration of bowel continuity using primary anastomosis and primary abdominal wall closure is recommended here. More research should be focused to predict complex gastroschisis and to improve prenatal diagnosis and postnatal management, without a significant increase in morbidity and mortality. KEY WORDS Gastroschisis, Gastric perforation, Stenosis of jejunum.
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Marinovic VM, Lukac ML, Mikovic Z, Grujic B, Stojanovic A, Sabbagh D, Samardžija G. Gastroschisis with gastric perforation and jejunal stenosis A rare association of anomalies. Ann Ital Chir 2016; 87:263-267. [PMID: 27345767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
AIM Gastroschisis with prenatal gastric perforation and intestinal stenosis is a rare and serious anomaly. although there are several case reports, no case series exists to suggest the prognosis for these infants. MATERIAL AND METHODS In this report a case of gastroschisis with gastric perforation and jejunal stenosis in male newborn is presented with literature review. The stomach, small bowel and the part of the colon were herniated through the abdominal wall defect. A large perforation site at the anterior wall of fundus and a thin fibrous strip that causing stenosis of jejunum was found. RESULTS Gastrorraphy was performed. Stenosis of jejunum was resected and t-t anastomosis was performed, followed by primary fascial closure. DISCUSSION The prenatal sonographic finding of bowel or gastric perforation are variable. Antenatal bowel dilatation and in particular intraabdominal bowel dilatation is prognostically useful for detection of patients with worse outcome. The absence of bowel dilatation cannot fully exclude complex patients. Early restoration of bowel continuity using primary anastomosis and primary abdominal wall closure are not associated with prolonged time for full enteral feeding and length of hospital stay. CONCLUSIONS We have presented the first detailed report of surgical intervention and outcomes in case of gastroschisis with prenatal gastric perforation and congenital jejunal stenosis. Early restoration of bowel continuity using primary anastomosis and primary abdominal wall closure is recommended here. More research should be focused to predict complex gastroschisis and to improve prenatal diagnosis and postnatal management, without a significant increase in morbidity and mortality. KEY WORDS Gastroschisis, Gastric perforation, Stenosis of jejunum.
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Marinovic VM, Lukac M, Mikovic Z, Grujic B, Milickovic M, Samardžija G, Stojanovic A, Sabbagh D. Outcome differences between simple and complex gastroschisis. Ann Ital Chir 2016; 87:525-530. [PMID: 27845942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND We reviewed differences of the outcome of newborn with simple and complex gastroschisis treated at our institution over the past fifteen years. METHODS A retrospective cohort study was performed on all infants with gastroschisis treated at the Institute for mother and child health care, Belgrade, between 2001 and 2015 (n=70). Premature infants (<34 weeks of gestation) and babies with birth weight less than 1500 g were excluded (n=5). We compared outcomes in infants with simple gastroschisis and those with complex gastroschisis. An outcome analysis was performed for birth weight, gestational age, gender, mode of defect closure, presence of intestinal necrosis or perforation, reoperation, duration of mechanical ventilation and total parenteral nutrition, presence of bowel pseudoopstraction, sepsis, total duration of hospital stay, mortality rates. RESULTS Of 65 patients, 15 (23,07%) had complex gastroschisis, including atresia 5 patients (33,3%), ischemic complication 9 patients (60%) and one patient with closing gastroschisis (6,66%). Sixty eight percent underwent primary closure.There was difference between the simple and the complex gastroschisis in duration of mechanical ventilation (P= ,000003), total parenteral nutrition (P= ,000019), bowel pseudoobstruction (P= ,00067), reoperation (P= ,00122), sepsis (P= ,0043), hospital stay (P= ,000198). In the simple gastroschisis group 92% of patients survived to discharge. In the complex gastroschisis group 3 patients died in hospital (P= ,338). CONCLUSIONS More research should be focused to predict complex gastroschisis and to improve prenatal diagnosis and postnatal management, without a significant increase in morbidity and mortality. KEY WORDS Complex, Gastroschisis, Outcomes, Simple, Vanishing.
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Macnaught G, Gray C, Walker J, Simpson M, Norman J, Semple S, Denison F. (1)H MRS: a potential biomarker of in utero placental function. NMR Biomed 2015; 28:1275-1282. [PMID: 26313636 DOI: 10.1002/nbm.3370] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 06/30/2015] [Accepted: 07/07/2015] [Indexed: 06/04/2023]
Abstract
The placenta is a temporary organ that is essential for a healthy pregnancy. It performs several important functions, including the transport of nutrients, the removal of waste products and the metabolism of certain substances. Placental disorders have been found to account for over 50% of stillbirths. Despite this, there are currently no methods available to directly and non-invasively assess placental function in utero. The primary aim of this pilot study was to investigate the use of (1)H MRS for this purpose. (1)H MRS offers the possibility to detect several placental metabolites, including choline, lipids and the amino acids glutamine and glutamate (Glx), which are vital to fetal development and placental function. Here, in utero placental spectra were acquired from nine small for gestational age (SGA) pregnancies, a cohort who are at increased risk of perinatal morbidity and mortality, and from nine healthy gestation-matched pregnancies. All subjects were between 26 and 39 weeks of gestation. Placenta Glx, choline and lipids at 1.3 and 0.9 ppm were quantified as amplitude ratios to that of intrinsic H2O. Wilcoxon signed rank tests indicated a significant difference in Glx/H2O (p = 0.024) between the two groups, but not in choline/H2O (p = 0.722) or in either lipid/H2O ratio (1.3 ppm, p = 0.813; 0.9 ppm, p = 0.058). This study has demonstrated that (1)H MRS has potential for the detection of placental metabolites in utero. This warrants further investigation as a tool for the monitoring of placental function.
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Affiliation(s)
- Gillian Macnaught
- Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, UK
| | - Calum Gray
- Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, UK
| | - Jane Walker
- Simpson Centre for Reproductive Health, Royal Infirmary, Edinburgh, UK
| | - Mary Simpson
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Jane Norman
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Scott Semple
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Fiona Denison
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
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Marseglia L, Manti S, D’Angelo G, Gitto E, Salpietro C, Centorrino A, Scalfari G, Santoro G, Impellizzeri P, Romeo C. Gastroesophageal reflux and congenital gastrointestinal malformations. World J Gastroenterol 2015; 21:8508-8515. [PMID: 26229394 PMCID: PMC4515833 DOI: 10.3748/wjg.v21.i28.8508] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 04/24/2015] [Accepted: 05/27/2015] [Indexed: 02/06/2023] Open
Abstract
Although the outcome of newborns with surgical congenital diseases (e.g., diaphragmatic hernia; esophageal atresia; omphalocele; gastroschisis) has improved rapidly with recent advances in perinatal intensive care and surgery, infant survivors often require intensive treatment after birth, have prolonged hospitalizations, and, after discharge, may have long-term sequelae including gastro-intestinal comorbidities, above all, gastroesophageal reflux (GER). This condition involves the involuntary retrograde passage of gastric contents into the esophagus, with or without regurgitation or vomiting. It is a well-recognized condition, typical of infants, with an incidence of 85%, which usually resolves after physiological maturation of the lower esophageal sphincter and lengthening of the intra-abdominal esophagus, in the first few months after birth. Although the exact cause of abnormal esophageal function in congenital defects is not clearly understood, it has been hypothesized that common (increased intra-abdominal pressure after closure of the abdominal defect) and/or specific (e.g., motility disturbance of the upper gastrointestinal tract, damage of esophageal peristaltic pump) pathological mechanisms may play a role in the etiology of GER in patients with birth defects. Improvement of knowledge could positively impact the long-term prognosis of patients with surgical congenital diseases. The present manuscript provides a literature review focused on pathological and clinical characteristics of GER in patients who have undergone surgical treatment for congenital abdominal malformations.
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MESH Headings
- Digestive System Abnormalities/complications
- Digestive System Abnormalities/diagnosis
- Digestive System Abnormalities/physiopathology
- Digestive System Abnormalities/surgery
- Digestive System Surgical Procedures/adverse effects
- Esophageal Atresia/complications
- Esophageal Atresia/physiopathology
- Esophageal Atresia/surgery
- Esophagus/growth & development
- Esophagus/physiopathology
- Esophagus/surgery
- Gastroesophageal Reflux/diagnosis
- Gastroesophageal Reflux/etiology
- Gastroesophageal Reflux/physiopathology
- Gastroschisis/complications
- Gastroschisis/physiopathology
- Gastroschisis/surgery
- Hernia, Umbilical/complications
- Hernia, Umbilical/physiopathology
- Hernia, Umbilical/surgery
- Hernias, Diaphragmatic, Congenital/complications
- Hernias, Diaphragmatic, Congenital/physiopathology
- Hernias, Diaphragmatic, Congenital/surgery
- Humans
- Infant
- Infant, Newborn
- Intestinal Volvulus/complications
- Intestinal Volvulus/physiopathology
- Intestinal Volvulus/surgery
- Pressure
- Risk Factors
- Treatment Outcome
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48
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Vandewalle RJ, Carr MG, Koontz CS, Mitchell E, Torres C, Lam G. Can prenatal ultrasound predict secondary gastrointestinal complications in neonates with gastroschisis? Am Surg 2015; 81:E246-E247. [PMID: 26031255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Robert J Vandewalle
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, Tennessee, USA
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49
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Safavi A, Skarsgard ED. Advances in the Surgical Treatment of Gastroschisis. Surg Technol Int 2015; 26:37-41. [PMID: 26054989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Gastroschisis (GS) is a structural defect of the anterior abdominal wall, usually diagnosed antenatally, that occurs with a frequency of approximately 4 per 10,000 pregnancies. Babies born with GS require neonatal intensive care and surgical management of the abdominal wall defect soon after birth. Although contemporary survival rates for GS are over 90%, these babies are at risk for significant morbidity, and require 4 to 6 weeks of costly, resource-intensive care in specialized neonatal units. Much consideration has been given to how best to treat the abdominal wall defect of GS. The traditional approach, necessitated by a need to establish enteral feeding as quickly as possible, consists of early postnatal visceral reduction and sutured abdominal closure. Advances in neonatal nutritional support have enabled the development of surgical approaches, which permit gradual visceral reduction and delayed abdominal closure. In cases where early visceral reduction cannot be achieved, delayed closure enabled by the initial placement of a prosthetic silo has been a live-saving alternative. The development of preformed silos has simplified their use and led to an interest in treating all cases with a delayed closure philosophy. Most recently, a sutureless technique of abdominal closure has been reported, which has the benefit of avoiding general anesthesia and offers other outcome improvements over sutured closure of the defect. The debate over primary closure versus silo placement and delayed closure continues to receive much attention. The goal of this article is to review historical aspects of gastroschisis closure, and then focus on current surgical techniques, including the innovative sutureless closure, with an analysis of the comparative clinical effectiveness of these approaches to treatment of the abdominal wall defect in GS.
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Affiliation(s)
- Arash Safavi
- Department of Surgery, University of Arizona, Tucson, Arizona
| | - Erik D Skarsgard
- Division of Pediatric Surgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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50
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Ross AR, Eaton S, Zani A, Ade-Ajayi N, Pierro A, Hall NJ. The role of preformed silos in the management of infants with gastroschisis: a systematic review and meta-analysis. Pediatr Surg Int 2015; 31:473-83. [PMID: 25758783 DOI: 10.1007/s00383-015-3691-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND The pre-formed silo (PFS) is increasingly used in the management of gastroschisis, but its benefits remain unclear. We performed a systematic review and meta-analysis of the literature comparing use of a PFS with alternate treatment strategies. METHODS Studies comparing the use of a PFS with alternate strategies were identified and data extracted. The primary outcome measure was length of time on a ventilator. Mean difference (MD) between continuous variables and 95% confidence intervals were calculated. Risk difference and 95% CI were determined for dichotomous data. RESULTS Eighteen studies, including one randomised controlled trial, were included. Treatment strategy and outcome measures reported varied widely. Meta-analysis demonstrated no difference in days of ventilation, but a longer duration of parenteral nutrition (PN) requirement [MD 6.4 days (1.3, 11.5); p = 0.01] in infants who received a PFS. Subgroup analysis of studies reporting routine use of a PFS for all infants demonstrated a significantly shorter duration of ventilation with a PFS [MD 2.2 days (0.5, 3.9); p = 0.01] but no difference in duration of PN requirement. Other outcomes were similar between groups. CONCLUSION The quality of evidence comparing PFS with alternate treatment strategies for gastroschisis is poor. Only routine use of PFS is associated with fewer days on a ventilator compared with other strategies. No strong evidence to support a preference for any strategy was demonstrated. Prospective studies are required to investigate the optimum management of gastroschisis. Standardised outcome measures for this population should be established to allow comparison of studies.
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Affiliation(s)
- Andrew R Ross
- Department of Paediatric Surgery, Great Ormond Street Hospital, London, UK
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