Evolution of critically ill patients with gastroschisis from three tertiary centers

Abstract

OBJECTIVES AND INTRODUCTION:Gastroschisis is a congenital abdominal wall defect with increasing occurrence worldwide over the past 20–30 years. Our aim was to analyze the morbidity of newborns after gastroschisis closure, with emphasis on metabolic and hydroelectrolyte disturbances in patients at three tertiary university centers.METHODS:From January 2003 to June 2009, the following patient data were collected retrospectively: (A) Background maternal and neonatal data: maternal age, prenatal diagnosis, type of delivery, Apgar scores, birth weight, gestational age and sex; (B) Surgical modalities: primary or staged closure; and (C) Hospital course: levels of serum sodium and levels of serum albumin in the two first postoperative days, number of ventilation days, other postoperative variables and survival. Statistical analyses were used to examine the associations between some variables.RESULTS:163 newborns were included in the study. Primary closure of the abdominal defect was performed in 111 cases (68.1%). The mean serum sodium level was 127.4±6.7 mEq/L, and the mean serum albumin level was 2.35±0.5 g/dL. Among the correlations between variables, it was verified that hyponatremia and hypoalbuminemia correlated with the number of days on the ventilator but not with the number of days on total parenteral nutrition (TPN); mortality rate correlated with infection. The final survival rate was 85.9%.CONCLUSION:In newborns with gastroschisis, more aggressive attention to hyponatremia and hypoalbuminemia would improve the outcome.

Characteristics of the clinical development of a newborn with gastroschisis in an intensive care unit in latin america

“…The severity and progression of this case often affects the maintenance of PPN or even makes it unfeasible since the proposed treatment is a reduction of amino acids and lipid emulsion, resulting in an unsatisfactory supply of nutrients for proper growth 19,20 .…”

“…The recent introduction of a 20% lipid emulsion with fi sh oil (omega-3) brought a better outlook in the control of CANP 19 . The replacement of the 20% lipid emulsion (20% Lipid® SMOF), consisting of fi sh and olive oils as well as long chain triglycerides (TCM/TCL) increased direct bilirubin and liver enzymes.…”

“…The replacement of the 20% lipid emulsion (20% Lipid® SMOF), consisting of fi sh and olive oils as well as long chain triglycerides (TCM/TCL) increased direct bilirubin and liver enzymes. A decrease in these indicators allows for the maintenance of adequate protein-calorie offering PPN and satisfactory weight gain [19][20][21] .…”

Validation of the gastroschisis experimental model and the influence of the mother's diet enriched with glutamine in the fetal morphology

“…Though the gastroschisis survival rate is of 90% in several neonatal intensive therapy centers, its morbidity remains high due to the intestine dysfunction and the difficulty in the fetus's nutrition [9][10][11][12][13] .…”

“…Gastroschisis (GTS) is a congenital malformation of the abdomen characterized by a ventral defect on the right of the intact umbilical cord, with protrusion of the abdomen organs, generally the intestine 1,2,3,12 .…”