Adverse outcome after prenatal diagnosis of gastroschisis: The role of fetal monitoring

Burge, D.M.; Ade-Ajayi, Niyi

doi:10.1016/s0022-3468(97)90601-1

Cited by 57 publications

(61 citation statements)

References 15 publications

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“…Outcomes for the traditional approach to gastroschisis have been summarized in several case series [5], [6], [7], [9] and [10]. Hospital mortality ranges from 7% to 10%, often related to septicemia.…”

Section: Discussionmentioning

confidence: 99%

“…There is normally a prolonged hospital admission with a median duration of around 6 weeks in most series. Other possible complications of gastroschisis include hemodynamic compromise of the lower abdomen, kidneys and legs with abdominal compartment syndrome; gut perforation; infection (septicemia and/or wound infection); abdominal scars; a cosmetically abnormal umbilicus; late surgery for gut adhesions or scar cosmesis; compromised nutrition; and adverse neurologic outcome [9], [10] and [11]. Bianchi and Dickson [1] reported 14 cases treated with reduction in the neonatal unit-there were 12 survivors: 9 uncomplicated, 2 with mild periumbilical inflammation, and 1 requiring an intestinal lengthening procedure for ileal atresia.…”

Section: Discussionmentioning

confidence: 99%

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Gastroschisis: ward reduction compared with traditional reduction under general anesthesia

Davies

Kimble

Cartwright

2005

Journal of Pediatric Surgery

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Background/PurposeIn gastroschisis it is proposed that gut reduction may be achieved without intubation or general anesthesia (GA) through ward reduction. The authors aimed to determine if ward reduction decreased morbidity and duration of treatment. Methods Infants born from January 1, 1995, to December 31, 2001, with gastroschisis were managed with either reduction under GA in the operating theatre (OT group)-up to September 1999, or ward reduction (when eligible) in the neonatal unit without GA/ventilation (ward reduction [WR] group)-from September 1999. Results Of the 37 infants, 31 were eligible for ward reduction-15 from the OT group, 16 from the WR group. All infants in the OT group had at least 1 episode of ventilation and 1 GA: 62% of infants in the WR group avoided ventilation (P = .0002) and 81% avoided GA (P < .0001). Infants who had ward reduction had significantly shorter durations of ventilation and oxygen therapy. Septicemia occurred in 31% of the WR group and 7% of the OT group (P = .17). Infants who had ward reduction left intensive care 16 days earlier (P = .02) and tended to reach full enteral feeds 8 days sooner (P = .06) and be discharged from hospital 15 days earlier (P = .05). ConclusionsInfants who had ward reduction do better in terms of avoiding GA/ventilation, establishing feeds, and going home earlier. A randomized, controlled trial comparing the 2 approaches is feasible, safe, and worthwhile.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Gastroschisis: ward reduction compared with traditional reduction under general anesthesia

Davies

Kimble

Cartwright

2005

Journal of Pediatric Surgery

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“…Barisic and coworkers 1 demonstrate a relatively high risk of still birth in isolated cases of gastroschisis (11%) and in isolated cases of omphalocele (20%). A study from England demonstrates that 23 (43%) of 54 liveborn babies with gastroschisis had signs of fetal distress prior to delivery, and the authors found that 16% of all cases of gastroschisis were associated with abnormal neurological outcome 9 . Thus, fetuses with gastroschisis have a high risk for fetal distress and still birth, and careful fetal monitoring in the third trimester is indicated.…”

Section: Pregnancy Surveillancementioning

confidence: 99%

Fetal abdominal wall defects—easy to diagnose—and then what?

Salvesen

2001

Ultrasound in Obstet & Gyne

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Section: Introductionmentioning

confidence: 99%

“…Prenatal care is of great importance since early termination of pregnancy may occur due to changing foetal vitality. Although it does not seem to increase morbidity or mortality in vaginal delivery, often these deliveries are performed by caesarean section 11,12 .Mortality rates range from 3 to 10%, and high morbidity in the neonatal period is associated with factors related to slow post-operative intestinal adaptation with the use of prolonged parenteral nutrition (PPN), causing cholestasis associated with parenteral nutrition (CAPN) and central venous catheters (CVC) use for a prolonged period, infections and the presence of hydroelectrolytic disturbances associated with renal insuffi ciancy 12 . The complexity of this malformation depends on its association with intestinal atresia, perforation, necrosis and volvulus, which makes the surgical management needed evolve to a short bowel syndrome frame, prolongs the hospital stay and promotes a number of comorbidities 13 .…”

mentioning

confidence: 99%

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

Redondo¹,

Feferbaum

Vieira

et al. 2016

J. Hum. Growth Dev.

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Introduction: Congenital malformations are major diseases observed at birth. They are the second most common cause of death in the neonatal population, the fi rst one being prematurity.Objective: To characterise the clinical outcome of newborns with gastroschisis (GS) in a neonatal intensive care unit. Methods:A retrospective observational clinical study in 50 infants with GS using the association of intestinal abnormalities, impossibility of primary closure of the abdominal defect and reoperation necessity as classifi cation criteria for the disease. The signifi cance level was p < 0.05. Results:The hospitalisation to primary surgery occurred with a median age of 2 hours. Fourteen percent of children were subjected to a primary silo interposition and 24% had associated intestinal malformation. Nineteen newborns (NB) required more than one surgery. The median length of stay was 33 days, higher in patients with complex GS (56 days). All NB recovered from urine output 48 hours after surgery and 40% had hyponatraemia and oligoanuria in this period. There was no difference between the natraemia and fasting time (p = 0.79). Weight gain was similar in both groups with total parenteral nutrition and became signifi cantly higher in patients with simple GS after enteral feeding (p = 0.0046). These NB evolved 2.4 times less cholestasis. Late-onset sepsis occurred in 58% of patients and was related to the infection of the central venous catheter in 37.9% of cases. Mortality was higher in infants infected with complex GS and the overall mortality rate was 14%. Conclusion:Clinical characterisation of newborns with gastroschisis depends on the complexity and the knowledge and conduct of morbidities to reduce mortality.Key words: gastroschisis, new-born, mortality, total parenteral nutrition, renal insuffi ciency, infection. INTRODUCTIONCongenital malformations are major diseases observed at birth. In the United States, a prevalence of about 3% 1 is cited. In Brazil, a study at the Fernandez Figueira Institute in Rio de Janeiro found that the prevalence was similar, i.e. 2.7% among live newborns (NB) and 6.7% among stillbirths. Among the causes of death, neonatal malformations are the second most common reason, the fi rst one being prematurity 2 .Gastroschisis (GS) is a congenital malformation of the abdominal wall that has increased in prevalence worldwide; its causes have not been fully elucidated 3 . In the 1960s, the prevalence of this disease was 1:50,000 live births. However, Kirby et al. 4 - -Characteristics of the clinical development of a newborn with gastroschisis in an intensive care unit in latin america J Hum Growth Dev. 2016; 26(2): 190-198 DOI: http://dx.doi.org/10.7322/jhgd.119266 temporal increase of 2.23 per 10,000 live births to 4.42 per 10,000 Regarding the defi nition of live births. The current prevalence in South America is 2.9:10,000 5 . This disease is characterised by a defect in abdominal wall closure with herniation of the intestines and other abdominal organs into the amniotic cavity. ...

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Adverse outcome after prenatal diagnosis of gastroschisis: The role of fetal monitoring

Cited by 57 publications

References 15 publications

Gastroschisis: ward reduction compared with traditional reduction under general anesthesia

Gastroschisis: ward reduction compared with traditional reduction under general anesthesia

Fetal abdominal wall defects—easy to diagnose—and then what?

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

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