Congenital Abdominal Wall Defects: An Update

Wilson, R. Douglas; Johnson, Mark P.

doi:10.1159/000078990

Cited by 148 publications

(146 citation statements)

References 95 publications

(124 reference statements)

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“…On the other hand, prematurity and low birth weight seem to correlate with adverse outcome, such as higher occurrence of sepsis and longer time to full feeds and hospitalization period [1,10,16]. However, in our analysis low birth weight and preterm labor were not associated with adverse outcome.…”

Section: Discussioncontrasting

confidence: 76%

“…Although this survival in gastroschisis is fairly good gastrointestinal complications, intestinal motility and absorption disturbances occurred frequently with consequent long and expensive hospital stays [1][2][3][4]. In our series 22%, approximately one out of five patients with gastroschisis, was jeopardized with a complicated post-operative course, characterized by multiple interventions, possible death and if surviving with a significant increased time to establish oral feedings and prolonged hospital stay.…”

Section: Discussionmentioning

confidence: 65%

“…Gastrointestinal complications, intestinal motility and absorption disturbances are frequently present with consequent long and expensive hospital stays [1][2][3][4].…”

Section: Introductionmentioning

confidence: 99%

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Factors determining outcome in gastroschisis: clinical experience over 18 years

Jager

Heij

2007

Pediatr Surg Int

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Although the survival in gastroschisis has improved to more than 85%, serious morbidity with consequent long hospital stay is still very common. Alternative strategies such as planned early delivery and amniotic fluid exchange are being explored. In order to evaluate these approaches, adequate risk stratification of patients with gastroschisis is required. The aim of this study was to identify the risk factors associated with increased morbidity and mortality. A retrospective analysis of all patients with gastroschisis treated at our institution between 1988 and 2005 was conducted. Patients' data were collected from the files and compared for statistical significance with three outcome measures: (1) complicated post-operative course; (2) time to full enteral feeding (TFE); (3) length of hospital stay (LOS). SPSS was used for statistical analysis. Fifty-nine newborns with gastroschisis were admitted during the study period. Antenatal diagnosis was made in 40 cases (68%). Associated malformations (other than intestinal anomalies) were present in eight patients. One patient with trisomy 13 was excluded from the analysis. Ten patients (17%) had compromised bowel (atresia, severe ischaemia or a combination). Primary repair was successful in 47 (81%) and in 11 patients a silo was applied. Overall survival was 54/58 children (93%), four patients died. Complications associated with closure occurred in eight patients. Postoperative course was uncomplicated in 45 patients and complicated in 13. The RR for patients with compromised bowel to have a complicated post-operative course is 9 (95% CI 2-39) and the RR to die is 20 (95% CI 2-222) for these patients. Risk stratification of patients with gastroschisis appears possible based on the presence of compromised bowel before closure.

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Section: Discussioncontrasting

confidence: 76%

Section: Discussionmentioning

confidence: 65%

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Factors determining outcome in gastroschisis: clinical experience over 18 years

Jager

Heij

2007

Pediatr Surg Int

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“…3 The modern era of treatment is one of the remarkable success stories of medicine in which advances in neonatal critical care, parenteral nutrition and pediatric surgical techniques have contributed to a documented survival of greater than 90% in the United States. 4,5 Gastroschisis can occur as an isolated abnormality (simple) or it can be associated with other gastrointestinal anomalies such as intestinal atresia, perforation, necrosis or volvulus (complex). Although extensive literature is available regarding the surgical treatment of gastroschisis, 4,[6][7][8][9] few reports have focused on the categorization and risk stratification of this abnormality.…”

Section: Introductionmentioning

confidence: 99%

Gastroschisis in the United States 1988–2003: analysis and risk categorization of 4344 patients

et al. 2006

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Objective: Gastroschisis is a rare congenital abdominal wall defect through which intraabdominal organs herniate and it requires surgical management soon after birth. The objectives of this study were to profile patient characteristics of this anomaly utilizing data from two large national databases and to validate previous risk stratification categories of infants born with this condition.Methods: An analysis was performed using 13 years of the National Inpatient Sample database (1988-1996, 1998, 1999, 2001, 2002) and 3 years of the Kids' Inpatient Database (1997, 2000. These combined databases contain information from nearly 93 million discharges in the United States. Infants with gastroschisis were identified by International Classification of Disease-9 procedure code 54.71 (repair of gastroschisis) and an age at admission of <8 days. Variables of gender, race, geographic region, co-existing diagnoses, length of stay, hospital charges adjusted to 2005 dollars, complications and inpatient mortality were collected from the databases. Infants were divided into simple and complex categories based on the absence or presence of intestinal atresia, stenosis, perforation, necrosis or volvulus. Comparisons between groups were performed using Pearson's w 2 for categorical outcomes and the Kruskal-Wallis test for non-normally distributed continuous variables.Results: A total of 4344 infants with gastroschisis were identified. These were comprised of 44.0% female infants (n ¼ 1910), 46.4% male infants (n ¼ 2017) whereas 9.6% were not reported (n ¼ 415). Racial analysis showed the largest subset being white in 40.9% of infants (n ¼ 1775) with Hispanic infants being the next highest group reported at 17.2% (n ¼ 745). Co-existing intestinal anomalies were the most common, affecting 9.9% (n ¼ 429) infants, whereas certain cardiac (6.8%, n ¼ 294) and pulmonary (1.7%, n ¼ 72) conditions were also identified. Simple gastroschisis represented 89.1% (n ¼ 3870) of the group whereas 10.9% (n ¼ 474) were complex in nature. Simple and complex patients differed in median length of stay (28 vs 67 days, P<0.01), inpatient mortality (2.9 vs 8.7%, P<0.01) and median inflation-adjusted hospital charges ($90 788 vs $197 871, P<0.01).Conclusions: These data represent a national analysis of the largest group of infants with gastroschisis to date which further aids the characterization and understanding of this serious congenital condition.

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“…1 This anomaly requires immediate postnatal surgery, which has a good outcome, with most contemporary series reporting survival rates of over 90%. 2 Infants who have had the surgery require a resource-intensive, neonatal intensive care unit stay averaging 6 weeks. 3 A subset of infants with gastroschisis who suffer a more severe form of intestinal injury require prolonged hospitalization, specialized nutrition, multiple surgeries and in some instances organ transplantation to survive.…”

mentioning

confidence: 99%

Spatial variability of gastroschisis in Canada, 2006–2011: An exploratory analysis

Bassil

Yang

Arbour

et al. 2016

Can J Public Health

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OBJECTIVES: Gastroschisis is a serious birth defect of the abdominal wall that is associated with mortality and significant morbidity. Our understanding of the factors causing this defect is limited. The objective of this paper is to describe the geographic variation in incidence of gastroschisis and characterize the spatial pattern of all gastroschisis cases in Canada between 2006 and 2011. Specifically, we aimed to ascertain the differences in spatial patterns between geographic regions and identify significant clusters and their location. METHODS:The study population included 641 gastroschisis cases from the Canadian Pediatric Surgery Network (CAPSNet) database, a population-based dataset of all gastroschisis cases in Canada. Cases were geocoded based on maternal residence. Using Statistics Canada live-birth data as a denominator, the total prevalence of gastroschisis was calculated at the provincial/territorial levels. Random effects logistic models were used to estimate the rates of gastroschisis in each census division. These rates were then mapped using ArcGIS. Cluster detection was performed using Local Indicators of Spatial Association (LISA). RESULTS:There is significant spatial heterogeneity of the rate of gastroschisis across Canada at both the provincial/territorial and census-division level. The Yukon, Northwest Territories and Prince Edward Island have higher overall rates of gastroschisis relative to other provinces/territories. Several census divisions in Alberta, Manitoba, Saskatchewan, Ontario, Northwest Territories and British Columbia demonstrated case "clusters", i.e., focally higher rates in discrete areas relative to surrounding areas. CONCLUSIONS:There is clear evidence of spatial variation in the rates of gastroschisis across Canada. Future research should explore the role of area-based variables in these patterns to improve our understanding of the etiology of gastroschisis.KEY WORDS: Spatial analysis; gastroschisis; cluster analysis; Canada La traduction du résumé se trouve à la fin de l'article.

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Congenital Abdominal Wall Defects: An Update

Cited by 148 publications

References 95 publications

Factors determining outcome in gastroschisis: clinical experience over 18 years

Factors determining outcome in gastroschisis: clinical experience over 18 years

Gastroschisis in the United States 1988–2003: analysis and risk categorization of 4344 patients

Spatial variability of gastroschisis in Canada, 2006–2011: An exploratory analysis

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