Delivery room surgery: an applicable therapeutic strategy for gastroschisis in developing countries

Du, Lixin; Pan, Weihua; Cai, Wei; Wang, Jun; Wu, Yeming; Shi, Cheng-ren

doi:10.1007/s12519-014-0455-3

Cited by 9 publications

(9 citation statements)

References 15 publications

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“… 3 , 4 In contrast, these rates remain high, ranging from 39.1% to 58%, according to data from recent studies, in low middle-income countries. 5 , 6 , 7 Delivery outside the referral center, which is more likely to happen in those countries, has been described as a risk factor associated with death. 5 , 6 , 7 …”

Section: Introductionmentioning

confidence: 99%

Influence of birthplace on gastroschisis outcomes in a state in the southeastern region of Brazil

Muniz¹,

Netto²,

Carvalho³

et al. 2021

Jornal de Pediatria

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Section: Introductionmentioning

confidence: 99%

Influence of birthplace on gastroschisis outcomes in a state in the southeastern region of Brazil

Muniz¹,

Netto²,

Carvalho³

et al. 2021

Jornal de Pediatria

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“…However, the proportion with intestinal pathology or ‘complex gastroschisis’ is greater in LMICs; up to 25% compared to 10% in HICs (defined as intestinal ischaemia, necrosis, perforation or atresia) 7, 10 . A lack of antenatal diagnosis, delivery outside a tertiary paediatric surgery centre, and inadequate pre-hospital management and transfer results in significant delays in reaching care, during which time the bowel is exposed, contaminated, damaged and/ or torted on the vascular pedicle resulting in postnatal ischaemia and necrosis 1, 6, 7, 12 . In addition, neonates commonly arrive hypovolaemic, hypothermic and septic 6, 7, 11, 44 .…”

Section: Introductionmentioning

confidence: 99%

Developing and implementing an interventional bundle to reduce mortality from gastroschisis in low-resource settings

et al. 2019

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Background: Gastroschisis is associated with less than 4% mortality in high-income countries and over 90% mortality in many tertiary paediatric surgery centres across sub-Saharan Africa (SSA). The aim of this trial is to develop, implement and prospectively evaluate an interventional bundle to reduce mortality from gastroschisis in seven tertiary paediatric surgery centres across SSA. Methods: A hybrid type-2 effectiveness-implementation, pre-post study design will be utilised. Using current literature an evidence-based, low-technology interventional bundle has been developed. A systematic review, qualitative study and Delphi process will provide further evidence to optimise the interventional bundle and implementation strategy. The interventional bundle has core components, which will remain consistent across all sites, and adaptable components, which will be determined through in-country co-development meetings. Pre- and post-intervention data will be collected on clinical, service delivery and implementation outcomes for 2-years at each site. The primary clinical outcome will be all-cause, in-hospital mortality. Secondary outcomes include the occurrence of a major complication, length of hospital stay and time to full enteral feeds. Service delivery outcomes include time to hospital and primary intervention, and adherence to the pre-hospital and in-hospital protocols. Implementation outcomes are acceptability, adoption, appropriateness, feasibility, fidelity, coverage, cost and sustainability. Pre- and post-intervention clinical outcomes will be compared using Chi-squared analysis, unpaired t-test and/or Mann-Whitney U test. Time-series analysis will be undertaken using Statistical Process Control to identify significant trends and shifts in outcome overtime. Multivariate logistic regression analysis will be used to identify clinical and implementation factors affecting outcome with adjustment for confounders. Outcome: This will be the first multi-centre interventional study to our knowledge aimed at reducing mortality from gastroschisis in low-resource settings. If successful, detailed evaluation of both the clinical and implementation components of the study will allow sustainability in the study sites and further scale-up. Registration: ClinicalTrials.gov Identifier NCT03724214.

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“…On the other hand, infections during transfer were the cause of sepsis in externally-born infants (9). Therefore, if suitable conditions are available, neonates with gastroschisis, antenatal diagnosed, should be born in a pediatric surgical center, with keeping in mind delivery room surgery (4,9). In our study, 11 patients were diagnosed as antenatal gastroschisis by ultrasonography, while the rest were without prenatally diagnosis.…”

Section: Discussionmentioning

confidence: 78%

“…Although antenatal diagnosis and care have improved during the last thirty years; there were patients that were not diagnosed at antenatal period in our study (4).The mothers, not followed regularly in prenatal period, usually give birth at regional maternity hospitals where pediatric surgeons not working. On the other hand, infections during transfer were the cause of sepsis in externally-born infants (9). Therefore, if suitable conditions are available, neonates with gastroschisis, antenatal diagnosed, should be born in a pediatric surgical center, with keeping in mind delivery room surgery (4,9).…”

Section: Discussionmentioning

confidence: 99%

Gastroschisis Treatment: Evaluation of Surgical Techniques and Results

İnce¹,

Ezer²,

Temız³

et al. 2020

Bezmialem Science

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Amaç: Son zamanlarda, gastroşizisli hastalar için iyi bir kozmetik sonuç elde etmek, visseral organları karın boşluğuna güvenle yerleştirmek kadar popülerlik kazanmaktadır. Çalışmanın amacı, kozmetik sonuçlara odaklanarak hastaların sonuçlarını değerlendirmek ve literatürde kozmetik sonuçlara odaklanan sınırlı sayıdaki verilere katkıda bulunmaktır. Yöntemler: Ocak 2005'ten Mayıs 2018'e kadar gastroşizis nedeniyle opere edilen tüm hastaların tıbbi kayıtları geriye dönük olarak değerlendirildi. Bulgular: Gastroşizisi olan 22 hasta tedavi edildi (10 kız/12 erkek). Ortalama gebelik yaşı 38,2±2,1 hafta idi. Ortalama doğum ağırlığı 2256,9±418,2 g idi. Onbir hastaya doğum öncesi tanı kondu. Beş hastada komplike gastroşizis vardı; nekroz (n=3), perforasyon (n=4), volvulus (n=1) ve jejunal atrezi (n=1). Primer kapama (n=16) veya aşamalı kapama (n=6) yapıldı. Mekanik ventilasyon süresi ve total parenteral beslenme sırasıyla 3,7±1 gün ve 24,3±9,7 gündü. Enteral beslenmeye 15,9±10,5 günde başlandı. Hastanede kalış süresi 36,7±13,3gündü. Üç hasta sepsis ve multiorgan yetmezliği nedeniyle öldü. Sonuç: Hastaların doğduğu hastanede opere olmasının ve uygun cerrahi prosedür seçilmesinin başarı şansının ana faktörleri olduğunu düşünüyoruz. Bu çalışma da hastaların %86,3'ünde iyi kozmetik sonuçlar ve visseral fonksiyonlar elde edildi. Anahtar Sözcükler: Abdominal duvar defekti, gastroşizis, yenidoğan cerrahisi Objective: Recently, getting good cosmetic results for patients with gastroschisis gains popularity, as putting visceral organs safely into the abdominal cavity as. We aimed to evaluate the outcomes of the patients focusing on the cosmetic results to contribute to a limited number of data on this subject in the literature. Methods: From January 2005 to May 2018, patients operated for gastroschisis in a single institution were evaluated retrospectively. Results: Twenty-two patients with gastroschisis were treated (10girls/12boys). Mean gestational age was 38.2±2.1 weeks. Mean birth weight was 2256.9±418.2 g. Eleven patients were diagnosed by prenatally. Five patients had complex gastroschisis; necrosis (n=3), perforated (n=3), volvulus (n=1) and jejunal atresia (n=1). Primary closure (n=16) and staged closure (n=6) were performed. Patients needed mechanical ventilation and total parenteral nutrition for 3.7±1.0 days and 24.3±9.7 days, respectively. Enteral feeding was started at 15.9±10.5days. The duration of hospitalization was 36.7±13.3 days. Three patients were died from sepsis and multi-organ failure. Conclusion: We consider that appropriate surgery of gastroschisis at the same hospital without transferring another center is the main factor in the success. Good cosmetic results and visceral functions were able to achieve in this study in 86.3% patients.

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Delivery room surgery: an applicable therapeutic strategy for gastroschisis in developing countries

Abstract: The strategy of delivery of patients in a center prepared to perform delivery room closure of gastroschisis appears to improve the survival of patients with gastroschisis. Further reduction in mortality rates will depend on improved conditions of outborn infants.

Cited by 9 publications

References 15 publications

Influence of birthplace on gastroschisis outcomes in a state in the southeastern region of Brazil

Influence of birthplace on gastroschisis outcomes in a state in the southeastern region of Brazil

Developing and implementing an interventional bundle to reduce mortality from gastroschisis in low-resource settings

Gastroschisis Treatment: Evaluation of Surgical Techniques and Results

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