Management and outcome challenges in newborns with gastroschisis: A 6-year retrospective French study

Tosello, Barthélémy; Zahed, Meriem; Guimond, Floriane; Baumstarck, Karine; Faure, A.; Michel, Fabrice; Claris, Olivier; Gire, Catherine; Berakdar, Isabelle; Massardier, Jérôme; D’ercole, C.; Merrot, Thierry

doi:10.1080/14767058.2016.1265935

Cited by 8 publications

(5 citation statements)

References 17 publications

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“…This high proportion of deaths did not prompt the data safety management group to request an interruption of the trial at the first interim analysis, but it influenced our final decision to stop the study. Most studies report a rate of around 2–10% for prenatal death, which is in accordance with our own findings …”

Section: Discussionsupporting

confidence: 92%

“…Another way of decreasing the inflammatory reaction is by using steroidal anti‐inflammatory compounds (dexamethasone), which have been used with success in various species . A recent study by Tosello et al also suggested that steroid administration reduces the duration of parenteral feeding in humans . In our study we decided to include dexamethasone injection in both arms because we considered that there was a risk of prematurity induced by the procedure, and an intrinsic risk of prematurity associated with gastroschisis.…”

Section: Discussionmentioning

confidence: 99%

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A randomised controlled trial of amnioexchange for fetal gastroschisis

Luton

Mitanchez

Winer

et al. 2019

BJOG

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Objective Morbidity in fetuses affected by gastroschisis is mainly the result of bowel ischaemic and inflammatory processes. Experimental studies on animal models show that clearing amniotic fluid from the digestive secretions by amnioexchange procedures reduces the inflammatory process. We evaluated the benefit of the amnioexchange procedure for fetal gastroschisis in humans. Design Prospective, interventional, randomised study. Setting Eight referral centres for fetal medicine. Population Pregnant women carrying a fetus with gastroschisis. Methods We compared, in utero, amnioexchange with a sham procedure. The protocol included, in both arms, steroid injections at 30 weeks of gestation and the use of postnatal minimal enteral feeding. Main outcome measures The primary outcome was a composite variable based on the duration of ventilation and parenteral nutrition. Secondary outcomes were the effectiveness and safety of the amnioexchange procedure, including the rate of perinatal death, time to full enteral feeding, primary closure, and late feeding disorders. Results Sixty‐four patients were randomised. There was no difference in the composite criteria between the amnioexchange and control groups. Based on an intention‐to‐treat analysis, there were no significant between‐group differences in pregnancy outcome or complications. When studying the relationship between digestive compounds and amniotic fluid inflammatory markers, a clear correlation was found between bile acid and both ferritin and interleukin 1β (IL1β). Conclusions In humans, amnioexchange, as described in our protocol, is not an option for fetal care; however, we provide supplementary proof of the involvement of inflammation in the pathogenicity of gastroschisis and suggest that future research should aim at reducing inflammation. ClinicalTrials.gov: NCT00127946. Tweetable abstract A prospective, interventional, randomised study shows no benefit of amnioexchange for fetal gastroschisis in humans.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

A randomised controlled trial of amnioexchange for fetal gastroschisis

Luton

Mitanchez

Winer

et al. 2019

BJOG

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“…Two RCTs and eight observational cohort studies were included in the meta-analysis. 4,5,[11][12][13][14][15][16][17][18] All studies were published in English. Six of the included studies compared elective delivery at GA of 34 to 35 weeks for the infants with antenatally detected gastroschisis versus the control of expectant management, and four studies compared elective delivery at GA of 36 to 37 weeks versus the control of expectant management and delivery after GA of 36 to 37 for gastroschisis.…”

Section: Resultsmentioning

confidence: 99%

“…Group 1: Data was not sufficient for meta-analysis as only one study 15 presented date showing 0 death in elective delivery group and 2 (5.1%) deaths in control group.…”

Section: Mortalitymentioning

confidence: 99%

Elective Delivery versus Expectant Management for Gastroschisis: A Systematic Review and Meta-Analysis

et al. 2022

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Introduction: The optimal timing of delivery for pregnancies complicated by foetal gastroschisis remains controversial. Therefore, the aim of this study is to find whether elective or expectant delivery is associated with improved neonatal outcome. Materials and Methods: MEDLINE and Embase databases were searched for studies up to 2021 that reported timing of delivery for foetal gastroschisis. A systematic review and meta-analysis were then performed in group 1: moderately preterm (Gestational age, [GA] 34-35 weeks) elective delivery versus expectant management after GA 34-35 weeks; and group 2: near-term (GA 36-37 weeks) elective delivery versus expectant management after GA 36-37 weeks. The following clinical outcomes were evaluated: length of stay (LOS), total parenteral nutrition (TPN) days, bowel morbidity (atresia, perforation, and volvulus), sepsis, time of first feeding, short gut syndrome and respirator days, and mortality. Results: Two randomised controlled trails (RCT)s and eight retrospective cohort studies were included, comprising of 629 participants. Moderately preterm elective delivery failed to improve clinical outcomes. However, near-term elective delivery significantly reduced bowel morbidity (7.4% vs 15.4%, RR=0.37; CI 0.18, 0.74; p=0.005; I2=0%) and TPN days (MD=-13.44 days; CI -26.68, -0.20; p=0.05; I2=45%) compared to expectant delivery. The mean LOS was 39.2 days after near-term delivery and 48.7 days in the expectant group (p=0.06). Conclusions: Based on the data analysed, near-term elective delivery (GA 36-37 weeks) appears to be the optimal timing for delivery of pregnancies complicated by foetal gastroschisis as it is associated with less bowel morbidity and shorter TPN days. However, more RCTs are necessary to better validate these findings.

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“…According to the literature, 17.4–55.5% of foetuses with GS have foetal growth restriction (FGR). Abnormal Doppler parameters in foetuses with gastroschisis are rarely seen, so FGR in this group may be related to protein and fluid loss through the exposed intestine rather than placental insufficiency [ 29 , 36 , 37 , 38 ]. In our study group, we observed a smaller number of foetuses with an FGR diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Perinatal Outcomes of Neonates with Complex and Simple Gastroschisis after Planned Preterm Delivery—A Single-Centre Retrospective Cohort Study

Jaczyńska¹,

Mydlak²,

Mikulska³

et al. 2023

Diagnostics

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This research analysed early neonatal outcomes of complex and simple gastroschisis following planned elective preterm delivery in relation to prenatal ultrasound assessment of bowel conditions. A retrospective study of 61 neonates with prenatal gastroschisis diagnosis, birth, and management at a single tertiary centre from 2011 to 2021 showed a 96.72% survival rate with no intrauterine fatalities. Most cases (78.7%) were simple gastroschisis. Neonates with complex gastroschisis had longer hospital stays and time to full enteral feeding compared to those with simple gastroschisis—75.4 versus 35.1 days and 58.1 versus 24.1 days, respectively. A high concordance of 86.90% between the surgeon’s and perinatologist’s bowel condition assessments was achieved. The caesarean delivery protocol demonstrated safety, high survival rate, primary closure, and favourable outcomes compared to other reports. Prenatal ultrasound effectively evaluated bowel conditions and identified complex gastroschisis cases.

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Management and outcome challenges in newborns with gastroschisis: A 6-year retrospective French study

Abstract: Future research should focus on decisions about delivery timing by incorporating risk of neonatal morbidity.

Cited by 8 publications

References 17 publications

A randomised controlled trial of amnioexchange for fetal gastroschisis

A randomised controlled trial of amnioexchange for fetal gastroschisis

Elective Delivery versus Expectant Management for Gastroschisis: A Systematic Review and Meta-Analysis

Perinatal Outcomes of Neonates with Complex and Simple Gastroschisis after Planned Preterm Delivery—A Single-Centre Retrospective Cohort Study

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