Neonatal outcome of gastroschisis and exomphalos: A 10‐year review

Kitchanan, Srinivasan; Patole, Sanjay; Müller, Reinhold; Whitehall, JS

doi:10.1046/j.1440-1754.2000.00551.x

Cited by 56 publications

(33 citation statements)

References 27 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%

“…Only separate case series have been described for each approach [1], [2], [5], [6] and [7] and comparisons between these do no allow us to determine which is better. Case series describing the traditional approach usually report outcomes on all cases of gastroschisis, whereas those reporting ward reduction are selective and the outcomes are usually better.…”

Section: Index Words: Cohort Studies; Gastroschisis; Operative Surgicmentioning

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: Index Words: Cohort Studies; Gastroschisis; Operative Surgicmentioning

confidence: 99%

Gastroschisis: ward reduction compared with traditional reduction under general anesthesia

Davies

Kimble

Cartwright

2005

Journal of Pediatric Surgery

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“…Taking into account both mortality and morbidity data, the authors of the different studies gave a recommendation on whether to perform an elective CS in cases with prenatally diagnosed gastroschisis. In all, three papers recommended CS 15,23,31 nine papers did not recommend CS 13,16,19,20,24,25,27,29,33 six papers said that it does not matter what you do 21,22,28,30,32,34 and four papers did not give any recommendations 14,17,18,26 . The comparable data on delivery in cases of omphalocele were equally inconclusive.…”

Section: Mode and Timing Of The Deliverymentioning

confidence: 95%

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

Salvesen

2001

Ultrasound in Obstet & Gyne

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“…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.…”

mentioning

confidence: 99%

“…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.…”

mentioning

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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Neonatal outcome of gastroschisis and exomphalos: A 10‐year review

Abstract: Increased morbidity in outborn neonates may be related to factors such as temperature, care, hydration status, care of the defect and vascular compromise of prolapsed gut during prolonged transportation.

Cited by 56 publications

References 27 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?

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

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