Outcomes in gastroschisis: expectations in the postnatal period for simple vs complex gastroschisis

Dekonenko, Charlene; Fraser, Jason D.; Deans, Katherine J.; Fallat, Mary E.; Helmrath, Michael A.; Kabre, Rashmi; Leys, Charles M.; Burns, R. Cartland; Corkumd, Kristine; Dillon, Patrick A.; Downard, Cynthia D.; Wright, Tiffany; Gadepalli, Samir K.; Grabowski, Julia; Hernandez, Edward; Hirschl, Ronald B.; Johnson, K. Norman; Kohler, Jonathan E.; Landman, Matthew P.; Landisch, Rachel M.; Lawrence, Amy E.; Mak, Grace Z.; Minneci, Peter C.; Rymeski, Beth; Sato, Thomas T.; Slater, Bethany J.; Peter, Shawn D. St.

doi:10.1038/s41372-021-01093-8

Cited by 7 publications

(6 citation statements)

References 11 publications

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“…Interestingly, lower gestational age and the presence of bowel matting were associated with increased length of stay, while lower birth weight was associated with mortality. 101 Furthermore, long-term morbidity from gastroschisis could be related to intestinal dysmotility (pseudointestinal obstruction), malabsorption (mucosal injury), and gastroesophageal reflux disease. Difficulty obtaining wound closure contributes to morbidity by prolonging intestinal dysfunction (ileus) and creating ventral hernias, which may require surgical repair.…”

Section: Prognosismentioning

confidence: 99%

Gastroschisis: Anatomic Defects, Etiopathogenesis, Treatment, and Prognosis

Maheshwari¹,

Rahman²,

Kasniya³

et al. 2022

Newborn

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Gastroschisis is a congenital defect in the abdominal wall that is typically located to the right of the umbilicus. The intestines, and sometimes parts of the liver and the stomach, also protrude into the amniotic space. Unlike in omphaloceles, these visceral organs do not have a covering sac and are directly exposed to the amniotic fluid. The organs show variable degrees of inflammatory changes and scarring. In this review, we have summarized currently available information on the anatomical changes in the intestine directly exposed to the amniotic fluid, the etiopathogenesis, treatment, and prognosis.

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Section: Prognosismentioning

confidence: 99%

Gastroschisis: Anatomic Defects, Etiopathogenesis, Treatment, and Prognosis

Maheshwari¹,

Rahman²,

Kasniya³

et al. 2022

Newborn

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“…Data were extracted from a meta‐analysis 14 complemented by 11 other studies 1,15,19,23–25, 27,28,30,60,61 and calculated as an average of values from these studies.…”

Section: Background and Rationale For Fetal Repair Of Complex Gastros...mentioning

confidence: 99%

“…Advances in parenteral nutrition strategies, neonatal management and surgical care have reduced the overall perinatal mortality of patients with GS to less than 5% (0-4.6%) [20][21][22] . While the postnatal mortality for simple GS has improved (0-2.2%) 15,23,24 , complex GS is still associated with significant mortality in many USA (up to 11%) and European (up to 17%) centers (Table 1) 14,15,[25][26][27] . Sepsis, which usually presents in the neonatal period, is the leading cause of death in this population.…”

Section: Background and Rationale For Fetal Repair Of Complex Gastros...mentioning

confidence: 99%

“…Short-and medium-term intestinal complications are related to the ongoing bowel dysfunction and the subsequent need for total parenteral nutrition 21,25,29 . Patients with complex GS have a higher prevalence of short bowel syndrome, necrotizing enterocolitis and sepsis as well as a three-times longer length of hospital stay and duration of parenteral nutrition (around 4 months) when compared to cases with simple GS (Table 1) 14,15,60,61 . Short bowel syndrome and abdominal compartment syndrome require repeat surgeries, including emergent laparotomy, silo placement and staged delayed closure with a prosthetic patch 61 .…”

Section: Absence Of Fully Effective Gold-standard Postnatal Therapymentioning

confidence: 99%

“…Furthermore, a subtype of complex GS with necrosis called closed GS encompasses vanishing gut and short bowel syndrome [10][11][12][13][14] . Overall complex GS accounts for about 20% of cases of GS 14,15 .…”

Section: Background and Rationale For Fetal Repair Of Complex Gastros...mentioning

confidence: 99%

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Complex gastroschisis: a new indication for fetal surgery?

Joyeux

Belfort

Coppi

et al. 2021

Ultrasound in Obstet & Gyne

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Gastroschisis (GS) is a congenital abdominal wall defect, in which the bowel eviscerates from the abdominal cavity. It is a non‐lethal isolated anomaly and its pathogenesis is hypothesized to occur as a result of two hits: primary rupture of the ‘physiological’ umbilical hernia (congenital anomaly) followed by progressive damage of the eviscerated bowel (secondary injury). The second hit is thought to be caused by a combination of mesenteric ischemia from constriction in the abdominal wall defect and prolonged amniotic fluid exposure with resultant inflammatory damage, which eventually leads to bowel dysfunction and complications. GS can be classified as either simple or complex, with the latter being complicated by a combination of intestinal atresia, stenosis, perforation, volvulus and/or necrosis. Complex GS requires multiple neonatal surgeries and is associated with significantly greater postnatal morbidity and mortality than is simple GS. The intrauterine reduction of the eviscerated bowel before irreversible damage occurs and subsequent defect closure may diminish or potentially prevent the bowel damage and other fetal and neonatal complications associated with this condition. Serial prenatal amnioexchange has been studied in cases with GS as a potential intervention but never adopted because of its unproven benefit in terms of survival and bowel and lung function. We believe that recent advances in prenatal diagnosis and fetoscopic surgery justify reconsideration of the antenatal management of complex GS under the rubric of the criteria for fetal surgery established by the International Fetal Medicine and Surgery Society (IFMSS). Herein, we discuss how conditions for fetoscopic repair of complex GS might be favorable according to the IFMSS criteria, including an established natural history, an accurate prenatal diagnosis, absence of fully effective perinatal treatment due to prolonged need for neonatal intensive care, experimental evidence for fetoscopic repair and maternal and fetal safety of fetoscopy in expert fetal centers. Finally, we propose a research agenda that will help overcome barriers to progress and provide a pathway toward clinical implementation. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

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Gastroschisis: Progress and Challenges

Merritt

2022

The Journal of Pediatrics

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Outcomes in gastroschisis: expectations in the postnatal period for simple vs complex gastroschisis

Cited by 7 publications

References 11 publications

Gastroschisis: Anatomic Defects, Etiopathogenesis, Treatment, and Prognosis

Gastroschisis: Anatomic Defects, Etiopathogenesis, Treatment, and Prognosis

Complex gastroschisis: a new indication for fetal surgery?

Gastroschisis: Progress and Challenges

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