Risk factors for adverse outcome of newborns with gastroschisis in a Brazilian hospital

Vilela, Paulo Carvalho; Amorim, Melânia Maria Ramos; Falbo, Gilliatt Hanois; Santos, Luiz Carlos

doi:10.1053/jpsu.2001.22282

Cited by 42 publications

(33 citation statements)

References 30 publications

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“…bias because the children with severe intestinal damage were generally the ones that could not be closed primarily [7,15,16]. Several investigators in the 1980s and 1990s studied the phenomenon of ischemic bowel after primary closure for gastroschisis and suggested that elevated intraabdominal pressure was responsible [9,[17][18][19].…”

Section: Discussionmentioning

confidence: 99%

Routine use of a SILASTIC spring-loaded silo for infants with gastroschisis: a multicenter randomized controlled trial

Pastor

Phillips

Fenton

et al. 2008

Journal of Pediatric Surgery

104

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Section: Discussionmentioning

confidence: 99%

Routine use of a SILASTIC spring-loaded silo for infants with gastroschisis: a multicenter randomized controlled trial

Pastor

Phillips

Fenton

et al. 2008

Journal of Pediatric Surgery

104

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“…Controversies regarding time between delivery and surgery exist. For many surgeons, time between delivery and surgical repair have to be reduced as soon as possible to provide good outcome [35,36] by reducing bowel oedema and facilitating reintegration. Some studies focused on a delayed surgery, there were no difference (concerning morbidity, mortality, TPN duration) for newborn treated before or after 6-7 h [10, 37] (which is not a really long delay).…”

Section: Discussionmentioning

confidence: 99%

Scheduled preterm delivery for gastroschisis improves postoperative outcome

et al. 2008

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There are some evidence to suggest that careful antenatal monitoring, scheduled preterm delivery and immediate abdominal wall closure may reduce gastroschisis morbidity. We hypothesised that the advantages of a scheduled preterm delivery balance possible complications related to prematurity. A retrospective study was performed including all cases of gastroschisis born between 1990 and 2004 (n = 69). Cases were categorised in two groups. Group 1 contained gastroschisis cases born between 1990 and 1997. Group 2 contained cases occurring since 1997, when a new management pathway for gastroschisis was established: weekly evaluation of the foetal gut by ultrasound (>28 weeks), corticosteroids, and delivery by scheduled caesarean section at 35 weeks (before if evidence of bowel compromise was present). The primary endpoints of this study were the initiation of oral feeding and the number of re-operation for intestinal obstruction. There was a significantly faster initiation of oral feeding (P < 0.0001), however, duration of parenteral nutrition (34 vs. 38 days) and hospital discharge (53 vs. 58.5 days) was not reduced. There was no complication due to prematurity in group 2. Postoperative outcome was improved with less need for muscular stretching or prosthetic patch and less re-operation for intestinal obstruction (P < 0.05). Scheduled and elective preterm delivery facilitates surgical procedure and shortens the time to first feeding. A delivery at 35 weeks (preferring vaginal delivery) seems to be a good compromise between risks related to prematurity and complications related to intestinal peel.

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“…The incidence of sepsis in gastroschisis varies worldwide with up to 47% in complex cases of gastroschisis [10]. In many third world countries, the overall mortality rate for gastroschisis is over 50% with sepsis causing over 90% of these deaths [11]. Several factors have been reported as predictors for the onset of sepsis.…”

Section: Discussionmentioning

confidence: 99%

Infections in gastroschisis: organisms and factors

et al. 2008

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This study aimed to define the incidence, causative organisms and predisposing factors leading to infection related morbidity in newborns with gastroschisis. All gastroschisis patients admitted over the 5-year period (1999-2004) were retrospectively reviewed. Surveillance samples, wound, blood, urine and fecal cultures were analyzed. Duration of total parenteral nutrition, antibiotic therapy, feeding regimes and demographic data were also analyzed. Multiple logistic regression was employed using the SPSS system and p < 0.05 was considered as significant. Seventy-two neonates were identified with 53% having abnormal gut carriage mostly due to Enterobacter and Klebsiella. Wound infection occurred in 20% of cases. Abnormal gut carriage predisposed to the development of wound infection. Line sepsis occurred in 21% of neonates. Endogenous coagulase negative Staphylococcus caused 74% of septic episodes. There was no correlation between abnormal gut carriage and the development of line sepsis. Overall survival was 96%. The cause of infections in gastroschisis patients appears to be multifactorial. A multidisciplinary team can play an important role in reducing the incidence of infections. Strict aseptic protocols and auditing practice can be the invaluable tools in decreasing morbidity rates.

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Risk factors for adverse outcome of newborns with gastroschisis in a Brazilian hospital

Cited by 42 publications

References 30 publications

Routine use of a SILASTIC spring-loaded silo for infants with gastroschisis: a multicenter randomized controlled trial

Routine use of a SILASTIC spring-loaded silo for infants with gastroschisis: a multicenter randomized controlled trial

Scheduled preterm delivery for gastroschisis improves postoperative outcome

Infections in gastroschisis: organisms and factors

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