Characteristics of the clinical development of a newborn with gastroschisis in an intensive care unit in latin america

Abstract

Introduction: Congenital malformations are major diseases observed at birth. They are the second most common cause of death in the neonatal population, the fi rst one being prematurity.Objective: To characterise the clinical outcome of newborns with gastroschisis (GS) in a neonatal intensive care unit. Methods:A retrospective observational clinical study in 50 infants with GS using the association of intestinal abnormalities, impossibility of primary closure of the abdominal defect and reoperation necessity as classifi cation criteria for the disease. The signifi cance level was p < 0.05. Results:The hospitalisation to primary surgery occurred with a median age of 2 hours. Fourteen percent of children were subjected to a primary silo interposition and 24% had associated intestinal malformation. Nineteen newborns (NB) required more than one surgery. The median length of stay was 33 days, higher in patients with complex GS (56 days). All NB recovered from urine output 48 hours after surgery and 40% had hyponatraemia and oligoanuria in this period. There was no difference between the natraemia and fasting time (p = 0.79). Weight gain was similar in both groups with total parenteral nutrition and became signifi cantly higher in patients with simple GS after enteral feeding (p = 0.0046). These NB evolved 2.4 times less cholestasis. Late-onset sepsis occurred in 58% of patients and was related to the infection of the central venous catheter in 37.9% of cases. Mortality was higher in infants infected with complex GS and the overall mortality rate was 14%. Conclusion:Clinical characterisation of newborns with gastroschisis depends on the complexity and the knowledge and conduct of morbidities to reduce mortality.Key words: gastroschisis, new-born, mortality, total parenteral nutrition, renal insuffi ciency, infection. INTRODUCTIONCongenital malformations are major diseases observed at birth. In the United States, a prevalence of about 3% 1 is cited. In Brazil, a study at the Fernandez Figueira Institute in Rio de Janeiro found that the prevalence was similar, i.e. 2.7% among live newborns (NB) and 6.7% among stillbirths. Among the causes of death, neonatal malformations are the second most common reason, the fi rst one being prematurity 2 .Gastroschisis (GS) is a congenital malformation of the abdominal wall that has increased in prevalence worldwide; its causes have not been fully elucidated 3 . In the 1960s, the prevalence of this disease was 1:50,000 live births. However, Kirby et al. 4 - -Characteristics of the clinical development of a newborn with gastroschisis in an intensive care unit in latin america J Hum Growth Dev. 2016; 26(2): 190-198 DOI: http://dx.doi.org/10.7322/jhgd.119266 temporal increase of 2.23 per 10,000 live births to 4.42 per 10,000 Regarding the defi nition of live births. The current prevalence in South America is 2.9:10,000 5 . This disease is characterised by a defect in abdominal wall closure with herniation of the intestines and other abdominal organs into the amniotic cavity. ...

Growth Analysis of Preterm Newborns With Gastroschisis During Hospitalization in a Neonatal Intensive Care Unit

“…The median hospital stay was 39.5 days, like the literature, where the hospitalization time in three studies analyzed was 48 days (mean) (25) , 33 days (median) (26) and 37 days (median) (18) . In preterm infants smaller than 1500 g, the hospital stay in a recent publication was 77.5 days (18) .…”

Motor performance evaluation of newborns with gastroschisis after surgical correction

“…The assessment and monitoring of the DNPM of newborns with gastroschisis become a concern as its prevalence increases, although the cause is not fully understood. Some authors associate the increased incidence of the disease with maternal age below 20 years, smoking, use of illicit drugs during pregnancy, placental insufficiency, genetic, dietary factors, and exposure to chemicals 12 . Calderon et al demonstrated in their recent population study carried out in the state of São Paulo-Brazil between the periods from 2005 to 2016 that the annual prevalence of gastroschisis increased by 2.6% 13 .…”

“…The association of gastroschisis with other complications, such as atresia, perforation, necrosis, and intestinal volvulus, increases its complexity and can prolong the hospital stay and favor the occurrence of complications 12 . In surgical patients, infections are frequent complications and, therefore, a reason of concern 16 .…”

“…In surgical patients, infections are frequent complications and, therefore, a reason of concern 16 . Even with the improvement in neonatal intensive care, sepsis is still among the main causes of neonatal morbidity and mortality, associated with longer hospital stays and hospital costs 12,[16][17][18] . Neonatal sepsis, in addition to being a risk for delayed motor development, is associated with the incidence of cerebral palsy and high mortality 16,18 .…”

“…NB undergoing surgical procedures present several risks. In addition to sepsis, they are exposed to other situations that may influence neurological development, such as the need for mechanical lung ventilation, use of sedatives and anesthetics, difficulty in controlling pain, difficulty in progressing the diet with the use of prolonged parenteral nutrition, and frequently changes in DNPM will be evident in the long run 12,19,20 .…”