Gastroschisis: Small hole, big cost

Sydorak, Roman M.; Nijagal, Amar; Sbragia, Lourenço; Hirose, Shinjiro; Tsao, KuoJen; Phibbs, Roderic H.; Schmitt, Susan; Lee, H.; Farmer, Diana L.; Harrison, M. R.; Albanese, Craig T.

doi:10.1053/jpsu.2002.36689

Cited by 90 publications

(60 citation statements)

References 10 publications

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“…8 Gastroschisis is also known to be an 'expensive' malformation to care for, based on its disproportionate resource consumption relative to other NICU diagnostic cohorts. 9 For these reasons alone, there is potential value in discerning perinatal variables that would allow identification of the subset of infants who are likely to be the most resource intensive and who are at highest risk for adverse outcome. For research purposes, there is also potential benefit in being able to risk stratify infants with gastroschisis to allow analysis of outcome variation by treatment.…”

Section: Discussionmentioning

confidence: 99%

Perinatal predictors of outcome in gastroschisis

et al. 2010

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Objective: To identify perinatal risk variables predictive of outcome in gastroschisis.Study Design: Gastroschisis cases were collected over a 3-year period from a national database. Risk variables evaluated included gestational age (GA), birth weight, time of birth, admission illness severity (score for neonatal acute physiology-II, SNAP-II) score, and abdominal closure type. Mortality and survival outcomes were analyzed. Multivariate analyses were performed.Result: In all, 239 infants were survived (96%). SNAP-II score predicted mortality (relative risk (RR) ¼ 1.07, 95% confidence interval (CI) ¼ 1.0 to 1.1). Length of hospital stay (LOS) and ventilation days were predicted by GA and by SNAP-II score. SNAP-II score predicted total parenteral nutrition (TPN) days (P ¼ 0.006). Severe cholestasis (conjugated bilirubin of >10 mg per 100 ml) was inversely related to GA (RR ¼ 0.77, 95% CI ¼ 0.61 to 0.97) and directly to categorical SNAP-II score (RR ¼ 3.4, 95% CI ¼ 1.2 to 10.1). Urgent closure predicted fewer TPN days (P ¼ 0.003) and shorter LOS (P ¼ 0.0002).Conclusion: SNAP-II scores significantly predict mortality and survival outcomes. Urgent closure favors fewer TPN days and shorter LOS. Our data refute routine preterm delivery in gastroschisis.

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Section: Discussionmentioning

confidence: 99%

Perinatal predictors of outcome in gastroschisis

et al. 2010

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“…[2][3][4]8,9,[11][12][13]16 secondary to direct action on the eviscerated loops for a large part of the pregnancy. [5][6][7][8][9][10][17][18][19][20] However, there are doubts about which component substances or substances might be responsible for the intestinal shortening, thickening and reduced peristalsis found in these patients. [1][2][3][4][11][12][13][14]21 Urine is the principal component of amniotic fluid, 5,9,[11][12][13]17 and, because of this, it has often been blamed for the intestinal damage, since the fetus physiologically urinates into the amniotic cavity.…”

Section: Discussionmentioning

confidence: 99%

“…The first attempt to quantify the inflammatory reaction of the surface of the intestinal loops and correlate it with substances present in the amniotic fluid of patients suffering from gastroschisis was made by Sherman et al 1 Because gastroschisis results in the bowel loops being in direct contact with the amniotic fluid, this exposure is held to be one of the principal factors responsible for the thickening and shortening of the intestine, which is common with this pathology. [2][3][4][5][6][7][8][9][10] Urine, the major component of this embryonic fluid compartment, has been blamed for damage to the intestinal wall by many authors. 5,9,[11][12][13] These observations are based on the physiological principal that all of the fetus' urine is excreted into the amniotic cavity.…”

Section: Introductionmentioning

confidence: 99%

Reação inflamatória nas alças intestinais de ratos: pode a urina intraperitonial causar dano?

Ferreira¹,

Amantéa²,

Trindade³

et al. 2003

J. Pediatr. (Rio J.)

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Objective: To observe the intensity of the inflammatory reaction caused by urine on the intestinal wall of rats. Methods:Experimental model, using 20 Wistar rats divided into two groups. All the animals were submitted to abdominal puncture at the right inferior quadrant, twice daily for five days. In Group I (control group) no substance was inoculated during the procedure, while in Group II (urine group), 3 ml of neonatal urine were inoculated. The animals were killed on the sixth day. A small-bowel specimen was fixed in paraffin and stained with hematoxylin-eosin. Microscopic analysis was performed by the same pathologist in all cases for determination of the degree of inflammatory reaction in the intestinal wall.Results: All animals completed the experiment. In group I (control group) serositis was observed in six animals and enteritis in one. In group II (urine group) serositis was observed in nine animals and enteritis in four. The groups were similar in terms of the intensity of the inflammatory reaction observed (p = 0.1). Conclusion:The intra-abdominal inoculation of neonatal urine did not produce significant inflammatory reactions in the intestinal wall of rats.J Pediatr (Rio J). 2003;79(6):525-29: Gastrosquise, rats, intestine damage, urine.

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“…The complexity of this malformation depends on its association with intestinal atresia, perforation, necrosis and volvulus, which makes the surgical management needed evolve to a short bowel syndrome frame, prolongs the hospital stay and promotes a number of comorbidities 13 .…”

Section: Introductionmentioning

confidence: 99%

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

Redondo¹,

Feferbaum

Vieira

et al. 2016

J. Hum. Growth Dev.

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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. ...

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Gastroschisis: Small hole, big cost

Cited by 90 publications

References 10 publications

Perinatal predictors of outcome in gastroschisis

Perinatal predictors of outcome in gastroschisis

Reação inflamatória nas alças intestinais de ratos: pode a urina intraperitonial causar dano?

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

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