Gastroschisis with intestinal atresia leads to longer hospitalization and poor feeding outcomes

Riddle, Stefanie; Haberman, Beth; Miquel-Verges, Franscesca; Sømme, Stig; Sullivan, Kevin M.; Rajgarhia, Ayan; Zaniletti, Isabella; Jacobson, Elizabeth

doi:10.1038/s41372-021-01131-5

Cited by 10 publications

(5 citation statements)

References 21 publications

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“…It has previously been reported that 42.2% of infants with gastroschises 18 and 24.0% of infants with EA and LGEA 19 were breastfed at discharge. However, growth status at discharge and at 1 year of age was not reported.…”

Section: Introductionmentioning

confidence: 99%

Feeding Practice, Nutrition, and Growth in Infants with Abdominal Wall Defects and Esophageal Atresia: A Retrospective Case–Control Study

et al. 2022

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Introduction Infants born with abdominal wall defects and esophageal atresia (EA) are at risk of impaired growth. Little is known about the optimal nutritional strategy and its impact on growth for these infants. This study aims to explore nutrition, focusing on breastfeeding, and the presumed impact on infant growth during the first year of life. Materials and Methods We performed a registry study. The participants comprised infants born with gastroschisis, omphalocele, or EA from 2009 to 2020. Breastfed healthy infants from the Odense Child Cohort served as the control group. Descriptive statistics were applied when presenting data on nutrition. Growth data were converted to weight z-scores at birth and at discharge, and estimated weight z-scores at 6 and 12 months were calculated. Univariate regression analysis was applied. Results The study included 168 infants in the study group and 403 infants in the control group. Exclusive breastfeeding rates at discharge were as follows: 55.7% (gastroschisis), 58.3% (omphalocele), 50.9% (EA), and 7.7% (long-gap EA). For the study group our data demonstrate no difference in growth at 1 year of age when comparing mother's milk to formula feeding. During the first year of life, infants in the study group showed slower growth compared with the control group. At 12 months of age, all infants had a mean weight z-score above –2. Conclusion Breastfeeding in infants with abdominal wall defects and EA can be established without compromising growth. Mother's milk can be recommended for infants with abdominal wall defects and EA.

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Section: Introductionmentioning

confidence: 99%

Feeding Practice, Nutrition, and Growth in Infants with Abdominal Wall Defects and Esophageal Atresia: A Retrospective Case–Control Study

et al. 2022

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“…1 When an associated intestinal atresia is present, management becomes more nuanced based on clinical stability and intra-abdominal findings. 2 Traditional surgical options include primary closure with delayed resection and anastomosis, undertaken when abdominal adhesions have improved (approximately 6-8 weeks later at our institution) or stoma creation with delayed anastomosis. 1,2 Primary closure with delayed anastomosis without an ostomy is generally favored to avoid ostomy complications and allow resolution of inflammation and edema.…”

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confidence: 99%

“…These findings highlight the need for individualized care and more specifically that restoration of intestinal continuity is paramount to the treatment and outcomes of complex gastroschisis. 2 In cases of complex gastroschisis presenting with concomitant intestinal atresia, the positive outcomes including restoration of intestinal continuity with reduced surgical interventions, decreased length of stay, as well as decreased use of prolonged parenteral nutrition and its associated complications suggest surgical management of intestinal atresias at the initial abdominal closure may prove efficacious. Specific considerations at the time of assessment include absence of edema in the bowel wall, absence of interloop adhesions or bowel matting, appropriate size match between 2 segments planned for anastomotic repair, and ensurance of adequate mesenteric blood flow.…”

mentioning

confidence: 99%

“…2 Traditional surgical options include primary closure with delayed resection and anastomosis, undertaken when abdominal adhesions have improved (approximately 6-8 weeks later at our institution) or stoma creation with delayed anastomosis. 1,2 Primary closure with delayed anastomosis without an ostomy is generally favored to avoid ostomy complications and allow resolution of inflammation and edema. 1 Historically, discussion regarding the safety and timing of primary anastomosis has been limited to case reports and seminar publications with few comparative studies.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

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Management of Complex Gastroschisis: Early Primary Anastomoses at the Time of Abdominal Wall Closure

Lotakis

Parekh

Kim

et al. 2023

The American Surgeon™

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Long‐term gastrointestinal morbidity in patients born with gastroschisis: A national register‐based cohort study

Caldeman,

Fogelström,

Wester

et al. 2024

J. pediatr. gastroenterol. nutr.

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ObjectivesIn gastroschisis, the intestines are exposed to amniotic fluid during pregnancy. The defect in the abdominal wall may also compress the mesentery and impair the intestinal blood supply. There is a varying degree of intestinal damage at birth. Complex gastroschisis is defined as gastroschisis with severe complications such as intestinal atresia, volvulus, necrosis and perforation. The aim of this study was to investigate long‐term gastrointestinal morbidity and compare simple and complex cases.MethodsA nation‐wide retrospective cohort study with data from national registers was conducted. All children born with gastroschisis in Sweden from 1 January 1997 to 31 December 2016 were included in the study. Exposure was complex gastroschisis and the primary outcomes were intestinal failure and bowel obstruction.ResultsThe study included 315 cases with gastroschisis, 260 classifieds as simple gastroschisis and 55 as complex. The median time to follow was 8 years. A significantly higher risk of developing intestinal failure (hazard ratio [HR]: 11.7) was found in complex cases. Nine percent of the complex cases underwent autologous gastrointestinal reconstructive surgery for intestinal failure, none of the simple cases did. The complex cases had a higher risk for bowel obstruction (HR: 4.3) with a higher proportion requiring surgery (18.2% vs. 6.9%) compared to simple cases.ConclusionsThis nationwide study showed that the risk for intestinal failure and bowel obstruction is significantly higher for children with complex gastroschisis compared to simple gastroschisis. Most of the events occurred during the first 2 years of life.

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Gastroschisis with intestinal atresia leads to longer hospitalization and poor feeding outcomes

Cited by 10 publications

References 21 publications

Feeding Practice, Nutrition, and Growth in Infants with Abdominal Wall Defects and Esophageal Atresia: A Retrospective Case–Control Study

Feeding Practice, Nutrition, and Growth in Infants with Abdominal Wall Defects and Esophageal Atresia: A Retrospective Case–Control Study

Management of Complex Gastroschisis: Early Primary Anastomoses at the Time of Abdominal Wall Closure

Long‐term gastrointestinal morbidity in patients born with gastroschisis: A national register‐based cohort study

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