Outcome and management in neonates with gastroschisis in the third millennium—a single-centre observational study

Abstract

Gastroschisis is one of the most common congenital malformations in paediatric surgery. However, there is no consensus regarding the optimal management. The aims of this study were to investigate the management and outcome and to identify predictors of outcome in gastroschisis. A retrospective observational study of neonates with gastroschisis born between 1999 and 2020 was undertaken. Data was extracted from the medical records and Cox regression analysis was used to identify predictors of outcome measured by length of hospital stay (LOS) and duration of parenteral nutrition (PN). In total, 114 patients were included. Caesarean section was performed in 105 (92.1%) at a median gestational age (GA) of 36 weeks (range 29–38) whereof (46) 43.8% were urgent. Primary closure was achieved in 82% of the neonates. Overall survival was 98.2%. One of the deaths was caused by abdominal compartment syndrome and one patient with intestinal failure–associated liver disease died from sepsis. None of the deceased patients was born after 2005. Median time on mechanical ventilation was 22 h. Low GA, staged closure, intestinal atresia, and sepsis were independent predictors of longer LOS and duration on PN. In addition, male sex was an independent predictor of longer LOS.Conclusion: Management of gastroschisis according to our protocol was successful with a high survival rate, no deaths in neonates born after 2005, and favourable results in LOS, duration on PN, and time on mechanical ventilation compared to other reports. Multicentre registry with long-term follow-up is required to establish the best management of gastroschisis. What is Known:• Gastroschisis is one of the most common congenital malformations in paediatric surgery with increasing incidence.• There is no consensus among clinicians regarding the optimal management of gastroschisis. What is New:• Although primary closure was achieved in 82% of the patients, mortality rate was very low (1.8%) with no deaths in neonates born after 2005 following the introduction of measurement of intraabdominal pressure at closure.• Low gestational age, staged closure, intestinal atresia, sepsis, and male sex were independent predictors of longer length of hospital stay.

Estudos Multidisciplinares Sobre Saúde Da Criança E Do Adolescente

“…Descrita pela primeira vez na literatura por Calder em 1733, trata-se de um defeito congênito da parede abdominal periumbilical normalmente a direita do cordão umbilical onde as vísceras intra-abdominais sofrem herniação e ficam expostas ao líquido amniótico durante o período gravidez. (RÄSÄNEN, et al;2022. O'CONNELL, et al; É uma alteração que ocorre precocemente no desenvolvimento embriológico, em torno de 6 a 10 semanas após a concepção e pode ser detectada durante o pré-natal, de forma que o acompanhamento adequado da gestante desempenha um papel fundamental no prognóstico dos pacientes.…”

“…O'CONNELL, et al; É uma alteração que ocorre precocemente no desenvolvimento embriológico, em torno de 6 a 10 semanas após a concepção e pode ser detectada durante o pré-natal, de forma que o acompanhamento adequado da gestante desempenha um papel fundamental no prognóstico dos pacientes. A etiologia ainda é desconhecida, porém, acredita-se que pode envolver falha do mesoderma em formar a parede corporal, ruptura do âmnio ao redor do anel umbilical, involução anormal da veia umbilical direita levando enfraquecimento da parede do corpo e ruptura da artéria vitelina direita, ou artéria do saco vitelino, com posterior danos na parede do corpo (RÄSÄNEN, et al;2022. SKARSGARD;.…”

Role of Surgery in the Outcome Difference of Gastroschisis between High-income and Lowmiddle- income Countries: A Review

“…Still, there are endeavors to modify surgical procedures to reduce morbidity in HICs and mortality in LMICs. 1,5,[7][8][9][10] The uncovered intestine creates two different types of problems. In utero, it is exposed to the amniotic fluid and undergoes chemical changes.…”

Gastrosquise: Uma Emergência Pediátrica

“…Descrita pela primeira vez na literatura por Calder em 1733, trata-se de um defeito congênito da parede abdominal periumbilical normalmente a direita do cordão umbilical onde as vísceras intra-abdominais sofrem herniação e ficam expostas ao líquido amniótico durante o período gravidez. (RÄSÄNEN, et al;2022. O'CONNELL, et al;2016) É uma alteração que ocorre precocemente no desenvolvimento embriológico, em torno de 6 a 10 semanas após a concepção e pode ser detectada durante o pré-natal, de forma que o acompanhamento adequado da gestante desempenha um papel fundamental no prognóstico dos pacientes.…”

“…O'CONNELL, et al;2016) É uma alteração que ocorre precocemente no desenvolvimento embriológico, em torno de 6 a 10 semanas após a concepção e pode ser detectada durante o pré-natal, de forma que o acompanhamento adequado da gestante desempenha um papel fundamental no prognóstico dos pacientes. A etiologia ainda é desconhecida, porém, acredita-se que pode envolver falha do mesoderma em formar a parede corporal, ruptura do âmnio ao redor do anel umbilical, involução anormal da veia umbilical direita levando enfraquecimento da parede do corpo e ruptura da artéria vitelina direita, ou artéria do saco vitelino, com posterior danos na parede do corpo (RÄSÄNEN, et al;2022. SKARSGARD;2016).…”