Perinatal management of gastroschisis: analysis of a newly established clinical pathway

Vegunta, Ravindra K.; Wallace, Lizabeth J.; Leonardi, Michael R.; Gross, Tom L.; Renfroe, Yolanda; Marshall, J. Stephen; Cohen, Howard; Hocker, James R.; Macwan, Kamlesh S.; Clark, Shealagh; Ramiro, Susan; Pearl, Richard H.

doi:10.1016/j.jpedsurg.2004.11.037

Cited by 65 publications

(46 citation statements)

References 35 publications

(45 reference statements)

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“…While ultrasound for EFW was performed weekly by the majority of providers (79%; 104/131), at least two other studies disagreed on its ability to accurately predict adverse outcomes [27, 28]. There is also debate in the literature regarding the value of measuring bowel wall diameter and its relationship to outcomes, which may further explain the wide range of practices seen in our survey [6, 13, 15, 16, 29, 30]. …”

Section: Discussionmentioning

confidence: 96%

National Practice Patterns for Prenatal Monitoring in Gastroschisis: Gastroschisis Outcomes of Delivery (GOOD) Provider Survey

et al. 2018

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Background: Gastroschisis is an abdominal wall defect with increasing incidence. Given the lack of surveillance guidelines among maternal-fetal medicine (MFM) specialists, this study describes current practices in gastroschisis management. Materials and Methods: An online survey was administered to MFM specialists from institutions affiliated with the North American Fetal Therapy Network (NAFTNet). Questions focused on surveillance timing, testing, findings that changed clinical management, and delivery plan. Results: Responses were obtained from 29/29 (100%) NAFTNet centers, comprising 143/371 (39%) providers. The majority had a regimen for antenatal surveillance in patients with stable gastroschisis (94%; 134/141). Antenatal testing began at 32 weeks for 68% (89/131) of MFM specialists. The nonstress test (55%; 72/129), biophysical profile (50%; 63/126), and amniotic fluid index (64%; 84/131) were used weekly. Estimated fetal weight (EFW) was performed monthly by 79% (103/131) of providers. At 28 weeks, abnormal EFW (77%; 97/126) and Doppler ultrasound (78%; 99/127) most frequently altered management. In stable gastroschisis, 43% (60/140) of providers delivered at 37 weeks, and 29% (40/ 140) at 39 weeks. Discussion: Gastroschisis management differs among NAFTNet centers, although the majority initiate surveillance at 32 weeks. Timing of delivery still requires consensus. Prospective studies are necessary to further optimize practice guidelines and patient care.

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Section: Discussionmentioning

confidence: 96%

National Practice Patterns for Prenatal Monitoring in Gastroschisis: Gastroschisis Outcomes of Delivery (GOOD) Provider Survey

et al. 2018

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“…Moreover, most experts advocate delivery in a tertiary center with neonatal intensive care and pediatric surgery services. Although this would probably lessen the morbidity, there is no firm evidence to date that premature delivery of fetuses with gastroschisis is beneficial for the outcome , however it has been reported that 30% of patients with gastroschisis are delivered prematurely [11]. At our organization, the policy is to deliver infants with gastroschisis by induced vaginal delivery at approximately 37 to 38 weeks because these babies are more likely to develop IUGR and are more prone to fetal demise.…”

Section: Discussionmentioning

confidence: 99%

Neonatal Outcome of Abdominal Wall Defects at a Tertiary Center in Oman

Abdellatif¹,

Ahmad²,

A³

et al. 2017

Neonat Pediatr Med

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“…Although multivariate analysis suggests that SNAP-II and GA predict independently, one might reasonably assume that there is some clinical overlap between what the two variables measure physiologically. The issue of the effect of preterm delivery on outcome in gastroschisis continues to evoke debate, with advocates favoring 13,14 and opposing 15 preterm delivery. Our data are in contradiction with the reports of improved outcome resulting from planned delivery before 37 weeks.…”

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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Perinatal management of gastroschisis: analysis of a newly established clinical pathway

Cited by 65 publications

References 35 publications

National Practice Patterns for Prenatal Monitoring in Gastroschisis: Gastroschisis Outcomes of Delivery (GOOD) Provider Survey

National Practice Patterns for Prenatal Monitoring in Gastroschisis: Gastroschisis Outcomes of Delivery (GOOD) Provider Survey

Neonatal Outcome of Abdominal Wall Defects at a Tertiary Center in Oman

Perinatal predictors of outcome in gastroschisis

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