Statistical Analysis of the Main Risk Factors of an Unfavorable Evolution in Gastroschisis

Ţarcă, Elena; Roşu, Solange Tamara; Cojocaru, Elena; Trandafir, Laura Mihaela; Luca, Alina Costina; Lupu, Vasile Valeriu; Moisă, Ştefana Maria; Munteanu, Valentin; Butnariu, Lăcrămioara Ionela; Ţarcă, Viorel

doi:10.3390/jpm11111168

Cited by 7 publications

(17 citation statements)

References 17 publications

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“…The package of free services included risk assessments, medical examinations, laboratory tests and screenings, behavioral screenings, and prenatal counselling sessions [ 17 , 18 ]. However, after 10 years of implementation, 9 out of 10 pregnant women did not receive all the necessary medical services; in the year 2010, seventy-eight percent of mothers underutilized prenatal care services, and after almost 30 years, the antenatal diagnosis rate of congenital malformations detectable antenatally is only 30–50% [ 3 , 18 ]. Young maternal age, marital status—unmarried, low educational level, rural environment, alcohol and tobacco consumption, and Roma ethnicity are the factors most frequently associated with the low use of the free prenatal medical services offered by the health services in our country [ 18 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…Education combined with preconception and premarital counseling are important prevention strategies, focusing on increasing awareness to allow couples to make more informed choices [ 14 , 30 , 31 ]. Health education programs should be implemented in schools to emphasize the importance of preventing unwanted pregnancies at a young age and of a planned pregnancy at the optimal age (20 to 30 years), to ensure adequate periconceptional folic acid intake and avoid the use of toxic substances [ 2 , 3 , 14 , 30 ]. In terms of perinatal management, increasing the rate of antenatal diagnosis of severe associated malformations or giant omphalocele with abdominal-visceral disproportion will lead to therapeutic abortion and decreased postnatal mortality.…”

Section: Discussionmentioning

confidence: 99%

“…In terms of perinatal management, increasing the rate of antenatal diagnosis of severe associated malformations or giant omphalocele with abdominal-visceral disproportion will lead to therapeutic abortion and decreased postnatal mortality. Proper surgical treatment, careful monitoring of abdominal pressure, avoiding the use of empirical antibiotic therapy, and ensuring the strictest aseptic measures in neonatal intensive care units will prevent acute renal failure and sepsis and decrease morbidity and mortality in the case of omphalocele [ 2 , 3 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

“…Although similar in terms of perinatal management and frequently analyzed together as "anterior abdominal wall defects", omphalocele and gastroschisis are two malformations with different etiologies and different antenatal and postnatal risk factors [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

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Current Challenges in the Treatment of the Omphalocele—Experience of a Tertiary Center from Romania

Ţarcă

Cojocaru

Trandafir

et al. 2022

JCM

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Omphalocele is a congenital abdominal wall defect with a constant incidence in recent decades, sometimes representing a real burden for neonatal intensive care units due to prolonged hospitalization and the evolution to death. In our study, we aimed to detect the main risk factors of an unfavorable evolution in the case of omphalocele. Methods: Retrospective cohort study of all neonates with omphalocele treated in our tertiary pediatric hospital during the last three decades; from 158 patients, 139 patients were eligible for the study. We tried to determine the risk of death using logistic regression model. Results: If the neonate develops sepsis, then there is an increased risk (13.03 times) of evolution to death. Similarly, the risk of death is 10.82 times higher in the case of developing acute renal failure, 6.28 times higher in the case of associated abnormalities, 5.54 in the case of developing hemorrhagic disease, and 3.78 in the case of conservative treatment (applied for giant omphalocele or severe chromosomal abnormalities). Prematurity increases by 3.62 times the risk of death. All six independent variables contributed 61.0% to the risk of death. The area under the ROC curve is 0.91, meaning that the diagnostic accuracy of our logistic regression model is very good for predicting the contribution of the six independent variables to the risk of death. Conclusion: Although in the past 30 years we witnessed several improvements in the antenatal diagnosis and management of omphalocele, survival rate remained constant, 47.5% overall. Much effort is still needed to eliminate the risk factors for death in this condition.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Current Challenges in the Treatment of the Omphalocele—Experience of a Tertiary Center from Romania

Ţarcă

Cojocaru

Trandafir

et al. 2022

JCM

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“…The timing and mode of delivery should be based on standard obstetric indications. In the case of a giant omphalocele with a herniated liver, a ruptured sac, and especially when a severe cardiac malformation or an ectopia cordis is associated, cesarean delivery is recommended to avoid herniated viscera damage and prolonged cardiac compression [ 69 , 70 ]. Barring any fetal complications, preterm delivery is not recommended, the consensus being that the pregnancies should be allowed to proceed to term, but the delivery will be planned to take place in a tertiary hospital [ 19 ].…”

Section: Managementmentioning

confidence: 99%

Omphalocele and Cardiac Abnormalities—The Importance of the Association

Ţarcă

Namat²,

Luca

et al. 2023

Diagnostics

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Omphalocele is the most common ventral abdominal wall defect. Omphalocele is associated with other significant anomalies in up to 80% of cases, among which the cardiac ones are the most frequent. The aim of our paper is to highlight, through a review of the literature, the importance and frequency of association between the two malformations and what impact this association has on the management and evolution of patients with these pathologies. We reviewed the titles, the available abstracts, and the full texts of 244 papers from the last 23 years, from three medical databases, to extract data for our review. Due to the frequent association of the two malformations and the unfavorable effect of the major cardiac anomaly on the prognosis of the newborn, the electrocardiogram and echocardiography must be included in the first postnatal investigations. The timing of surgery for abdominal wall defect closure is mostly dictated by the cardiac defect severity, and usually the cardiac defect takes priority. After the cardiac defect is medically stabilized or surgically repaired, the omphalocele reduction and closure of the abdominal defect are performed in a more controlled setting, with improved outcomes. Compared to omphalocele patients without cardiac defects, children with this association are more likely to experience prolonged hospitalizations, neurologic, and cognitive impairments. Major cardiac abnormalities such as structural defects that require surgical treatment or result in developmental delay will significantly increase the death rate of patients with omphalocele. In conclusion, the prenatal diagnosis of omphalocele and early detection of other associated structural or chromosomal anomalies are of overwhelming importance, contributing to the establishment of antenatal and postnatal prognosis.

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Avoiding High Pressure Abdominal Closure of Congenital Abdominal Wall Defects—One Step Further to Improve Outcomes

Mocanu,

Cîrstoveanu,

Bizubac

et al. 2023

Children

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The main goal of surgical treatment for gastroschisis and omphalocele is the reduction of viscera in the abdominal cavity and closure of the abdomen, but the challenge is to succeed without the detrimental effects of increased intraabdominal pressure. In this regard, we performed a retrospective study for all patients admitted for gastroschisis and omphalocele to the Neonatal Intensive Care Unit of ‘Marie Sklodowska Curie’ Emergency Clinical Hospital for Children, from January 2011 until June 2021. Our aim was to highlight the presence of postoperative abdominal compartment syndrome. We observed that six out of forty-seven patients developed clinical signs of abdominal compartment syndrome, five associated with primary closure and one with staged closure with a polyvinyl chloride patch. Following the results, we decided to implement the trans-bladder measurement of intraabdominal pressure to avoid closing the abdomen at pressures higher than 10 mmHg in order to prevent the development of abdominal compartment syndrome. We consider that there is still place for the improvement of congenital abdominal wall defects management and that the measurement of intraabdominal pressure might help us reach our goal.

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Statistical Analysis of the Main Risk Factors of an Unfavorable Evolution in Gastroschisis

Cited by 7 publications

References 17 publications

Current Challenges in the Treatment of the Omphalocele—Experience of a Tertiary Center from Romania

Current Challenges in the Treatment of the Omphalocele—Experience of a Tertiary Center from Romania

Omphalocele and Cardiac Abnormalities—The Importance of the Association

Avoiding High Pressure Abdominal Closure of Congenital Abdominal Wall Defects—One Step Further to Improve Outcomes

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