miRNA-143 expression is associated with inflammation and time of exposure to amniotic fluid in experimental gastroschisis.

OBJECTIVE: Gastroschisis (GS) is a congenital anomaly in the abdominal wall with the intestinal loops exiting laterally to the umbilicus. The contact of the loops with Amniotic Fluid (AF) causes an inflammatory process in the exposed part, leading to an extended hospital stay and an increased risk of morbidity due to alterations related to intestinal motility. The authors aimed to evaluate the time of exposure to the AF in the experimental GS and to search for potential biomarkers of intestinal inflammation by measuring microRNAs. METHODS: Rat fetuses were divided into three groups: a) CONTROL, b) GS reared on day 18 (GS = 18), and c) GS reared on day 19.5 (GS = 19) (term = 22 days). On day 21.5, the fetuses were removed for biometric parameters and biochemical analyses: 1) Biometrics: Body and Intestinal Weight (BW, IW), and intestinal-body weight ratio (IW/BW); 2) Descriptive histopathology and 3) miR-143 quantification by real-time Polymerase Chain Reaction (PCR). RESULTS: BW was higher in CONTROL than GS 18 and G19 (p < 0.05). IW, IW/BW, intestinal water, and mRNA-143 were higher in GS 18 and GS 19 than in CONTROL, and GS 18 was higher than GS 19 (p < 0.05). The average of the inflammation score from the intestinal wall with mucosal inflammation and intra-epithelial lymphocytes shows worst in GS 18 and GS 19 vs. CONTROL (p < 0.05). CONCLUSIONS: The tissue expression of mRNA-143 and the morphological changes in the intestine of GS worsened according to the time of exposure to AF, which could be a possible marker of fetal intestinal damage.

Factors associated with cholestasis in newborns with gastroschisis.

OBJECTIVE: To describe the incidence and to analyze risk factors associated with cholestasis in neonates with gastroschisis. METHODS: This is a retrospective cohort study in a tertiary single center analyzing 181 newborns with gastroschisis between 2009 and 2020. The following risk factors associated with cholestasis were analyzed: gestational age, birth weight, type of gastroschisis, silo closure or immediate closure, days of parenteral nutrition, type of lipid emulsion, days of fasting, days to reach a full diet, days with central venous catheter, presence of infections, and outcomes. RESULTS: Among the 176 patients evaluated, 41 (23.3%) evolved with cholestasis. In the univariate analysis, low birth weight (p=0.023), prematurity (p<0.001), lipid emulsion with medium-chain triglycerides and long-chain triglycerides (p=0.001) and death (p<0.001) were associated with cholestasis. In the multivariate analysis, patients who received lipid emulsion with fish oil instead of medium chain triglycerides/long chain triglycerides (MCT/LCT) emulsion had a lower risk of cholestasis. CONCLUSIONS: Our study shows that lipid emulsion with fish oil is associated with a lower risk of cholestasis in neonates with gastroschisis. However, this is a retrospective study and a prospective study should be performed to confirm the results.

Predicting mortality in neonates with gastroschisis in a Southeastern state of Brazil.

OBJECTIVE: This study aimed to verify risk factors associated with gastroschisis mortality in three neonatal intensive care units located in the state of Espírito Santo, Brazil. METHODS: A retrospective cohort study of neonates with gastroschisis was performed between 2000 and 2018. Prenatal, perinatal, and postsurgical variables of survival or nonsurvival groups were compared using chi-square statistical test, t-test, Mann-Whitney U test, and logistic regression. Tests with p<0.05 were considered statistically determined. RESULTS: A total of 142 newborns were investigated. Mean maternal age, gestational age, and birth weight were lower in the group of nonsurvival (p<0.05). Poor clinical conditions during admission, complex gastroschisis, closure with silo placement, the use of blood products, surgical complications, and short bowel syndrome were more frequent in the nonsurvival group (p<0.05). Complex gastroschisis [adjusted odds ratio (OR) 3.74, 95% confidence interval (95%CI) 1.274-11.019] and short bowel syndrome (adjusted OR 7.55, 95%CI 2.177-26.225) increased the risk of death. Higher birth weight inversely reduced the risk for mortality (adjusted OR 0.99, 95%CI 0.997-1.000). CONCLUSION: Complex gastroschisis and short bowel syndrome increased the risk of death, with greater birth weight being inversely correlated with the risk of mortality. The findings of this research can contribute to the formulation of protocols to improve the quality and safety of care in order to reduce neonatal mortality associated with gastroschisis.

Resultados materno y perinatal de pacientes con diagnóstico prenatal de gastrosquisis en un centro de Medellín / Maternal and perinatal outcomes of patients with prenatal diagnosis of gastroschisis in a center in Medellin

Objetivo: Describir los resultados maternos y perinatales de pacientes con diagnóstico prenatal de gastrosquisis atendidos en un centro de referencia obstétrica de Medellín. Método: Estudio observacional, descriptivo y retrospectivo, llevado a cabo en la Clínica Universitaria Bolivariana en fetos con diagnóstico prenatal de gastrosquisis desde el 1 de enero de 2010 hasta el 31 de julio de 2021. Resultados: Se identificaron 54 gestantes con diagnóstico prenatal de gastrosquisis. En el 63% era su primer embarazo y el 27,8% eran adolescentes. La duración promedio de la gestación fue de 35 semanas y 6 días. La cesárea fue la vía más común (98,1%) y la indicación más frecuente fue sufrimiento de asa 66,7%. El 55,6% de los neonatos requirieron más de una intervención quirúrgica para el cierre de la pared abdominal. Las complicaciones más frecuentes fueron anemia (66,7%) e íleo posoperatorio (72,2%). La mortalidad fue del 13%. Conclusiones: Se evidencian algunas características similares a las reportadas en otras series. La mayor presentación fue en primer embarazo, la causa de finalización de la gestación fue sufrimiento de asas (demostrando la importancia del seguimiento ecográfico), y las complicaciones más frecuentes fueron anemia e íleo posoperatorio presentados por la prematuridad. La mortalidad comparada con la de otras instituciones locales fue menor.

Objective: To describe the outcomes of maternal and perinatal in patients diagnosed with prenatal gastroschisis that received medical care at an obstetric reference center in Medellin. Method: Observational, descriptive and retrospective study in fetuses with a prenatal diagnosis of gastroschisis performed in the Clínica Universitaria Bolivariana between January 1st 2010 and July 31st 2021. Results: Were included 54 pregnant women with prenatal diagnosis of gastroschisis. The 63% were their first pregnancy and 27,8% were adolescents. The average duration of gestation was 35 weeks and 6 days. Cesarean section was the most common way of delivery (98,1%) and the most frequent indication was suffering from loop (66,7%). The 55,6% of neonates required more than one surgical intervention for closure of the abdominal wall. The most frequent complications were anemia (66,7%) and postoperative ileus (72,2%). A mortality of 13% was presented. Conclusions: Some characteristics like reported in other series are evident. The greatest presentation was in the first pregnancy, the cause of termination of pregnancy was suffering from loops (demonstrating the importance of ultrasound monitoring) and the most frequent complications were anemia and postoperative ileus presented by prematurity. Mortality, compared to other local institutions, was lower.

Predicting Factors of Protracted Intestinal Failure in Children with Gastroschisis.

OBJECTIVE: To identify prenatal and neonatal predictors of short bowel syndrome-related intestinal failure (SBS-IF) in gastroschisis. STUDY DESIGN: This retrospective study included all patients with gastroschisis born between 2000 and 2017 who were enrolled in our home parenteral nutrition program, and all patients with gastroschisis born in our institution who survived 2 weeks, during the same time period. Prenatal ultrasound features, neonatal status, anatomic features, oral feeding, and parenteral nutrition dependency were analyzed. RESULTS: Among 180 patients, 35 required long-term parenteral nutrition (SBS-IF group) and 145 acquired full oral feeding within 6 months (oral feeding group). The mean follow-up was 7.9 years (IQR, 1.6-17.5 years) and 5.0 years (IQR, 0.1-18.2 years), respectively. Both bowel matting (OR, 14.23; 1.07-16.7; P = .039) and secondarily diagnosed atresia or stenosis (OR, 17.78; 3.13-100.98; P = .001) were independent postnatal predictors of SBS-IF. Eighteen children (51% of the SBS-IF group) were still dependent on artificial nutrition at the last follow-up. patients with SBS-IF who achieved full oral feeding had a median residual small-bowel length of 74 cm (IQR, 51-160 cm) vs 44 cm (IQR, 10-105 cm) for those still dependent on artificial nutrition (P = .02). An initial residual small bowel length of more than 50 cm was the best predictive cut-off for nutritional autonomy, with a sensitivity of 67% and a specificity of 100%. CONCLUSIONS: Bowel matting, complex gastroschisis, and secondary intestinal obstruction were associated with SBS-IF in gastroschisis. For patients with SBS-IF, a small bowel length of more than 50 cm was predictive of secondary nutritional autonomy.

Gastroschisis and late-onset neonatal sepsis in a tertiary referral center in Southeastern Brazil.

OBJECTIVES: To analyze late-onset sepsis and to describe the etiological agents in newborns with gastroschisis. METHODS: A retrospective cohort, including newborns with gastroschisis whose admissions occurred in the period between January 2012 to December 2018 in a tertiary referral center. Maternal and newborn characteristics, surgical procedures and evolution in hospitalization were verified. A bivariate analysis was performed with patients with proven late-onset neonatal sepsis and according to the simple or complex gastroschisis category, the prevalent microorganisms in positive cultures were identified, statistical tests were carried out and the significance level adopted was p < 0,05. Results are presented in proportions, averages and standard deviation or medians. The level of significance adopted was p < 0.05. RESULTS: 101 newborns were analyzed, 45 (44.5%) were confirmed late-onset sepsis. The median birth weight was 2285+498 grams, and the gestational age was 35.9 +1.74weeks. The incidence of complex gastroschisis was 17.8%, the hospitalization time was 48.2+29.67 days and mortality was 9.9%. The newborns were divided into 2 groups: Group 1: late-onset sepsis (44.6%), and Group 2: no late-onset sepsis. The presence of complex gastroschisis was a factor associated with infection (p < 0.009). Fasting time (p < 0.001), parenteral nutrition time (p < 0.001), time to achieve full diet (p < 0.001), and hospitalization stay (p < 0.001) were higher in group 2. Gram-positive were the most frequent (51.1%), followed by Gram-negative (20%), and fungi (4.4%). CONCLUSIONS: Newborns with gastroschisis have a higher risk of evolving with late-onset sepsis, despite this study did not calculate the risk of sepsis statistically, and the main germs detected by cultures were gram-positive bacteria, specifically Staphylococcus epidermidis.

Correlation between estimated fetal weight and weight at birth in infants with gastroschisis and omphalocele.

BACKGROUND: An accurate estimated fetal weight (EFW) calculated with traditional formulae in cases of abdominal wall defects (AWDs) can be challenging. As a result of reduced abdominal circumference, fetal weight may be underestimated, which could affect prenatal management. Siemer et al. proposed a formula without the use of abdominal circumference, but it is not used in our protocols yet. OBJECTIVES: Our aim was to evaluate the correlation of EFW and birth weight in fetuses with AWD by using Hadlock 1, Hadlock 2, and Siemer et al.'s formulae. Our secondary goal was to evaluate how often fetuses classified as small for gestational age (SGA) were in fact SGA at birth. STUDY DESIGN: This was a retrospective cohort study of gestations complicated by gastroschisis and omphalocele at two tertiary-care centers in Brazil and Italy during an 8-year period. Of a total of 114 cases, 85 (44 cases of gastroschisis and 41 cases of omphalocele) met our criteria. RESULTS: The last prenatal scan was performed 5.2 (±4.1) days before birth. The mean gestational age at birth was 37.2 (±1.8) weeks. Correlation of EFW with birth weight was calculated with the three formulae with and without adjustment for weight gain between scan and birth, with the use of the Spearman coefficient. The correlation between EFW and weight at birth was positive according to all three formulae for the infants with gastroschisis. This finding was not confirmed in the infants with omphalocele. All formulae overestimated the number of SGA cases: although only 17.6% of fetuses were actually SGA at birth, the Hadlock formulae had classified nearly 35% of them as SGA, and Siemer et al.'s formula, 15.3%. CONCLUSION: All three formulae yielded a good correlation between EFW in the last scan and birth weight in the infants with gastroschisis but not for those with omphalocele. Cases of SGA were overestimated.

Óbitos pós-cirúrgicos em neonatos com malformações congênitas do aparelho digestivo ou osteomuscular / Post-surgical deaths in neonates with congenital malformations in the digestive or musculoskeletal systems / Muertes post-quirúrgicas en neonatos con malformaciones congénitas digestivas o musculoesqueléticas

Objetivo: Analisar a ocorrência de óbitos pós-cirúrgicos em recém-nascidos com malformação do aparelho digestivo ou osteomuscular em uma maternidade de referência. Método: Estudo exploratório, retrospectivo, de abordagem quantitativa, realizado em uma maternidade de referência localizada em Teresina ­ PI. Os dados foram coletados do Tabwin e de fichas de investigação de óbito infantil de neonatos nascidos em 2016 e 2017 e analisados no software Statistical Package for the Social Sciences. Resultados: O tipo de malformação mais prevalente do aparelho digestivo e osteomuscular entre os neonatos que foram a óbito após cirurgia foi o ânus imperfurado (41%) e a gastrosquise (64,2%), respectivamente. O choque séptico, seguido da insuficiência renal aguda foram os fatores determinantes dos óbitos analisados. Conclusão: O diagnóstico precoce é o fator primordial para redução da morbimortalidade de neonatos acometidos por malformações congênitas, uma vez que contribui para o direcionamento e planejamento dos cuidados imprescindíveis a esses pacientes

Objective: To analyze the occurrence of post-surgical deaths in newborns with malformation in the digestive or musculoskeletal systems in a reference maternity hospital. Method: This is an exploratory and retrospective study, with a quantitative approach, conducted in a reference maternity located in Teresina ­ PI. Data were collected from Tabwin and infant death investigation forms of neonates born in 2016 and 2017 and analyzed through the Statistical Package for the Social Sciences software. Results: The most prevalent type of malformation of the digestive and musculoskeletal systems among neonates who died after surgery was the imperforate anus (41%) and gastroschisis (64.2%), respectively. Septic shock, followed by acute kidney failure, constituted the determining factors of the analyzed deaths. Conclusion: Early diagnosis is the key factor for reducing morbidity and mortality in neonates affected by congenital malformations, as it contributes to the targeting and planning of care actions essential for these patients

Objetivo: Analizar la ocurrencia de muertes post-quirúrgicas en recién nacidos con malformación digestiva o musculoesquelética en una maternidad de referencia. Método: Estudio exploratorio, retrospectivo, con enfoque cuantitativo, realizado en una maternidad de referencia ubicada en Teresina - PI. Los datos se recopilaron de Tabwin y de registros de investigación de muerte infantil de neonatos en 2016 y 2017 y se analizaron utilizando el programa Statistical Package for the Social Sciences. Resultados: El tipo de malformación digestiva y musculoesquelética más frecuente entre los neonatos que murieron después de la cirugía fue el ano imperforado (41%) y la gastrosquisis (64,2%), respectivamente. El shock séptico, seguido de insuficiencia renal aguda, constituyeron los factores determinantes de las muertes analizadas. Conclusión: El diagnóstico temprano es el factor principal para reducir la morbimortalidad en los neonatos afectados por malformaciones congénitas, ya que contribuye a la dirección y planificación de la atención esencial para estos pacientes

Gastrosquisis: análisis de situación entre los años 2011 y 2016 en el Hospital Pediátrico Pereira Rosell / Gastroschisis: study of the situation in the period between 2011-2016 at the Pereira Rossell Pediatric Hospital / Gastrosquise: análise da situação entre 2011 e 2016 no Hospital Pediátrico Pereira Rosell

La gastrosquisis es el defecto congénito más frecuente de la pared abdominal anterior. Se clasifican en simple o complicadas según si presentan o no anomalías a nivel intestinal. El diagnóstico prenatal se realiza en un 75%-95% de los pacientes. El tratamiento es quirúrgico, lográndose un cierre primario en el 80% de los casos. La mortalidad global reportada a nivel internacional es de un 10%. Se realizó un estudio observacional descriptivo retrospectivo transversal en el que se analizaron los pacientes con gastrosquisis operados en el Hospital Pediátrico del Centro Hospitalario Pereira Rossell entre el primero de enero de 2011 y el 30 de mayo de 2016. Se estudiaron las siguientes variables: incidencia de la patología, edad materna, edad gestacional al diagnóstico y al nacimiento, vía de nacimiento, anomalías asociadas, técnica quirúrgica, incidencia de complicaciones y mortalidad. En el período estudiado se intervinieron 62 pacientes con diagnóstico de gastrosquisis, de los cuales 48 fetos (77,4%) tenían diagnóstico prenatal. El 53,2% nacieron por parto vaginal y 53 % nacieron pretérmino. En el 85,5% se logró realizar un cierre primario. El 69,4% de los neonatos presentaron complicaciones, siendo las infecciosas las más frecuentes. La mortalidad fue de 12,9%, siendo la sepsis la causa más frecuente. Si bien hemos mejorado en el índice de diagnóstico prenatal y en la vía de nacimiento, y las cifras de tratamiento y mortalidad se encuentran dentro de las cifras publicadas a nivel internacional, existe un elevado número de complicaciones infecciosas, que condicionan la evolución y pronóstico de estos pacientes.

Gastroschisis is the most frequent congenital defect of the anterior abdominal wall. They are classified as simple or complicated according to whether or not they present abnormalities at the intestinal level. Prenatal diagnosis is made in 75%-95% of the patients. The treatment is surgical, achieving a primary closure in 80% of cases. The global mortality reported at an international level is 10%. A cross-sectional retrospective observational study was performed in which gastroschisis patients operated at the Pediatric Hospital of the Pereira Rossell Hospital Center between January 1, 2011 and May 30, 2016 were analyzed. The following variables were studied: the pathology, maternal age, gestational age at diagnosis and at birth, birth route, associated anomalies, surgical technique, incidence of complications and mortality. In the period under study, 62 patients diagnosed with gastroschisis were operated on, of which 48 fetuses (77.4%) had a prenatal diagnosis. 53.2% were born by vaginal delivery and 53% were born preterm. In 85.5% a primary closure was achieved. 69.4% of the neonates presented complications, infectious being the most frequent. Mortality was 12.9%, with sepsis being the most frequent cause. Although we have improved in the prenatal diagnosis index and in the route of birth, and the figures of treatment and mortality are among the figures published internationally, there is a high number of infectious complications, which condition the evolution and prognosis of these patients.

A gastrosquise é o defeito congênito mais freqüente da parede abdominal anterior. São classificadas como simples ou complicadas de acordo com a presença ou não de anormalidades no nível intestinal. O diagnóstico pré-natal é feito em 75% a 95% dos pacientes. O tratamento é cirúrgico, atingindo o fechamento primário em 80% dos casos. A mortalidade global reportada a nível internacional é de 10%. Um estudo observacional transversal foi realizado em gastrosquise retrospectiva que os pacientes operados no Hospital Pediátrico Pereira Rossell Hospital do Centro entre 1 de Janeiro de 2011 e 30 maio de 2016 foram analisados. As variáveis estudadas foram: a patologia, idade materna, idade gestacional no diagnóstico e no nascimento, rota nascimento, anomalias associadas, técnica cirúrgica, a incidência de complicações e mortalidade. No período em estudo, 62 pacientes diagnosticados com gastrosquise foram operados, dos quais 48 fetos (77,4%) tiveram o diagnóstico pré-natal. 53,2% nasceram por parto vaginal e 53% nasceram prematuros. Em 85,5%, um fechamento primário foi alcançado. 69,4% dos neonatos com o ser infeccioso mais freqüente. A mortalidade foi de 12,9%, sendo a sepse a causa mais freqüente. Temos melhorado, embora diagnóstico pré-natal no índice e na rota de nascimento, e os números de tratamento e mortalidade estão entre os números publicados Internacionalmente, há um elevado número de complicações infecciosas, que condicionam a evolução eo prognóstico desses pacientes.

A 25-year study of gastroschisis outcomes in a middle-income country.

BACKGROUND: Survival of newborns with gastroschisis is significantly higher in high-income versus low and middle-income countries. We reviewed treatment and outcomes of gastroschisis in a middle-income country setting with increasing protocolized management. METHODS: All newborns with gastroschisis treated during the period 1989-2013 at a single Brazilian academic surgical service were studied retrospectively. Protocolized diagnosis, delivery, nutrition, medical interventions, and surgical interventions were introduced in 2002. Outcomes before and after protocol introduction were studied using univariate and multivariate analysis. RESULTS: One hundred fifty-six newborns were treated for gastroschisis: 35 (22.4%) and 121 (77.6%) before and after 2002, respectively. When compared to the earlier cohort, patients treated after 2002 had higher rates of prenatal diagnosis (90.9% vs. 60.0%, p < 0.001), delivery at a tertiary center (90.9% vs. 62.9%, p < 0.001), early closure (65.3% vs. 33.3%, p = 0.001), primary repair (55.4% vs. 31.4%, p = 0.013), monitoring of bladder pressure (62.0% vs. 2.9%, p = 0.001), PICC placement (71.1% vs. 25.7%, p < 0.001), early initiation of enteral feeding (54.5% vs. 20.0%, p < 0.001), and lower rates of electrolyte disturbances (53.7% vs. 85.7%, p = 0.001). Mortality decreased from 34.3% before 2002 to 24.8% (p = .27) after 2002 despite an increase in the complex gastroschisis rate from 11.4% to 15.7% during the same period. CONCLUSIONS: Gastroschisis outcomes in a middle-income country can be gradually improved through targeted interventions and management protocols. TYPE OF STUDY: Therapeutic. LEVEL OF EVIDENCE: III.

Defectos de la pared abdominal; gastrosquisis / Abdominal wall defects; Gastrosquisis

Introducción. Los defectos de pared muestran un aumento epidemia como de la prevalencia de 4.5 por cada 10.000 nacimientos presentando anomalías asociadas, fundamentalmente gastrointestinales, como defectos de rotación y atresia (10-20%), seguido de las cardíacas 4% vs 0,7% en población normal) y genitourinarias. Métodos: se realizó una búsqueda de artículos origina-les, de revisión, y revisiones sistemáticas en las bases de datos; PUBMED, SCIELO, e HINARI comprendida entre los años 2011 a 2016. Desarrollo: Las causas son multifactoriales, entre las más comunes primigestas, embarazos no planiicados de madres jóve-nes, cambio de pareja reciente, déicits nutricionales importantes, consumo de AINEs, alcohol, tabaco u otras drogas. El diagnóstico se realiza mediante ultrasonografía y el tratamiento es quirúrgico. Conclusión: Se recomienda el nacimiento en un centro con cirugía pediátrica y neonatología experta para mejorar los resultados perinatales. El desarrollo de técnicas quirúrgicas, la nutrición parenteral, los cuidados respiratorios y la práctica anestésica han reducido las tasas de mortalidad hasta menos del 5%, so bre todo a expensas de la disminución de infecciones nosoco miales, que constituyen la causa de muerte más frecuente.

Nueva estrategias del manejo perinatal de las gastrosquisis en 78 casos consecutivos en un hospital público de alta complejidad / NEW STRATEGIES FOR THE PERINATAL MANAGEMENT OF GASTROSCHISIS IN 78 CONSECUTIVE CASES AT A HIGH COMPLEXITY PUBLIC HOSPITAL

Introducción: La gastrosquisis es un defecto congénito en la pared abdominal anterior, paraumbilical, generalmente derecho, de causa no clara. La prevalencia es de 1 a 5/ 10000 nacidos vivos, y va en aumento. Objetivo: Describir los resultados perinatales utilizando nuevas estrategias en el manejo de las gastrosquisis en el Hospital Nacional A. Posadas en un periodo de 3 años. Pacientes y métodos: Estudio observacional, descriptivo, retrospectivo. Se presentan 78 casos de gastrosquisis consecutivos durante 2012-2015. Se consideraron variables demográficas, antecedentes familiares, personales y obstétricos. Se registraron datos prenatales, del nacimiento, del defecto y evolución. Variables categóricas: frecuencias; Continuas: medianas/rangos. p valor < = 0.05 Resultados: La prevalencia de gastroquisis fue de 5/1000 nacimientos (78 casos), donde la mediana de la edad materna fue de 20 años y la mediana de la edad gestacional al momento del diagnostico fue de 21 semanas. Las imágenes patológicas observadas en ecografía fueron tamaño del defecto de pared, asa centinela y dilatación intrabdominal. Estos signos ecográficos no indican el tipo de resolución ni la evolución postnatal. En el 96 % de los casos se realizó cesárea segmentaria (el 41 % fue intraparto). La mediana de la edad gestacional al nacer fue de 36 semanas. En nuestro servicio la resolución de gastroquisis se realiza con: cierre inmediato, cierre diferido o colocación de silo. Solo hubo 5 muertes posnatales. Se observo que los neonatos con cierre inmediato comenzaron la prueba de tolerancia oral en menos tiempo que con silo o cierre diferido (p=0.03). Conclusión: Se propone la planificación del nacimiento lo más cercano al término independientemente de las imágenes ecográficas intestinales. El cierre postnatal inmediato reduciría la morbimortalidad y el tiempo de internación

Introduction: Gastroschisis is a paraumbilical abdominal anterior wall defect, generally on the right site , and with unclear origin. The prevalence is 1 to 5/10000 in live births, and is increasing. Objective: To describe the perinatal outcomes using new strategies in the management of gastroschisis in the Posadas Hospital over a period of 3 years. Patients and methods: observational, descriptive, retrospective study. 78 consecutive cases of gastroschisis are presented for the period 2012-2015. Demographic variables, family, personal and obstetric histories were considered. Prenatal data , birth defect and evolution were recorded. Categorical variables: frequency; Continuous: medium / ranges. p value <= 0.05. Results: The prevalence of gastroschisis was 5 in 1000 births (78 cases), the median maternal age was 20 years, and the median gestational age at diagnosis was 21 weeks. Size defect swall, Centinel asa, and intraabdominal dilatation were the pathological ultrasound images observed. These sonographic signs do not indicate the type of resolution or postnatal development. Cesarean section was performed in 96% of cases (41% was intrapartum). The median gestational age at birth was 36 weeks. Immediate closure, delayed closure or placement silo, were the gastroschisis resolutions in our Service. There were only 5 postnatal deaths. Infants submitted to immediate closure began tolerance oral intake in less time than with silo or delayed closure (p = 0.03). Conclusion: birth planning as close to term regardless of intestinal ultrasound images is proposed. The immediate postnatal closure would reduce morbidity and mortality and length of hospital stay

Gastrosquisis: nueva técnica quirúrgica mediante el procedimiento simil exit experiencia en Hospital Universitario Japonés, clínica foianini y UDIME / Gastroschisis: new surgical technique using the exit procedure similar experience in Japanese University Hospital, clinic foianini and UDIME

Se denomina gastrosquisis al prolapso prenatal del intestino hacia la cavidad amniótica a través de un pequeño defecto de todos los planos de la pared abdominal, ubicado generalmente a la derecha del cordón umbilical. Su prevalencia está incrementándose progresivamente en las últimas décadas, desde un caso por cada 10.000 nacidos vivos en los años setenta, hasta uno por cada 2.500 en la actualidad. La gastrosquisis suele presentarse de forma aislada y esporádica y asociada a malformaciones congénitas...

Postnatal outcomes of infants with gastroschisis: a 5-year follow-up in a tertiary referral center in Brazil.

OBJECTIVE: The aim of this study was to evaluate postnatal outcomes in fetuses with gastroschisis. METHODS: This is a retrospective study (2009-2013) of patients with gastroschisis at the Hospital São Paulo (Federal University of São Paulo, Brazil). RESULTS: A total of 44 infants with gastroschisis were examined. The mean maternal age was 21.1 years and mean gestational age at delivery was 36.1 weeks. Delivery occurred before 34 weeks in 13.6%, between 34 and 36 weeks and 6 d in 40.9%, and after 37 weeks in 45.5%. The mean birth weight was 2349 g, with 37.2% small-for-gestational age infants. The mean umbilical cord blood pH was 7.32. Bowel resection and delayed fascial closure was performed in 14.6% and 19.5%, respectively. The mean hospitalization time in the neonatal intensive care unit was 52.7 d. Neonatal infection was detected in 52.4%, with a positive blood culture; 77.3% of those cases were coagulase negative staphylococci. The overall rate of mortality was 25%; 18.2% before birth, 45.4% during the neonatal period, and 36.4% in infants. The main cause of postnatal death was septicemia (55.5%). CONCLUSIONS: Despite advances in perinatal care and surgical techniques, infants with gastroschisis still present high rates of complications and death.

Associated congenital anomalies in infants with isolated gastroschisis: A single-institutional experience.

The aim of our study was to determine the frequency and type of associated congenital anomalies in patients with isolated gastroschisis born at the Dr. Juan I. Menchaca Civil Hospital of Guadalajara (Guadalajara, México), and to explore its possible association with the included outcome variables. One hundred-eight cases with isolated gastroschisis were reviewed from 2009 to 2014. The occurrence of intestinal and extraintestinal associated anomalies (either secondary or primary) was prospectively assessed. The type of gastroschisis, length of hospital stay (LOS), and in-hospital mortality were outcome variables for statistical analysis. Of infants with gastroschisis, 52 (48.1%) had one or more associated anomalies (AA), with increased odds in males (OR = 2.3, 95%CI: 1.1-5.0). AA classified, as secondary and primary were present in 34.3 and 5.6% of patients, respectively. Of secondary AA, 25.9% were intestinal anomalies, and 17.6% were extraintestinal. Primary AA were congenital heart disease (n = 3), meningomyelocele, and hydrocephaly and amniotic band sequence in one instance, respectively. Multivariate logistic regression showed that secondary AA (both intestinal and extraintestinal) were associated with complex gastroschisis, prolonged LOS, and in-hospital death, whereas primary AA were not related to a worse outcome. Our results highlight the pathogenic importance of properly investigating and categorizing the presence of others secondary or primary AA when diagnosis of gastroschisis is made.

Amputación de miembro inferior derecho fetal con hipoplasia de hemipelvis y gastrosquisis como secuencia de amputación vascular / Amputation of right leg with fetal hypoplastic hemipelvis and gastroschisis as a sequence of vascular amputation

Las anomalías congénitas requieren un manejo multidisciplinario desde que se realiza el diagnóstico hasta la vida postnatal. Incluyen anomalías en el desarrollo tisular y deformidades, causadas por estresores mecánicos. Pueden ocurrir de forma aislada o como parte de un síndrome generalmente con causa genética. El principal diagnóstico antenatal se realiza por ultrasonido o bien, con la resonancia magnética. Tanto la gastrosquisis como los defectos óseos requieren un momento y lugar óptimos para nacimiento y manejo ya que de éstos depende su pronóstico y evolución...

Asociación de gastrosquisis y artrogriposis múltiple congénita / Gastroschisis and arthrogryposis: clinical case

Introducción: La gastrosquisis (GQ) es un defecto congénito de cierre de la pared abdominal, a la derecha de la inserción del cordón umbilical. Una cantidad variable del intestino, y en ocasiones, otros órganos abdominales, se hernian fuera de la pared abdominal, sin cobertura membranosa. La Artrogriposis Múltiple Congénita (AMC) comprende un grupo de trastornos reumáticos caracterizados por contracturas articulares múltiples en que se afectan los músculos dorsales y de las extremidades superiores e inferiores. Objetivo: Describir una rara asociación de estas dos malformaciones congénitas. Caso clínico: Recién nacido con GQ clásica Se realizó cierre primario del defecto de pared abdominal en las primeras horas de vida, con buena evolución postoperatoria. Al nacimiento, se apreció además Artrogriposis de articulaciones distales de ambos miembros superiores y atrofia muscular en ellos asociada a paresia severa de miembros superiores. Conclusiones: Recientemente se ha señalado que la asociación entre GQ y AMC pueda ser más frecuente de lo que clásicamente se ha descrito. Aunque la etiología de estas dos afecciones no está clara, el fenómeno que causa la disrupción o accidente vascular podría explicar la coexistencia de estas dos patologías.

Introduction: Gastroschisis is a congenital abdominal wall closure defect, usually to the right of the umbilical cord insertion. A variable amount of the intestine and occasionally other abdominal organs herniate outside of the abdominal wall without a covering membrane. Arthrogryposis Multiplex Congenital (AMC) consists of a group of rheumatic disorders characterized by multiple joint contractures that may affect back muscles and upper and lower extremities. Objective: To describe a rare association of these two birth defects. Case report: Newborn with classical Gastroschisis; primary closure of the abdominal wall defect was performed in the first hours of life, with good results. At birth, Arthrogryposis in distal joints of both upper limbs and muscle atrophy associated with severe upper limb paresis were observed. Conclusions: It has recently been suggested that the association between Gastroschisis and AMC may be more common than previously described. Although the etiology of these conditions is unclear, the phenomenon that causes the disruption or stroke could explain the coexistence of both pathologies.

The role of gut-liver axis in the restriction of intrauterine growth in a model of experimental gastroschisis.

PURPOSE: To evaluate the intrauterine growth restriction (IUGR) by the expression of IR-ß, IRS-1, IRS-2, IGF-IRß and Ikappaß in experimental model of gastroschisis. METHODS: Pregnant rats at 18.5 days of gestation were submitted to surgery to create experimental fetal gastroschisis (term = 22 days) were divided in three groups: gastroschisis (G), control (C) and sham (S). Fetuses were evaluated for body weight (BW), intestinal (IW), liver (LW) and their relations IW/BW and LW/BW. IR-ß and IGF-IRß receptors, IRS-1 and IRS-2 substrates and Ikappaß protein were analyzed by western blotting. RESULTS: BW was lower in G, the IW and IW / BW were greater than C and S (p<0.05) groups. The liver showed no differences between groups. In fetuses with gastroschisis, compared with control fetuses, the expression of IGF-IRß (p<0.001) and Ikappaß (p<0.001) increased in the liver and intestine, as well as IR-ß (p<0.001) which decreased in both. In contrast to the intestine, IRS-1 (p<0.001) increased in the liver and IRS-2 decreased (p<0.01). CONCLUSION: The axis of the intestine liver has an important role in inflammation, with consequent changes in the metabolic pathway of glucose can contribute to the IUGR in fetuses with gastroschisis.