Contemporary Outcomes of Infants with Gastroschisis in North America: A Multicenter Cohort Study.

OBJECTIVE: To quantify outcomes and analyze factors predictive of morbidity and mortality in infants with gastroschisis. STUDY DESIGN: Clinical data regarding neonates with gastroschisis born between 2009 and 2014 were prospectively collected at 175 North American centers. Multivariate regression was used to assess risk factors for mortality and length of stay (LOS). RESULTS: Gastroschisis was diagnosed in 4420 neonates with median birth weight 2410 g (IQR 2105-2747). Survival (discharge home or alive in hospital at 1 year) was 97.8% with a 37 day median LOS (IQR 27-59). Sepsis, defined by positive blood or cerebrospinal fluid culture, was the only significant independent predictor of mortality (P = .04). Significant independent determinants of LOS and the percentage of neonates affected were as follows: bowel resection (9.8%, P < .0001), sepsis (8.6%, P < .0001), presence of other congenital anomalies (7.6%, including 5.8% with intestinal atresias, P < .0001), necrotizing enterocolitis (4.5%, P < .0001), and small for gestational age (37.3%, P = .0006). Abdominal surgery in addition to gastroschisis repair occurred in 22.3%, with 6.4% receiving gastrostomy or jejunostomy tubes and 6.3% requiring ostomy creation. At discharge, 57.0% were less than the 10th percentile weight for age. The mode of delivery (52.4% cesarean delivery) was not associated with any differences in outcome. CONCLUSIONS: Although neonates with gastroschisis have excellent overall survival they remain at risk for death from sepsis, prolonged hospitalization, multiple abdominal operations, and malnutrition at discharge. Outcomes appear unaffected by the use of cesarean delivery. Further opportunities for quality improvement include sepsis prevention and enhanced nutritional support.

Cirugía de la úlcera pilórica y pre-pilórica antes y después de la introducción de los bloqueadores H2 / Pyloric and prepyloric ulcer surgery before and after of the introduction of H2 blokers

Se compara la frecuencia de la cirugía de la úlcera gatroduodenal en dos períodos; uno antes (1984-1987) y otro después de la introducción de los bloqueadores H2 (1990-1993). Los resultados revelan una disminución global de un 29,9 por ciento, siendo más significativa en úlceras gástricas (54,6 por ciento). Las intervenciones de urgencia disminuyeron de 44 a 28 casos a expensas de la cirugía de la úlcera duodenal. La úlcera pilórica y prepilórica (UP y UPP) a diferencia de los otros tipos de úlcera mantienen su número de intervenciones y cuando son operados de urgencia, practicándoles sólo sutura, presentan una alta incidencia de reintervenciones por nueva perforación u obstrucción (41,6 por ciento). La morbimortalidad de la cirugía de la úlcera P y PP fue similar en ambos grupos

[Surgical jejunostomy as a route for enteral nutrition]. / Yeyunostomía quirúrgica como vía de nutrición enteral.

Ostomies are the nutritional route of choice when artificial nutrition could be necessary during more than thirty days. The surgical jejunostomy (SJ) is especially indicated in the patient undergoing major surgery of the digestive tract and the complications thereof. The present retrospective revision includes 57 cases of SJ followed during more than five days. The patients needed surgical treatment in nearly 80%. For the SJ the Witzel technique was used, with 18 Fr or more catheters. The mixes used were polymeric, in a closed circuit. The patients were a mean 60 +/- 13 years of age and 68.4% were male. They presented a medium level of undernourishment, with a 13% weight loss and a mean albumin level of 30.6 +/- 6.8 g/1000 cc. The Index of Nutritional Risk on average was 71.7 (normal 100). Complications appeared in 9/57 cases (15.7%), with the jejunostomy beginning to be used on average 2.3 +/- 2.4 days after surgery. Some form of support previous to the SJ was necessary in 31/57 patients, and 37/57 had another nutritional route in addition to the jejunostomy during an average of 8.9 +/- 11.1 days. In 49/57 patients (85.9%), 75% of the estimated calories were obtained in an average of 6.4 +/- 4.0 days, and in 42/57 patients (73.6%), 100% of the calories were obtained in an average of 8.6 +/- 3.0 days. Intolerance to the artificial nutrition occurred in 29/57 cases (50.8%), with diarrhoea being the most frequent in 16/57 (28.0%). The jejunostomy lasted for a mean of 28.4 +/- 43.0 days.(ABSTRACT TRUNCATED AT 250 WORDS)