Factors of poor prognosis in newborns with a prenatal diagnosis of gastroschisis in Bogota, Colombia.

OBJECTIVES: To identify factors associated with poor prognoses in newborns with a prenatal diagnosis of gastroschisis in eight hospitals in Bogota, Colombia, from 2011 to 2022. METHODS: A multi-center retrospective case-control study was conducted on newborns with gastroschisis in eight hospitals in Bogota, Colombia. Poor prognosis was defined as the presence of sepsis, intestinal complications, or death. RESULTS: The study included 101 patients. Preterm newborns under 32 weeks had a poor neonatal prognosis (OR 6.78 95 % CI 0.75-319). Oligohydramnios (OR 4.95 95 % CI 1.15-21.32) and staged closure with silo (OR 3.48; 95 % CI 1.10-10.96) were risk factors for neonatal death, and intra-abdominal bowel dilation of 20-25 mm was a factor for the development of intestinal complications (OR 3.22 95 % CI 1.26-8.23). CONCLUSIONS: Intra-abdominal bowel dilation between 20 and 25 mm was associated with intestinal complications, while oligohydramnios was associated with the risk of perinatal death, requiring increased antenatal surveillance of fetal wellbeing. Management with primary reduction when technically feasible is recommended in these infants, considering that the use of silos was associated with higher mortality.

Gastrosquisis / Gastroschisis

Introducción: La gastrosquisis es un defecto de la pared abdominal anterior, paraumbilical, habitualmente a la derecha con la protrusión de vísceras intraabdominales, las que flotan libremente en el líquido amniótico durante la vida intrauterina, solo recubiertas por su peritoneo visceral. Objetivo: Analizar la entidad a propósito de un caso portador de gastrosquisis compleja. . Caso clínico: Se describe una neonato de 4 días remitido al servicio de urgencias del Hospital Provincial de Cabinda, República de Angola, por presentar deshidratación severa y "evisceración". La paciente fallece 36 horas posteriores al ingreso. Conclusiones: Los neonatos con esta enfermedad se presentan como una emergencia quirúrgica que plantean un reto difícil para el cirujano tratante. Tiene una alta mortalidad aun con el tratamiento apropiado. Técnicas novedosas de tratamiento se acercan a las tasas de sobrevida esperadas para esta entidad(AU)

Introduction: Gastroschisis is a defect of the paraumbilical anterior abdominal wall, usually on the right with protrusion of intraabdominal viscera, which float freely in the amniotic fluid during intrauterine life, only covered by its visceral peritoneum. Objective: To analyze the entity apropos a case of complex gastroschisis. Clinical case: The case is described od a four-day-old neonate referred to the emergency service at Provincial Hospital of Cabinda, Republic of Angola, for presenting severe dehydration and "evisceration." The patient died 36 hours after admission. Conclusions: Neonates with this disease are presented as a surgical emergency that poses a difficult challenge for the treating surgeon. It has a high mortality even with the appropriate treatment. Novel treatment techniques are close to the expected survival rates for this entity(AU)

Mortality from gastroschisis in the state of Rio de Janeiro: a 10-year series.

OBJECTIVE: To analyze mortality and associated factors in a series of gastroschisis at birth in the state of Rio de Janeiro in a 10-year period (2005 to 2014). METHOD: A retrospective cohort study, which related the databases of the Live Births Information System and the Mortality Information System by probabilistic linkage. Final database was constructed in two stages: preparation of the two initial databases and establishment of relationships between them. RESULTS: Preterm newborns and those with low birthweight had higher risk of death, with statistical significance (p = 0.03 and p = 0.006, respectively). Regarding place of birth, although death frequency was higher in maternity units than in general hospitals (p = 0.04; OR = 0.5; 95%CI 0.3-1.0), it was observed that a unit characterized as a general hospital had a high birth frequency (61.2%). Furthermore, the comparative analysis of the risk of death between this unit and others showed a 7.5 higher risk of death in general hospitals and 3.2 higher in maternity units, with statistical significance (p < 0.001). Moreover, births in level II intensive care units had 3.9 times more risk of death compared with level III (p < 0.001). CONCLUSION: This study foments the discussion of two possible strategies in the treatment of gastroschisis in newborns. First, the centralization of care in tertiary units, enabling malformation care to be analyzed in a more detailed and standardized manner. Second, and perhaps more feasible, the elaboration of clinical guidelines to standardize immediate care for gastroschisis in babies born outside tertiary centers, as well as the standardization of their transportation until arrival at the tertiary center.

Intraoperative Findings Associated to Inpatient Mortality From Patients With Gastroschisis in Western Mexico.

BACKGROUND: Intraoperative findings during gastroschisis surgery are the main predictor associated with increased mortality. The aim of our study was to determine the type of surgical findings associated with inpatient mortality in a cohort of patients with gastroschisis from a university hospital in Western Mexico. MATERIALS AND METHODS: Infants with surgically repaired gastroschisis during the period 2011-2017 at the Dr. Juan I. Menchaca Civil Hospital of Guadalajara (Guadalajara, Mexico) were studied. Data regarding demographics, perinatal history, and intraoperative findings were collected and compared according to whether they were nonsurvivors (cases) or survivors (controls) at hospital discharge. Data were analyzed using logistic regression, determining its adjusted odds ratio (aOR) and its respective 95% confidence intervals (95% CIs). The proper adjustment of the model was verified using the Hosmer and Lemeshow test. RESULTS: Ninety-four patients with gastroschisis were studied, of which 13 were nonsurvivors (13.8%), and 81 (86.2%) were survivors at hospital discharge. In the group of survivors, primary surgical closure was performed more frequently (P = 0.018), whereas staged reduction with a silo predominated in the group of nonsurvivors (P = 0.018), and an increased frequency of complex gastroschisis (0.0001). After logistic regression analysis, intraoperative findings associated with nonsurvival were severe bowel matting (aOR: 7.3; 95% CI: 1.2-44), and prolapse of the small intestine and large intestine, plus any other organ (aOR: 15.9; 95% CI: 1.1-219.6). CONCLUSIONS: Mortality in our cohort was high (13.8%) and was significantly associated with severe bowel matting, and the prolapse of the small and large intestines, plus any other organ.

Gastroschisis in the neonatal period: A prospective case-series in a Brazilian referral center.

BACKGROUND/PURPOSE: Gastroschisis is increasing in incidence and has low mortality and high morbidity. We describe the clinical and surgical characteristics of gastroschisis patients in a Brazilian referral center. METHODS: Single-center prospective case series of gastroschisis patients. The following two groups were formed depending on the intestinal characteristics: simple and complex patients. RESULTS: In total, 79 patients were enrolled, 89% of whom were classified as simple and 11% as complex. The baseline characteristics were similar between the groups, with the exception of the illness severity score. The complex group had a significantly smaller defect size, more reoperations and worse clinical outcomes than the simple group, with the initiation of feeding taking 1.5 times longer, the duration of total parenteral nutrition taking twice as long, and the length of hospitalization being 2.5 times longer; the complex group also included all the deaths that occurred. Overall, the survival rate was 96%. Patients who underwent the sutureless technique had significantly fewer wound infections and a decreased duration of mechanical ventilation than sutured patients. CONCLUSIONS: This study provides a comprehensive picture of gastroschisis during the neonatal period in a Brazilian referral center, emphasizing the significantly higher risk for morbidity and mortality among complex patients than among simple patients and the few advantages of the sutureless technique over the sutured technique in terms of closing the defect. TYPE OF STUDY: Prognostic. LEVEL OF EVIDENCE: IV.

Mortality from gastroschisis in the state of Rio de Janeiro: a 10-year series / Mortalidade por gastrosquise no estado do Rio de Janeiro: uma série de 10 anos

ABSTRACT OBJECTIVE To analyze mortality and associated factors in a series of gastroschisis at birth in the state of Rio de Janeiro in a 10-year period (2005 to 2014). METHOD A retrospective cohort study, which related the databases of the Live Births Information System and the Mortality Information System by probabilistic linkage. Final database was constructed in two stages: preparation of the two initial databases and establishment of relationships between them. RESULTS Preterm newborns and those with low birthweight had higher risk of death, with statistical significance (p = 0.03 and p = 0.006, respectively). Regarding place of birth, although death frequency was higher in maternity units than in general hospitals (p = 0.04; OR = 0.5; 95%CI 0.3-1.0), it was observed that a unit characterized as a general hospital had a high birth frequency (61.2%). Furthermore, the comparative analysis of the risk of death between this unit and others showed a 7.5 higher risk of death in general hospitals and 3.2 higher in maternity units, with statistical significance (p < 0.001). Moreover, births in level II intensive care units had 3.9 times more risk of death compared with level III (p < 0.001). CONCLUSION This study foments the discussion of two possible strategies in the treatment of gastroschisis in newborns. First, the centralization of care in tertiary units, enabling malformation care to be analyzed in a more detailed and standardized manner. Second, and perhaps more feasible, the elaboration of clinical guidelines to standardize immediate care for gastroschisis in babies born outside tertiary centers, as well as the standardization of their transportation until arrival at the tertiary center.

RESUMO OBJETIVO Analisar a mortalidade e fatores associados em uma série de nascimentos com gastrosquise no estado do Rio de Janeiro em 10 anos (2005 a 2014). MÉTODO Estudo de coorte retrospectiva, no qual foram relacionadas as bases de dados do Sistema de Informação sobre Nascidos Vivos e do Sistema de Informação sobre Mortalidade por linkage probabilístico. A base de dados final foi construída em duas etapas, que consistiram em: preparo das duas bases de dados iniciais e estabelecimento de relações entre elas. RESULTADOS Os recém-nascidos pré-termo e os com baixo peso ao nascer tiveram maior chance de óbito, com significância estatística (p = 0,03 e p = 0,006, respectivamente). Em relação ao local de nascimento, embora a frequência de óbito tenha sido maior nas maternidades do que em hospitais gerais (p = 0,04; OR = 0,5; IC95% 0,3-1,0), foi observado que uma unidade caracterizada como hospital geral apresentou uma frequência alta de nascimentos (61,2%) e, na análise comparativa da chance de óbito dessa unidade com as demais, encontrou-se uma chance de morrer 7,5 maior em hospitais gerais e 3,2 maior em maternidades, com significância estatística (p < 0,001). Além disso, nascer em unidades de terapia intensiva tipo II aumentou a chance de óbito em 3,9 vezes em comparação com as do tipo III (p < 0,001). CONCLUSÃO Este estudo dá subsídios para a discussão de duas possíveis estratégias no tratamento de recém-nascidos com gastrosquise. A primeira seria a centralização do cuidado em unidades terciárias, possibilitando que o cuidado à malformação seja analisado de forma mais minuciosa e padronizada. A segunda, e talvez mais factível, seria a elaboração de diretrizes clínicas que padronizem o cuidado imediato aos bebês com gastrosquise nascidos fora de centros terciários, bem como a padronização do transporte deles até a chegada ao centro terciário.

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.

Low serum fatty acid levels in pregnancies with fetal gastroschisis: A prospective study.

Fetal gastroschisis is a paraumbilical abdominal wall defect with herniation of abdominal organs. The underlying cause of the disease remains unknown; however, studies suggest that nutritional factors may play a role in its development. This prospective case-control study explored the association of serum fatty acid levels of pregnant women and occurrence of gastroschisis. Gastroschisis group comprised 57 pregnant women with fetuses with gastroschisis, and the control group comprised 114 pregnant women with normal fetuses. Serum fatty acids levels were compared between the groups for the overall pregnancy at <34 weeks; ≤25 weeks, and >25 and <34 weeks; and at delivery. Total fatty acids (p = .008), unsaturated fatty acids (p = .002), and the C18:1n9/C18:00 ratio (p = .021) were lower in the gastroschisis group than in the control group during the overall pregnancy; however, the C16:00/C18:2n6 ratio (p = .018) was higher in the gastroschisis group than in the control group during the same period. Total fatty acids (p = .044) and unsaturated fatty acids (p = .024) were lower in the gastroschisis group at ≤25 weeks, and unsaturated fatty acid (p = .025) and the C18:1n9/C18:00 ratio (p = .013) were lower in the gastroschisis group than in the control group at >25 and <34 weeks. Pregnant women with fetuses with gastroschisis have low serum fatty acids levels during pregnancy. These findings suggest that fatty acids levels may be involved in the pathogenesis of fetal gastroschisis.

Prevalence, Mortality, and Spatial Distribution of Gastroschisis in Mexico.

STUDY OBJECTIVE: To explore the prevalence, mortality, and spatial distribution of gastroschisis using a large population-based sample with cases identified according to birth and death certificates (ICD-10 diagnosis code Q79.3, gastroschisis) through the General Directorate of Health Information of the Secretary Health of Mexico, over the course of a 15-year period. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: A descriptive study examining 10,287 cases of gastroschisis was performed from 2000-2014 using public natality data for denominators (more than 25 million live births). Gastroschisis prevalence and mortality was calculated for each of year, state, maternal, and newborn characteristics. Spatial distribution was analyzed according to gastroschisis prevalence in the 32 states of Mexico. RESULTS: Gastroschisis prevalence was 4.01 per 10,000 live births (annual trend 2.09-6.85). Mortality associated with gastroschisis was 1.28 per 10,000 live births. Women younger than 20 years old, primiparae, and preterm infants had the highest gastroschisis-related prevalence (13.12, 5.83, and 7.51 per 10,000 live births, respectively). Gastroschisis prevalence and mortality did not differ according to newborn sex. A negative binomial distribution, variance (82,391.87) greater than the mean (321.47) was identified. CONCLUSION: Our findings show an increasing temporal trend for gastroschisis since 2000 in Mexico. Additionally, gastroschisis might follow in future instances a positive binomial or Poisson distribution. Therefore, improving surveillance of risk factors and supporting research for gastroschisis is warranted among maternal age younger than 25, particularly, younger than 20 years of age.

Sonographic Markers in the Prediction of Fetal Complex Gastroschisis.

OBJECTIVE: To investigate the ultrasound (US) markers predictive of complex gastroschisis (CG), mortality, and morbidity in fetuses with gastroschisis. MATERIALS AND METHODS: This was a retrospective cohort study of 186 pregnancies with isolated fetal gastroschisis. Eight US markers were analyzed. The predictions and associations of US markers with CG, mortality, and morbidity were assessed. Combinations of US markers predictive of CG were investigated. RESULTS: Extra-abdominal bowel dilatation (EABD), intra-abdominal bowel dilatation (IABD), and polyhydramnios were predictive of CG. EABD between 25 and 28 weeks had a sensitivity of 64%, a specificity of 89%, a positive predictive value (PPV) of 56.2%, and negative predictive value (NPV) of 91.8%. The predictions of IABD were sensitivity = 26.7%, specificity = 96.7%, PPV = 61.5%, and NPV = 86.8%. The odds ratios for CG in the presence of 1 and 2 US markers, compared with the absence of a US marker, were 18.3 (95% CI, 3.83-87.64) and 73.3 (95% CI, 6.14-876), respectively. CONCLUSION: US markers predictive of CG were established. The combination of these markers increases the probability of CG.

Mortality-related factors in gastroschisis - a Jamaican perspective.

OBJECTIVE: To determine the mortality rate of patients treated with gastroschisis at a Jamaican pediatric hospital, and to identify factors that contribute significantly to mortality. METHODS: Eighty-five patients were treated with gastroschisis between November 1, 2006 and November 30, 2015. Of these, 80 records were recovered and reviewed retrospectively. Records were analyzed for maternal and patient characteristics, and details of the clinical course. Death during admission was the primary outcome measure. RESULTS: 63 of the 80 patients died during admission, giving a mortality rate of 78.8%. Sepsis was the main cause of death (82.4%). 27 patients (33.8%) had complicated gastroschisis (necrosis, perforation and/or atresia), all of whom died. Only preterm gestational age, complicated gastroschisis, and the lack of parenteral nutrition were found to be statistically associated with increased mortality. CONCLUSION: Our mortality rate is higher than those quoted in high-income countries, and correlates to those found in low- to middle-income countries. Mortality in our cohort was significantly associated with prematurity, complicated gastroschisis, and the lack of parenteral nutrition. Efforts to improve outcome must focus on improving antenatal care, establishing transfer protocols, and optimizing nutrition for all patients with gastroschisis. STUDY TYPE: Prognostic/Retrospective Study LEVEL OF EVIDENCE: Level II.

Gastrosquisis: presentación de un caso / Gastroschisis. A propos of a case

Introducción: Las malformaciones congénitas del tubo digestivo se presentan con una frecuencia elevada en el periodo neonatal, la gastrosquisis es una de ellas, presentan una alta mortalidad. Presentación de casos: Se presenta un caso de gastrosquisis de un bebé que nace en salón de partos con atención médica especializada, con antecedentes de no haber recibido atención médica prenatal especializada, con factores de riesgos asociados. Se recibió neonato con defecto de la pared abdominal, localizado en región paraumbilical derecha con intestino expuesto, flácido, con cianosis generalizada, taquicardia, en parada respiratoria, se realiza reanimación y se recupera frecuencia respiratoria, manteniéndose distrés respiratorio, mejoró coloración de la piel, se realizó empaquetamiento de las asas intestinales, colocándose sonda orogástrica se canalizó vena con solución para mantener hidratación. Conclusiones: El diagnóstico prenatal haría posible un tratamiento oportuno con mejores resultados. El bebé fue referido a un hospital de tercer nivel(AU)

Introduction: congenital malformations of the gastrointestinal tract are present at a high frequency in the neonatal period, gastroschisis is one of them, and they present a high mortality. Case presentation: A case of gastroschisis of a baby born in a delivery room with specialized medical care is presented, with a history of not having specialized prenatal care, with associated risk factors. A neonate with a wall defect abdominal, located in the right paraumbilical region with exposed intestine, flaccid, with generalized cyanosis, tachycardia, in respiratory arrest, resuscitation is carried out and respiratory rate is recovered, respiratory distress is maintained, skin color is improved, intestinal loops are packaged, placing an orogastric tube, vein was channeled with solution to maintain hydration. Conclusions: the prenatal diagnosis would allow a timely treatment with better results. The baby was referred to a third-level hospital(EU)

Nutritional management and postoperative prognosis of newborns submitted to primary surgical repair of gastroschisis / Manejo nutricional e prognóstico pós-operatório do recém-nascido submetido à correção cirúrgica primária de gastrosquise

Abstract Objective Gastroschisis is a defect of the abdominal wall, resulting in congenital evisceration and requiring neonatal intensive care, early surgical correction, and parenteral nutrition. This study evaluated newborns with gastroschisis, seeking to associate nutritional characteristics with time of hospital stay. Methods This was a retrospective cohort study of 49 newborns undergoing primary repair of gastroschisis between January 1995 and December 2010. The newborns’ characteristics were described with emphasis on nutritional aspects, correlating them with length of hospital stay. Results The characteristics that influenced length of hospital stay were: (1) newborn small for gestational age (SGA); (2) use of antibiotics; (3) day of life when enteral feeding was started; (4) day of life when full diet was reached. SGA infants had longer length of hospital stay (24.2%) than other newborns. The length of hospital stay was increased by 2.1% for each additional day taken to introduce enteral feeding. However, slower onset of full enteral feeding acted as a protective factor, decreasing length of stay by 3.6%. The volume of waste drained by the stomach catheter in the 24 h prior the start of enteral feeding was not associated with the timing of diet introduction or length of hospital stay. Conclusion Early start of enteral feeding and small, gradual increase of volume can shorten the use of parenteral nutrition. This management strategy contributes to reduce the incidence of infection and length of hospital stay of newborns with gastroschisis.

Resumo Objetivo A gastrosquise é uma malformação da parede abdominal que resulta em evisceração congênita e requer tratamento intensivo neonatal, correção cirúrgica precoce e nutrição parenteral. Investigaram-se neste estudo os recém-nascidos com gastrosquise e procurou-se correlacionar as suas características nutricionais com o tempo da internação hospitalar. Métodos Estudo de coorte retrospectivo de 49 recém-nascidos submetidos à correção primária de gastrosquise de janeiro de 1995 a dezembro de 2010. As características dos neonatos foram descritas com ênfase nos aspectos nutricionais e relacionadas com o tempo de internação hospitalar. Resultados As características que influenciaram a duração da internação foram: 1) recém-nascidos pequenos para a idade gestacional (PIG); 2) uso de antibióticos; 3) dia de vida ao iniciar a dieta enteral; 4) dia de vida ao atingir a dieta plena. Recém-nascidos PIG tiveram maior tempo de internação (24,2%) do que demais neonatos. O tempo de internação foi aumentado em 2,1% para cada dia a mais que se demorou a introduzir a dieta enteral. Entretanto, atingir mais lentamente o aporte pleno da dieta enteral agiu como fator protetor, diminuiu 3,6% no tempo de internação. O volume de resíduo drenado pelo cateter gástrico, nas últimas 24 horas antes do início da dieta enteral, não apresentou correlação com o momento da introdução da dieta nem com a duração da hospitalização. Conclusão Iniciar a dieta enteral precocemente, com aumento gradativo em pequenos volumes, pode abreviar a duração da nutrição parenteral. Esse manejo contribui para a diminuição da incidência de infecções e do tempo de hospitalização de recém-nascidos com gastrosquise.

Nutritional management and postoperative prognosis of newborns submitted to primary surgical repair of gastroschisis.

OBJECTIVE: Gastroschisis is a defect of the abdominal wall, resulting in congenital evisceration and requiring neonatal intensive care, early surgical correction, and parenteral nutrition. This study evaluated newborns with gastroschisis, seeking to associate nutritional characteristics with time of hospital stay. METHODS: This was a retrospective cohort study of 49 newborns undergoing primary repair of gastroschisis between January 1995 and December 2010. The newborns' characteristics were described with emphasis on nutritional aspects, correlating them with length of hospital stay. RESULTS: The characteristics that influenced length of hospital stay were: (1) newborn small for gestational age (SGA); (2) use of antibiotics; (3) day of life when enteral feeding was started; (4) day of life when full diet was reached. SGA infants had longer length of hospital stay (24.2%) than other newborns. The length of hospital stay was increased by 2.1% for each additional day taken to introduce enteral feeding. However, slower onset of full enteral feeding acted as a protective factor, decreasing length of stay by 3.6%. The volume of waste drained by the stomach catheter in the 24h prior the start of enteral feeding was not associated with the timing of diet introduction or length of hospital stay. CONCLUSION: Early start of enteral feeding and small, gradual increase of volume can shorten the use of parenteral nutrition. This management strategy contributes to reduce the incidence of infection and length of hospital stay of newborns with gastroschisis.

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.

Fatores associados à mortalidade em recém-nascidos com gastrosquise / Associated factors for perinatal mortality in gastroschisis

OBJETIVO: Analisar a taxa de mortalidade perinatal dos casos de gastrosquise e os possíveis fatores associados. MÉTODOS: Foi realizado estudo de coorte retrospectivo entre 1992 e 2012. Foram incluídos todos os casos de gastrosquise nascidos no Hospital de Clínicas de Porto Alegre (HCPA) naquele período. O diagnóstico de gastrosquise foi obtido por meio do exame ultrassonográfico morfológico ou pelo exame clínico ao nascimento nos casos desconhecidos no pré-natal. As variáveis de nascimento (peso ao nascer, idade gestacional e escore de Apgar, modo de parto, tipo de gastrosquise e anomalias associadas) e cirúrgicas (tipo de fechamento cirúrgico, reintervenção e sepse) foram comparadas entre os casos sobreviventes e os óbitos. Os resultados desta comparação foram analisados de acordo com o tipo de variável por meio de testes paramétricos e não paramétricos (Mann-Whitney ou teste t de Student, χ² ou teste exato de Fisher) sendo considerado o nível de significância de 5% (p=0,05). RESULTADOS: Foram incluídos 64 recém-nascidos com gastrosquise, 59 deles (92,2%) diagnosticados durante o pré-natal. Vinte e seis casos (40,6%) tinham somente intestino exposto, classificados como gastrosquise simples, 22 tinham intestino e estômago (34,4%) e 16 tinham intestino e outros órgãos (25%), totalizando 38 casos de gastrosquise complexa. O reparo cirúrgico primário foi realizado em 44 casos (68,8%). A mortalidade foi de 23,4% (15 mortes). Os casos de óbito tinham peso ao nascer (p=0,001), escore de Apgar (p=0,03) e idade gestacional (p=0,03) significativamente menores que os sobreviventes. Não houve diferença no modo de parto (p=0,8) e, com relação ao conteúdo eviscerado, não houve diferença entre os casos de gastrosquise simples e complexa (p=0,06). A mortalidade foi significativamente mais elevada entre os casos que necessitaram de reintervenção (p=0,001) e com sepse (p=0,008). CONCLUSÃO: A mortalidade perinatal da gastrosquise parece depender principalmente da prematuridade, baixo peso e complicações cirúrgicas.

PURPOSE: To analyze the perinatal mortality rate in cases of gastroschisis and possible associated factors. METHODS: A retrospective cohort study was conducted between 1992 and 2012. All cases of gastroschisis born in Hospital de Clínicas de Porto Alegre (HCPA) during that period were included. The diagnosis of gastroschisis was obtained by morphological ultrasound examination or clinical examination at birth in prenatally unknown cases. The variables of birth (birthweight, gestational age and Apgar score, mode of delivery, type of gastroschisis and associated anomalies) and the surgical ones (type of surgical closure, reintervention and sepsis) were compared between surviving cases and deaths. The results of this comparison were analyzed according to the type of variable using parametric and non-parametric tests (Mann-Whitney or Student's t-test, χ² or Fisher's exact test), with the level of significance set at 5% (p=0.05). RESULTS: Sixty-four newborns with gastroschisis were included, 59 of them (92.2%) diagnosed during the prenatal period. Twenty-six patients (40.6%) had only exposed intestines, classified as simple gastroschisis, 22 had exposure of the intestines and stomach (34.4%) and 16 had exposure of the intestine and other organs (25%), for a total of 38 cases of complex gastroschisis. Primary surgical repair was performed in 44 cases (68.8%). The mortality rate was 23.4% (15 deaths). Babies who died had significantly lower birth weight (p=0.001), gestational age (p=0.03) and Apgar score (p=0.03) than survivors. There was no difference in mode of delivery (p=0.8) and, with respect to gut contents, there was no difference between the cases of simple and complex gastroschisis (p=0.06). Mortality was significantly higher in patients with sepsis (p=0.008) and reintervention (p=0.001). CONCLUSION: in the present study, perinatal mortality due to gastroschisis seemed to depend mainly on prematurity, low birth weight, and surgical complications.

Defectos de la pared abdominal. Estudio comparativo entre onfalocele y gastrosquisis / Abdominal wall defects. A Comparative investigation between omphalocele and gastroschisis

Introducción: Onfalocele y gastrosquisis son los defectos de la pared abdominal (DPA) más frecuentes, que por su importancia y las diferencias entre ellos merecen ser estudiados en forma especial. Objetivos: Establecer las tasas de prevalencia de onfalocele y gastroaquisis al nacimiento. Verificar variaciones de ellas en distintos períodos. Estudiar la morbimortalidad asociada y su sobrevida. Pacientes y Método: Se revisó la base de datos ECLAMC (Estudio Colaborativo Latino Americano de Malformaciones Congênitas) para el período 1996-2010. Resultados: Se pesquizarón 33 recién nacidos (RN) con DPA. (11,6 por 10.000 nacimientos). De ellos 19 fueron onfalocele (6,7 por 10.000) y 14 (4,9 por 10.000) gastrosquisis. Los niños con onfalocele tenían significativamente mayor asociación con otras malformaciones, su frecuencia en el sexo masculino fue mayor y mostró mayor letalidad que la gastrosquisis. Todos los niños con gastrosquisis nacieron vivos, con predominio del sexo femenino, sus madres eran significativamente más jóvenes. Conclusión: Onfalocele y gastros-quisis presentaron una prevalencia al nacimiento mayor que lo publicado, probablemente por ser el HCUCH un Centro de Referencia. Ambas anomalías mostraron un aumento significativo en sus tasas de prevalencia al nacimiento al compararlas con las obtenidas anteriormente por nosotros en el mismo hospital. Se demostró diferencias significativas entre estas dos entidades: Onfalocele tiene mayor mortinatalidad, mortalidad y letalidad, mayor frecuencia de malformaciones asociadas y mayor promedio de edad materna.

Introduction: Omphalocele and Gastroschisis are the two most common congenital abdominal wall (AWD) defects. Objectives: To determine birth prevalence of Omphalocele and Gastroaquisis; to verify variations in different periods and to study the associated morbidity, mortality and survival. Patients and Method: The database of the Latin American Collaborative Study of Congenital Malformations (ECLAMC) was searched between the years 1996 and 2010. Results: 33 newborns (NB) with AWD were investigated (11.6 per 10,000 births). 19 of the cases corresponded to omphalocele (6.7 per 10,000 births) and 14 to gastroschisis (4.9 per 10,000 births). Children with omphalocele had significantly greater association with other malformations and the frequency in males was higher and showed higher mortality rates than gastroschisis. All children with gas-troschisis were born alive; they were predominantly female infants whose mothers were significantly younger. Conclusion: Birth omphalocele and gastroschisis prevalence were higher than published information, perhaps due to the fact that the HCUCH (Clinical Hospital of Universidad de Chile) is a reference center. Both anomalies showed a significant increase in their birth prevalence rates when compared with those previously obtained by us in the same hospital. Significant differences between these two entities were described. Omphalocele presented higher stillbirth, mortality and fatality rates; higher frequency of associated malformations and higher average maternal age.

[Associated factors for perinatal mortality in gastroschisis]. / Fatores associados à mortalidade em recém-nascidos com gastrosquise.

PURPOSE: To analyze the perinatal mortality rate in cases of gastroschisis and possible associated factors. METHODS: A retrospective cohort study was conducted between 1992 and 2012. All cases of gastroschisis born in Hospital de Clínicas de Porto Alegre (HCPA) during that period were included. The diagnosis of gastroschisis was obtained by morphological ultrasound examination or clinical examination at birth in prenatally unknown cases. The variables of birth (birthweight, gestational age and Apgar score, mode of delivery, type of gastroschisis and associated anomalies) and the surgical ones (type of surgical closure, reintervention and sepsis) were compared between surviving cases and deaths. The results of this comparison were analyzed according to the type of variable using parametric and non-parametric tests (Mann-Whitney or Student's t-test, χ² or Fisher's exact test), with the level of significance set at 5% (p=0.05). RESULTS: Sixty-four newborns with gastroschisis were included, 59 of them (92.2%) diagnosed during the prenatal period. Twenty-six patients (40.6%) had only exposed intestines, classified as simple gastroschisis, 22 had exposure of the intestines and stomach (34.4%) and 16 had exposure of the intestine and other organs (25%), for a total of 38 cases of complex gastroschisis. Primary surgical repair was performed in 44 cases (68.8%). The mortality rate was 23.4% (15 deaths). Babies who died had significantly lower birth weight (p=0.001), gestational age (p=0.03) and Apgar score (p=0.03) than survivors. There was no difference in mode of delivery (p=0.8) and, with respect to gut contents, there was no difference between the cases of simple and complex gastroschisis (p=0.06). Mortality was significantly higher in patients with sepsis (p=0.008) and reintervention (p=0.001). CONCLUSION: in the present study, perinatal mortality due to gastroschisis seemed to depend mainly on prematurity, low birth weight, and surgical complications.

Factores asociados a la mortalidad de recién nacidos con gastrosquisis en el Hospital Nacional Guillermo Almenara Irigoyen entre 2001 al 2010 / Factors associated with mortality of newborns with gastroschisis at the National Hospital Guillermo Almenara Irigoyen from 2001 to 2010

Introducción: La gastrosquisis es un defecto congénito de la pared abdominal cuya prevalencia ha aumentado notablemente en varios países y constituye una urgencia quirúrgica en neonatología. La sobrevida de estos pacientes ha aumentado con el advenimiento de las unidades de cuidados intensivos, las técnicas de cierre diferido y la nutrición parenteral total. Objetivo: Determinar los factores asociados a la mortalidad de los recién nacidos con gastrosquisis en el Hospital Nacional Guillermo Almenara lrigoyen. Pacientes y Métodos: Se realizó un estudio retrospectivo, de observación, descriptivo y comparativo de pacientes con gastrosquisis en el Hospital Nacional Guillermo Almenara lrigoyen del 2001 al 2010. Se realizó un estudio comparativo entre neonatos con gastrosquisis tratados en dicho hospital y se les dividió en dos grupos: los que vivieron y los que fallecieron. Se estudiaron los factores que pudieron estar relacionados con la evolución final. Resultados: Se encontraron 25 neonatos con gastrosquisis, de los cuales 44 por ciento eran de sexo femenino y 56 por ciento de sexo masculino. En este análisis descriptivo se encontró un 24 por ciento para el grupo de los fallecidos y 76 por ciento para el grupo de los vivos. El 66,6 por ciento de los fallecidos eran de sexo masculino y el 33,3 por ciento femenino. Se realizó cierre primario en 68 por ciento y colocación de Silo en 32 por ciento. El género, la edad materna, el estado civil, el lugar de nacimiento, el lugar donde se realizaron los controles prenatales, la paridad, el diagnóstico prenatal, el consumo de alcohol u otros medicamentos, antecedente de infección urinaria, la edad gestacional, la atresia intestinal, el medio de transporte, la sepsis pre y post operatoria, la deshidratación y la hipotermia, el riesgo quirúrgico, la eliminación de meconio, el cierre primario, el distrés respiratorio, el uso de NPT y NE, el tipo de germen aislado, la candidiasis, la segunda y tercera cirugía, son...

Gastrosquisis: presentación de un caso / Gastroschisis: a case presentation

La gastrosquisis se caracteriza por un defecto de la pared abdominal en el cual los intestinos y otras vísceras se desarrollan fuera del abdomen. Se presenta un caso de un recién nacido de una paciente de 25 años producto de un embarazo de 38.5 semanas, con diagnóstico prenatal tardío de gastrosquisis que se comprueba al nacimiento, se constata salida al exterior de gran parte del intestino delgado, estómago y parte del hígado; a consecuencia de la exposición a que fueron sometidos estos órganos, el estómago presentaba múltiples perforaciones; se interviene quirúrgicamente y se realiza resección amplia de estómago que incluía las perforaciones y se cierra el abdomen, colocándose los órganos expuestos en su interior; evoluciona desfavorablemente y fallece horas después de la intervención(AU)

Gastroschisis is characterized by abdominal wall defect in which intestines and other organs develop outside the abdomen. We report a case of a newborn of a 25 years patient as a result of a 38.5 weeks pregnancy,with delayed prenatal diagnosis of gastroschisis that is checked at birth,there has been found outside most of the small intestine, stomach and part of the liver as a result of the exposure these organs were subjected, the stomach had multiple piercings, and surgical interventions are performed wide resection of the stomach and the abdomen is closed, placing the exposed organs inside; this patient evolves unfavorably and dies hours after surgery(AU)