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Pramod S Puligandla, Robert Baird, Eric D Skarsgard, Sherif Emil, Jean-Martin Laberge
PURPOSE: The GPS enables risk stratification for gastroschisis and helps discriminate low from high morbidity groups. The purpose of this study was to revalidate GPS's characterization of a high morbidity group and to quantify relationships between the GPS and outcomes. METHODS: With REB approval, complete survivor data from a national gastroschisis registry was collected. GPS bowel injury scoring was revalidated excluding the initial inception/validation cohorts (>2011)...
January 27, 2017: Journal of Pediatric Surgery
Chris Houben, Mark Davenport, Niyi Ade-Ajayi, Nicki Flack, Shailesh Patel
PURPOSE: Gastroschisis (GS) is defined as a full-thickness abdominal wall defect (usually right-sided) with intestinal prolapse and occasionally other viscera. The defect itself may close around the viscera causing exit or entry level intestinal atresia and ischaemia or midgut infarction, previously described as closed GS. We now report the largest series of infants born with various stages of closing GS describing features, management, and outcome. METHODS: The study used a single-centre retrospective review of infants with GS and evidence of defect closure at birth...
February 2009: Journal of Pediatric Surgery
Kat Ford, Dan Poenaru, Olivier Moulot, Kate Tavener, Sarah Bradley, Rouma Bankole, Nyaweleni Tshifularo, Emmanuel Ameh, Nelson Alema, Eric Borgstein, Ann Hickey, Niyi Ade-Ajayi
INTRODUCTION: Economic disadvantage may adversely influence the outcomes of infants with gastroschisis (GS). Gastroschisis International (GiT) is a network of seven paediatric surgical centres, spanning two continents, evaluating GS treatment and outcomes. MATERIAL AND METHODS: A 2-year retrospective review of GS infants at GiT centres. Primary outcome was mortality. Sites were classified into high, middle and low income country (HIC, MIC, and LIC). MIC and LIC were sometimes combined for analysis (LMIC)...
August 2016: Journal of Pediatric Surgery
Erik D Skarsgard
PURPOSE OF REVIEW: The diagnosis and treatment of gastroschisis spans the perinatal disciplines of maternal fetal medicine, neonatology, and pediatric surgery. Since gastroschisis is one of the commonest and costliest structural birth defects treated in neonatal ICUs, a comprehensive review of its epidemiology, prenatal diagnosis, postnatal treatment, and short and long-term outcomes is both timely and relevant. RECENT FINDINGS: The incidence of gastroschisis has increased dramatically over the past 20 years, leading to a renewed interest in causation...
June 2016: Current Opinion in Pediatrics
Fouad Youssef, Li Hsia Alicia Cheong, Sherif Emil
BACKGROUND: Care of infants with gastroschisis is centralized in Canada and noncentralized in the United States. We conducted an outcomes comparison between the two countries and analyzed the determinants of such outcomes. METHODS: Inpatient mortality and hospital stay of gastroschisis patients from the Canadian Pediatric Surgery Network prospective clinical database for the period 2005-2013 were compared with those from the US Kids Inpatient Database for the period 2003-2012...
June 2016: Journal of Pediatric Surgery
Fouad Youssef, Andrew Gorgy, Ghaidaa Arbash, Pramod S Puligandla, Robert J Baird
BACKGROUND: Flap closure represents an alternative to fascial closure for gastroschisis. We performed a systematic review and meta-analysis of outcomes comparing these techniques. METHODS: A registered systematic review ( PROSPERO: CRD42015016745) of comparative studies was performed, querying multiple databases without language or date restrictions. Gray literature was sought. Outcomes analyzed included: mortality, ventilation days, feeding parameters, length of stay (LOS), wound infection, resource utilization, and umbilical hernia incidence...
May 2016: Journal of Pediatric Surgery
Arash Safavi, Erik D Skarsgard
Gastroschisis (GS) is a structural defect of the anterior abdominal wall, usually diagnosed antenatally, that occurs with a frequency of approximately 4 per 10,000 pregnancies. Babies born with GS require neonatal intensive care and surgical management of the abdominal wall defect soon after birth. Although contemporary survival rates for GS are over 90%, these babies are at risk for significant morbidity, and require 4 to 6 weeks of costly, resource-intensive care in specialized neonatal units. Much consideration has been given to how best to treat the abdominal wall defect of GS...
May 2015: Surgical Technology International
Carmen Mesas Burgos, Anna Svenningsson, Jenny Hammarqvist Vejde, Tina Granholm, Peter Conner
BACKGROUND: The timing and mode of delivery of pregnancies with prenatally diagnosed gastroschisis remains controversial. AIM: To evaluate the outcome of patients with gastroschisis managed during two time periods: 2006-2009 and 2010-2014, with planned elective cesarean delivery at 37 versus 35 gestational weeks (gw). A secondary aim was to analyze the outcome in relation to the gestational age at birth. MATERIAL AND METHODS: Retrospective review of all cases with gastroschisis managed at our institution between 2006 and 2014...
November 2015: Pediatric Surgery International
Dong Luo, Lan Wu, Hai Wu, Wei Huang, Han Huang
Gastroschisis requires surgical repair, which is generally performed after birth. We report a case in which a fetus with gastroschisis underwent the abdominal wall defect repair before birth. To ensure reliable operating conditions for the repair (to prevent fetal movement and crying), the fetus received deep anesthesia via placental transfer of maternally administered anesthetics. Meanwhile, the ex utero intrapartum treatment procedure was performed to ensure fetal oxygen supply, which was likely to be compromised by the deep fetal anesthesia...
2015: International Journal of Clinical and Experimental Medicine
Rachel K Schlueter, Kenneth S Azarow, Andrea Green Hines, Meera Varman, Shahab F Abdessalam, Stephen C Raynor, Robert A Cusick
PURPOSE: We describe the infectious complications of gastroschisis in order to identify modifiable factors to decrease these complications. METHODS: Data from 155 gastroschisis patients (2001-2013) were reviewed. Complicated gastroschisis (intestinal atresia, necrotic bowel, or perforation) were excluded, leaving 129 patients for review. Patient demographics, surgical details, postoperative infections and complications, and length of stay were reviewed. We used CDC definitions of infectious complications...
January 2015: Journal of Pediatric Surgery
Anne Dariel, Wannisa Poocharoen, Nicole de Silva, Hazel Pleasants, Justin Ted Gerstle
INTRODUCTION: Nonsurgical closure after primary silo placement, secondary plastic closure (SPC), has been used as an alternative to secondary surgical closure (SSC) in gastroschisis. The benefits described were closure without formal surgical procedure, cosmetic aspect, and minimization of intra-abdominal pressures. This study compared requirements for mechanical ventilation and general anesthesia, nutritional care, and outcomes between SPC and SSC. PATIENTS AND METHODS: We included patients with primary staged-silo reduction with a 1-year minimum follow-up...
February 2015: European Journal of Pediatric Surgery
Piergiorgio Gamba, Paola Midrio
Omphalocele and gastroschisis represent the most frequent congenital abdominal wall defects a pediatric surgeon is called to treat. There has been an increased reported incidence in the past 10 years mainly due to the diffuse use of prenatal ultrasound. The early detection of these malformations, and related associated anomalies, allows a multidisciplinary counseling and planning of delivery in a center equipped with high-risk pregnancy assistance, pediatric surgery, and neonatology. At present times, closure of defects, even in multiple stages, is always possible as well as management of most of cardiac-, urinary-, and gastrointestinal-associated malformations...
October 2014: Seminars in Pediatric Surgery
Abdullah Alshehri, Sherif Emil, Jean-Martin Laberge, Erik Skarsgard
BACKGROUND: Gastroschisis may be complicated by intestinal atresia, necrosis, and/or perforation. In the absence of an urgent indication, intestinal procedures are often delayed to allow for bowel recovery. This practice has not been evaluated. METHODS: We queried a prospective Canadian database of all patients with gastroschisis born between 2005 and 2011. Patients with intestinal atresia who underwent an intestinal operation during the first 21 days of life (EARLY GROUP) were compared with those who underwent operations later (LATE GROUP)...
October 2013: Journal of Pediatric Surgery
Akram Aljahdali, Noosheen Mohajerani, Erik D Skarsgard
BACKGROUND: Timely initiation of enteral nutrition is pivotal to outcome optimization in gastroschisis (GS). The purpose of our study was to analyze the effect of timing of first feeds on outcome. METHOD: GS cases accrued between May 2005 and August 2011 were abstracted from a national database. Risk variables evaluated included GA, illness severity, bowel injury severity, and post-closure days to first feed (DTF). The outcomes analyzed included duration of TPN, LOS, and infectious complications...
May 2013: Journal of Pediatric Surgery
David Baud, Andrea Lausman, Malikah A Alfaraj, Gareth Seaward, John Kingdom, Rory Windrim, Jacob C Langer, Edmond N Kelly, Greg Ryan
OBJECTIVE: To estimate obstetric and neonatal outcomes after induction of labor at 37 weeks of gestation compared with expectant management in pregnancies complicated by fetal gastroschisis. METHODS: The management of 296 pregnancies involving fetal gastroschisis (1980-2011) was reviewed from a single perinatal center. Ultrasound surveillance and nonstress testing were performed every 2 weeks from 30 weeks of gestation, weekly from 34 weeks of gestation, and twice weekly after 35 weeks of gestation until delivery...
May 2013: Obstetrics and Gynecology
Wilson W Choi, Craig A McBride, Chris Bourke, Peter Borzi, Kelvin Choo, Rosslyn Walker, Tuan Nguyen, Mark Davies, Tim Donovan, David Cartwright, Roy M Kimble
BACKGROUND: A sutureless ward reduction (SWR) protocol was implemented in the neonatal intensive care unit of a tertiary level hospital in 1999. Although the short-term outcomes associated with SWR have been documented, the long-term outcomes are unknown. METHODS: Retrospective data were collected from the medical records of all neonates with gastroschisis from September 1999 to December 2010. Data on their growth and development and the prevalence of any health problems were collected...
August 2012: Journal of Pediatric Surgery
Kyle N Cowan, Pramod S Puligandla, Jean-Martin Laberge, Erik D Skarsgard, Sarah Bouchard, Natalie Yanchar, Peter Kim, Shoo Lee, Douglas McMillan, Peter von Dadelszen
BACKGROUND/PURPOSE: Disease-specific outcome predictors are required for gastroschisis. We derived and validated a gastroschisis prognostic score (GPS) based on bowel appearance after birth. METHODS: Visual scoring of bowel matting, necrosis, atresia, and perforation generated a novel gastroschisis bowel injury score recorded in a national database. Reweighting of score components by regression analysis led to assessments of model calibration and goodness of fit...
June 2012: Journal of Pediatric Surgery
Daniel J Ledbetter
The embryology, epidemiology, associated anomalies, prenatal course and the neonatal and surgical care of newborns with gastroschisis and omphalocele are reviewed. For gastroschisis temporary intestinal coverage is often done before a more definitive operative closure that may be immediate or delayed. Outcomes in gastroschisis are determined by associated bowel injury. For omphalocele small defects are closed primarily while large defects are treated topically to allow initial skin coverage before a later definitive closure...
June 2012: Surgical Clinics of North America
Brent R Weil, Charles M Leys, Frederick J Rescorla
PURPOSE: Management of gastroschisis has shifted from early primary closure to preformed silo placement and delayed closure. We aimed to identify how closure techniques have changed and how outcomes have been affected. METHODS: Records of patients undergoing gastroschisis closure at a single institution from 2000 to 2009 were reviewed. Patient characteristics and outcomes were collected and compared among those undergoing primary closure vs preformed silo placement...
January 2012: Journal of Pediatric Surgery
Kristine Clodfelter Orion, Michael Krein, Junlin Liao, Aimen F Shaaban, Graeme J Pitcher, Joel Shilyansky
BACKGROUND: Gastroschisis is a congenital abdominal wall defect in which the intestines develop outside the abdomen and are exposed to amniotic fluid. When the defect is small, lymphatic, venous, and intestinal obstruction may occur and contribute to the formation of intestinal edema, atresia, ischemia, and a thick inflammatory peel. Treatment requires early coverage of abdominal contents either by primary closure or by the placement of temporary Silastic silo followed by abdominal wall closure...
August 2011: Surgery
2015-06-12 04:52:55
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