Outcomes of Complex Gastroschisis
DOI:
https://doi.org/10.52783/jns.v14.1603Keywords:
Gastroschisis, Total parenteral nutrition (TPN), Necrotizing enterocolitis (NEC), Silo closureAbstract
Background
Gastroschisis, an anterior abdominal wall defect, is associated with significant morbidity and mortality. This study aims to evaluate the early outcomes of neonates with complex gastroschisis and correlate outcomes with prevalent types of complications, such as a line infection and NEC.
Methods
A retrospective review was performed at multiple pediatric surgical centers (January 2001 and December 2019). Statistical analysis of categorical variables between the cohorts of the primary closure versus silo placement was conducted and 95% confidence intervals (CI) for variables were calculated.
Results
Two hundred and thirty-four neonates with gastroschisis were identified. The cohort of neonates having undergone silo closure had a longer duration of total parenteral nutrition (TPN) (32.5 vs. 48.17; P = .006), prolonged hospitalization (40.18 vs. 54.15; P = .007) and higher incidence of concomitant of bowel atresia (0.12 vs.0.20; P= .004). There was no difference observed in survival. Multivariate logistic regression demonstrated that time to closure and number of surgeries were significantly related to LOS as an independent variable.
Conclusion
The time to silo closure is the most significant variable related to the duration of TPN and hospitalization in gastroschisis patients, determined by the number of surgeries and severity of the disease. Furthermore, NEC and line infection were high after primary closure.
Downloads
Metrics
References
Kunz SN, Tieder JS, Whitlock K, Jackson JC, Avansino JR. Primary fascial closure versus staged closure with silo in patients with gastroschisis: a meta-analysis. J Pediatr Surg. 2013;48(4):845-57. doi: 10.1016/j.jpedsurg.2013.01.020
Holland AJ, Walker K, Badawi N. Gastroschisis: an update. Pediatr Surg Int. 2010;26(9):871-8. doi: 10.1007/s00383-010-2679-1
Bergholz R, Boettcher M, Reinshagen K, Wenke K. Complex gastroschisis is a different entity to simple gastroschisis affecting morbidity and mortality-a systematic review and meta-analysis. J Pediatr Surg. 2014;49(10):1527-32. doi: 10.1016/j.jpedsurg.2014.08.001
Rentea RM, Gupta V. Gastroschisis. 2020 doi: https://www.ncbi.nlm.nih.gov/books/NBK557894/
Kuleva M, Khen-Dunlop N, Dumez Y, Ville Y, Salomon LJ. Is complex gastroschisis predictable by prenatal ultrasound? Bjog. 2012;119(1):102-9. doi: 10.1111/j.1471-0528.2011.03183.x
Molik KA, Gingalewski CA, West KW, Rescorla FJ, Scherer LR, Engum SA, et al. Gastroschisis: a plea for risk categorization. J Pediatr Surg. 2001;36(1):51-5. doi: 10.1053/jpsu.2001.20004
Fraser JD, Deans KJ, Fallat ME, Helmrath MA, Kabre R, Leys CM, et al. Sutureless vs sutured abdominal wall closure for gastroschisis: Operative characteristics and early outcomes from the Midwest Pediatric Surgery Consortium. J Pediatr Surg. 2020 doi: 10.1016/j.jpedsurg.2020.02.017
Owen A, Marven S, Johnson P, Kurinczuk J, Spark P, Draper ES, et al. Gastroschisis: a national cohort study to describe contemporary surgical strategies and outcomes. J Pediatr Surg. 2010;45(9):1808-16. doi: 10.1016/j.jpedsurg.2010.01.036
Laje P, Fraga MV, Peranteau WH, Hedrick HL, Khalek N, Gebb JS, et al. Complex gastroschisis: Clinical spectrum and neonatal outcomes at a referral center. J Pediatr Surg. 2018;53(10):1904-7. doi: 10.1016/j.jpedsurg.2018.03.011
Bradnock TJ, Marven S, Owen A, Johnson P, Kurinczuk JJ, Spark P, et al. Gastroschisis: one-year outcomes from a national cohort study. Bmj. 2011;343:d6749. doi: 10.1136/bmj.d6749
Eggink BH, Richardson CJ, Malloy MH, Angel CA. Outcome of gastroschisis: a 20-year case review of infants with gastroschisis born in Galveston, Texas. J Pediatr Surg. 2006;41(6):1103-8. doi: 10.1016/j.jpedsurg.2006.02.008
Hawkins RB, Raymond SL, St Peter SD, Downard CD, Qureshi FG, Renaud E, et al. Immediate versus silo closure for gastroschisis: Results of a large multicenter study. J Pediatr Surg. 2020;55(7):1280-5. doi: 10.1016/j.jpedsurg.2019.08.002
Puligandla PS, Baird R, Skarsgard ED, Emil S, Laberge J-M. Outcome prediction in gastroschisis – The gastroschisis prognostic score (GPS) revisited. Journal of Pediatric Surgery. 2017;52(5):718-21. doi: https://doi.org/10.1016/j.jpedsurg.2017.01.017
Cowan KN, Puligandla PS, Laberge J-M, Skarsgard ED, Bouchard S, Yanchar N, et al. The gastroschisis prognostic score: reliable outcome prediction in gastroschisis. Journal of Pediatric Surgery. 2012;47(6):1111-7. doi: https://doi.org/10.1016/j.jpedsurg.2012.03.010
Harris J, Poirier J, Selip D, Pillai S, A NS, Jackson CC, et al. Early Closure of Gastroschisis After Silo Placement Correlates with Earlier Enteral Feeding. J Neonatal Surg. 2015;4(3):28.
Emil S, Canvasser N, Chen T, Friedrich E, Su W. Contemporary 2-year outcomes of complex gastroschisis. J Pediatr Surg. 2012;47(8):1521-8. doi: 10.1016/j.jpedsurg.2011.12.023
Poola AS, Aguayo P, Fraser JD, Hendrickson RJ, Weaver KL, Gonzalez KW, et al. Primary Closure versus Bedside Silo and Delayed Closure for Gastroschisis: A Truncated Prospective Randomized Trial. Eur J Pediatr Surg. 2019;29(2):203-8. doi: 10.1055/s-0038-1627459
Oyinloye AO, Abubakar AM, Wabada S, Oyebanji LO. Challenges and Outcome of Management of Gastroschisis at a Tertiary Institution in North-Eastern Nigeria. Front Surg. 2020;7:8. doi: 10.3389/fsurg.2020.00008
Jensen AR, Waldhausen JHT, Kim SS. The Use of a Spring-Loaded Silo for Gastroschisis: Impact on Practice Patterns and Outcomes. Archives of Surgery. 2009;144(6):516-9. doi: 10.1001/archsurg.2009.63
Weil BR, Leys CM, Rescorla FJ. The jury is still out: changes in gastroschisis management over the last decade are associated with both benefits and shortcomings. J Pediatr Surg. 2012;47(1):119-24. doi: 10.1016/j.jpedsurg.2011.10.029
Henrich K, Huemmer HP, Reingruber B, Weber PG. Gastroschisis and omphalocele: treatments and long-term outcomes. Pediatr Surg Int. 2008;24(2):167-73. doi: 10.1007/s00383-0072055-y
Snyder CL, Miller KA, Sharp RJ, Murphy JP, Andrews WA, Holcomb GW, 3rd, et al. Management of intestinal atresia in patients with gastroschisis. J Pediatr Surg. 2001;36(10):1542-5. doi: 10.1053/jpsu.2001.27040
Gornall P. Management of intestinal atresia complicating gastroschisis. J Pediatr Surg. 1989;24(6):522-4. doi: 10.1016/s0022-3468(89)80497-x
Jayanthi S, Seymour P, Puntis JW, Stringer MD. Necrotizing enterocolitis after gastroschisis repair: a preventable complication? J Pediatr Surg. 1998;33(5):705-7. doi: 10.1016/s00223468(98)90191-9
Oldham KT, Coran AG, Drongowski RA, Baker PJ, Wesley JR, Polley TZ. The development of necrotizing enterocolitis following repair of gastroschisis: A suprisingly high incidence. Journal of Pediatric Surgery. 1988;23(10):945-9. doi: https://doi.org/10.1016/S0022-3468(88)80392-0
Youssef F, Laberge J-M, Puligandla P, Emil S. Determinants of outcomes in patients with simple gastroschisis. Journal of Pediatric Surgery. 2017;52(5):710-4. doi: https://doi.org/10.1016/j.jpedsurg.2017.01.019
Logsdon NT, Sampaio FJB, Favorito LA. The role of intra-abdominal pressure in human testicular migration. Int Braz J Urol. 2021;47(1):36-44. doi: 10.1590/s1677-5538.Ibju.2021.99.03
Berger AP, Hager J. Management of neonates with large abdominal wall defects and undescended testis. Urology. 2006;68(1):175-8. doi: https://doi.org/10.1016/j.urology.2006.01.091
Chowdhary SK, Lander AD, Buick RG, Corkery JJ, Gornall P. The primary management of testicular maldescent in gastroschisis. Pediatric Surgery International. 2001;17(5):359-60. doi: 10.1007/s003830000571
Hill SJ, Durham MM. Management of cryptorchidism and gastroschisis. J Pediatr Surg. 2011;46(9):1798-803. doi: 10.1016/j.jpedsurg.2011.01.017
Barthold JS. Undescended testis: current theories of etiology. Current Opinion in Urology. 2008;18(4):395-400. doi: 10.1097/MOU.0b013e3283005869
Snyder AN, Burjonrappa S. Central line associated blood stream infections in gastroschisis patients: A nationwide database analysis of risks, outcomes, and disparities. Journal of Pediatric Surgery. 2020;55(2):286-91. doi: https://doi.org/10.1016/j.jpedsurg.2019.10.028
Khalil BA, Baath ME, Baillie CT, Turnock RR, Taylor N, Van Saene HFK, et al. Infections in gastroschisis: organisms and factors. Pediatric Surgery International. 2008;24(9):1031-5. doi: 10.1007/s00383-008-2210-0
Dubbink-Verheij GH, Bekker V, Pelsma ICM, van Zwet EW, Smits-Wintjens V, Steggerda SJ, et al. Bloodstream Infection Incidence of Different Central Venous Catheters in Neonates: A Descriptive Cohort Study. Front Pediatr. 2017;5:142. doi: 10.3389/fped.2017.00142
Zingg W, Tomaske M, Martin M. Risk of parenteral nutrition in neonates--an overview. Nutrients. 2012;4(10):1490-503. doi: 10.3390/nu4101490
Ma M, Garingo A, Jensen AR, Bliss D, Friedlich P. Complication risks associated with lower versus upper extremity peripherally inserted central venous catheters in neonates with gastroschisis. J Pediatr Surg. 2015;50(4):556-8. doi: 10.1016/j.jpedsurg.2014.08.026
Schlueter RK, Azarow KS, Hines AG, Varman M, Abdessalam SF, Raynor SC, et al. Identifying strategies to decrease infectious complications of gastroschisis repair. Journal of Pediatric Surgery. 2015;50(1):98-101. doi: https://doi.org/10.1016/j.jpedsurg.2014.10.001
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
