Gradual Bedside Reduction of Gastroschisis in a Resource Constrained Setting: Preliminary Results from 32 Cases

Introduction: Gastroschisis is one of the neonatal pathologies with bad prognosis in developing countries due to a lack of equipment. We aim to report one way of managing this malformation that could be practised everywhere, constituting an alternative approach to surgery in poor areas. Patients and Methods: This observational and descriptive study included newborn babies with gastroschisis who underwent gradual bedside reduction at the Paediatric Surgery Department of the Yaounde Central Hospital. Results: Our cohort was constituted by 32 newborn babies with a mean age of 18.12 hours on admission. The Lefort type 2 was the most frequent in 81.25% of cases. The mean time for oral feeding after complete reduction was 17.4 days and the duration of hospital stay was 24.91 days. Survival rates were at 40.63%, with a residual hernia after healing in 38.46% of cases. Conclusion: Despite the high rate of mortality, gradual reduction of gastroschisis at the bedside seems to be an opportunity for resource constrained areas and can be an alternative solution to surgery.

Vacuum Assisted Closure (VAC) and Platelet-Rich Plasma (PRP): A Successful Combination in a Challenging Case of Gastroschisis

Giant gastroschisis could be a surgical challenge concerning the abdominal wall reconstruction. Many techniques have been described for both primary or staged closure but sometimes neither of them is succesful in all patients. We are presenting the combined use of Vacuum Assisted Closure (VAC) and Platelet-Rich Plasma (PRP) to improve the result in this difficult case. The use of VAC device is a well known procedure in the treatment of adult difficult wounds closure. It consists of a sponge applied directly on the abdominal wall defect, covered with a transparent dressing and connected to a controlled continuous negative pressure system [1]. Platelet-rich plasma (PRP) is an autologous concentration of human platelets in a small volume of plasma. Due to this combination it provides multiple growth and healing factors actively secreted by platelets which have been shown to begin and accelerate wound healing [2] [3]. The association between VAC and PRP was effective in the shrinkage and reduction of the abdominal defect. Fifteen months after the removal of the VAC device the fascia appears competent with a cutaneus scar that will need a plastic correction in the future. The VAC should be considered as a helpful and effective device in case of complicated giant gastroschisis or omphalocele when traditional treatment is not sufficient.

Safety and efficacy of Dai-kenchu-to in postoperative infants with gastroschisis

Purpose: Intestinal dysfunction is a major problem after gastroschisis repair, and causes poor oral intake and poor body weight gain in infants with gastroschisis. Dai-kenchu-to (DKT) is often used in the treatment of gastrointestinal dysfunction in Japan. The purpose of this study was to analyze the effect of DKT on infants with uncomplicated gastroschisis. Methods: In this retrospective cohort study from 1991 to 2009, we assessed 16 infants with uncomplicated gastroschisis. Eight infants received 0.3 g/kg/day of DKT for 12 months (group 1) and 8 infants did not receive DKT (group 2). We analyzed their body weight as an indicator of the effect of DKT. Results: There were no significant differences in the background characteristics. The body weight of group 1 was significantly increased at the ages of 9 months (p = 0.0348) and 12 months (p = 0.0097), compared with group 2. Multivariate analyses revealed that only DKT administration had a significant impact on body weight gain at the ages of 9 months (p = 0.0201) and 12 months (p = 0.0111). No side effects related to DKT were reported. Conclusion: DKT administration might work safely and effectively for improving the body weight gain in infants with uncomplicated gastroschisis.

Gastroschisis Associated with Cleft Lip and Palate: Report of Three Cases

Gastroschisis is a malformation of the abdominal wall like omphalocele. In most cases, gastroschisis is isolated. But in some cases, we find malformations, essentially minor and concern gastrointestinal or genitourinary systems. Association with craniofacial congenital midline defects is uncommon. We report 3 cases of association between gastroschisis and cleft lip and palate for the benefit of the scientific community. Two 0-day-old and a 1-day newborns were admitted in our institution for malformation of face and abdominal wall. The physical examination confirmed the association of gastroschisis and cleft lip and palate. The patients underwent primary closure. Other malformations could not be sought until all patients died.

Predictive factors at birth of the severity of gastroschisis

AIM: To establish children born with gastroschisis(GS).METHODS: We performed a retrospective study covering the period from January 2000 to December 2007. The following variables were analyzed for each child: Weight, sex, apgar, perforations, atresia, volvulus, bowel lenght, subjective description of perivisceritis, duration of parenteral nutrition, first nasogastric milk feeding, total milk feeding, necrotizing enterocolitis, average period of hospitalization and mortality. For statistical analysis, descriptive data are reported as mean ± standard deviation and median(range). The non parametric test of Mann-Whitney was used. The threshold for statistical significance was P < 0.05(TwoTailed).RESULTS: Sixty-eight cases of GS were studied. We found nine cases of perforations, eight of volvulus, 12 of atresia and 49 children with subjective description of perivisceritis(72%). The mortality rate was 12%(eight deaths). Average duration of total parenteral nutrition was 56.7 d(8-950; median: 22), with five cases of necrotizing enterocolitis. Average length of hospitalization for 60 of our patients was 54.7 d(2-370;median: 25.5). The presence of intestinal atresia was the only factor correlated with prolonged parenteral nutrition, delayed total oral milk feeding and longer hospitalization.CONCLUSION: In our study, intestinal atresia was our predictive factor of the severity of GS.

Histological and Morphological Study of the Intestines of Wistar Rat Fetuses in a Modified Gastroschisis Experimental Model

In gastroschisis (G), the lesion degree of exposed intestinal segments is related to the time of its contact with the amniotic fluid (AF) and exposure to meconium which is the cause of intestinal morphological and histological alterations. The outcome of these alterations is intestinal hypoperistalsis and nutrient absorption deficiency, which contribute to increased morbidity and high medical-hospital costs. In this study, morphological and histological intestine alterations were identified at two different contact occasions with AF. Experimental gastroschisis (G) was performed on Wistar rat fetuses at a single gestational age on day 18.5th. The fetuses were removed on the 20.5th (G-1) and 21.5th days (G-2). Fetuses of both groups were divided in 3 sub-groups: control (C), gastroschisis (G) and sham (S). Measurements were taken of the Whole Set including fetus, placenta and membranes with AF (WS), fetus body weight (BW), intestinal weight (IW) and their diameters (DI). The objective of the present study is to test a new gastroschisis experimental model and identify differences in morphological and histological alterations in these two gestational periods that may be directly related to intestinal motility disorders in G. The WS and BW presented no significant statistical difference when compared G1 and G2. The results of the intestine average weight of G2 fetuses were significantly higher when compared to G1 fetuses in all subgroups (C: p = 0.02;G: p = 0.01;S: p = 0.02, Mann Whitney). The results of the intestinal average diameters (D/d) in G1 and G2 presented significant statistical difference only in G subgroup (p Kruskal Wallis). When compared intestinal average diameters, there was significant statistical difference of G fetuses in G1 and G2 (p Mann Whitney). In conclusion, the present experimental G model was adequate to reproduce G in rat fetuses. All G fetuses presented significant statistical difference when compared to other group in their subgroup and when compared G1 and G2 (p < 0.05). These alterations can explain the difficulties in accomplishing adequate peristalsis in G neonate bearers.

“Inverse Type” Apple-Peel Syndrome Is Associated with Type III Colonic Atresia in a Neonate with Gastroschisis—A “New” Subtype of Colonic Atresia

The colon is an unusual site of intestinal atresia. Colonic atresia is subdivided into three phenotypes. Type III is the most common phenotype, where the proximal and distal blind sacs are not connected. Here, we report on the presence of colonic atresia with an “inverse apple-peel” appearance in a neonate with gastroschisis. The lack of mesenteric fixation of the entire small intestine, including the proximal colon, and the twisting around the vascular axis of the superior mesenteric artery led to intrauterine volvulus and hemorrhagic infarction of the ileocolic bowel at 34 weeks of gestation. According to the current nomenclature for small bowel atresia, we introduce type IIIB into the current colonic atresia classification. The occurrence of type IIIB has been mentioned in the literature, but no single cases have been reported until now. Patients with this type of atresia are predisposed to the loss of the ileocecal region.

Are Fetuses Affected by Gastroschisis Benefited from Prenatal Maternal Corticosteroid Use and Early Parturition?

Introduction: Gastroschisis (G) is a congenital defect of the abdominal walls through which intestinal herniation and permanent exposure to amniotic liquid (AL) and its components are developed at the end of gestation. G affects mostly fetuses from young mothers under 25 - 29 years old, but it occurs more often in fetuses of mothers’ ages between 12 - 15 years old. Some authors assert that it is not the low weight, nor the low gestational age that influences mortality. In addition to morphological alterations, histological alterations are characterized by disorganization, distribution and the degree of ganglia maturity and myenteric plexuses. The literature describes parturition anticipation of G disease carriers to minimize damages to intestinal loops. There are studies suggesting corticosteroids at the end of gestation in order to avoid morphological and histological damages to the intestinal loop. Objective: Identify if live newborn infants delivery anticipation, that is, gestational date less than 37 weeks and prenatal maternal use of corticosteroid were benefited from early enteral diet, namely, less than 10 post-surgery days. Material and Method: From 33 newborns researched in the period from 2010 to 2014;28 newborns full records were included in the study with 15.2% mortality rate. These newborns were divided in 3 groups according to maternal age: 6 newborns from mothers’ age between 16 - 20 years old (Group 1);14 newborns from mothers’ age between 21 - 25 years old (Group 2) and 8 newborns from mothers’ age between 26 - 29 years old (Group 3). Gestational age at birth and prenatal maternal usage of corticosteroid and beginning oral feeding were assessed. Results: From 28 newborns, 19 mothers ingested prenatal corticosteroid and 16 newborns received the first enteric diet 10 days before and 3 days later. The mothers of the other 9 newborns were not treated with corticosteroid;only 3 newborns were fed before 10 days and 6 were fed later (p = 0.0016). Regarding gestational age, 17 newborns were born before 37 weeks and their 1st enteral diet was offered before 10 days. From the 11 newborns born after 37 weeks, only 4 received the 1st enteral diet before 10 days (p = 0.015). Conclusion: Newborn infants born with gestational age below 37 weeks, whose mothers received prenatal corticosteroid, were benefited with the first enteral diet before 10 postoperative days.

Delivery room surgery:an applicable therapeutic strategy for gastroschisis in developing countries

Background:The survival rate of infants with gastroschisis has improved significantly.It is over 90%in developed countries,but 50%in developing countries.This study aimed to investigate the factors improving the survival rate of infants with gastroschisis in developing countries.Methods:Neonates meeting the inclusion criteria,who presented to our center since the establishment of delivery room surgery,were enrolled into this retrospective study.Data were evaluated specifically to determine the role of delivery room surgery in reducing the mortality and morbidity of infants with gastroschisis and to identify factors optimizing the conditions of outborn infants.Results:A total of 64 infants were identified.The overall survival rate of the infants was 60.9%.The survival rate of infants in inborns was 76.5%,and the survival rate of infants in outborns was 43.3%.Infants of the outborn group took more time to reach full enteral feeding,and were more likely to require a prolonged stay in hospital when compared with those of the inborn group.Logistic analysis identified that the surgical technique,the presence of sepsis and intestinal necrosis could be expected to influence the outcome of gastroschisis.Conclusions:The strategy of delivery of patients in a center prepared to perform delivery room closure of gastroschisis appears to improve the survival of patients with gastroschisis.Further reduction in mortality rates will depend on improved conditions of outborn infants.

Gastroschisis at the Leon University Hospital, Nicaragua

Objective::The prevalence of midline birth defects, such as gastroschisis, has increased worldwide, over the last few decades. This study aims to explore the prevalence, maternal epidemiological characteristics, and natural history of neonates affected by gastroschisis at the University Hospital of Leon city, Nicaragua.Methods:Data were collected from the birth defect surveillance system of the Hospital Oscar Danilo Rosales (HEODRA). The analysis included all pregnancies that had gastroschisis complications between January 1 and December 31, 2020. The prevalence of gastroschisis was calculated according to maternal age. The mothers were interviewed, and the clinical records of the newborns were reviewed.Results::Among the 4,460 deliveries included in this study, four cases of gastroschisis were identified, including three live births and one stillbirth. The gastroschisis rate was 8.9 per 10,000 live births (95% confidence interval [CI]: 0.18-17.8). The prevalence among mothers younger than 20 years and those older than 20 years was 26.4 (95% CI: -3.43 to 56.25) and 3.01 (95% CI: 2.89-8.90)/10,000 births, respectively. Mothers of gastroschisis-affected fetuses were of rural origin ( n = 3), had normal body mass indexes ( n = 3), were exposed to tobacco and wood smoke ( n = 2), and one was exposed to pesticides during the periconceptional period. Primary closure of the gastroschisis was performed on one patient, and complex gastroschisis for intestinal perforation was observed in another patient. The mean hospitalization duration was 33 days, and two patients were discharged alive. Conclusions::Gastroschisis was a significant birth defect among children delivered at HEODRA in 2020. Its prevalence in Nicaragua was higher than that in other countries in the region. All complicated pregnancies were young women with unplanned pregnancies, from rural areas, with exposure to secondhand smoke, and without vitamin supplements before or during the first trimester of pregnancy. Only 67% of infants survived after hospital discharge.

Gastroesophageal reflux and congenital gastrointestinal malformations

Although the outcome of newborns with surgical congenital diseases(e.g.,diaphragmatic hernia;esophageal atresia;omphalocele;gastroschisis) has improved rapidly with recent advances in perinatal intensive care and surgery,infant survivors often require intensive treatment after birth,have prolonged hospitalizations,and,after discharge,may have longterm sequelae including gastro-intestinal comorbidities,above all,gastroesophageal reflux(GER).This condition involves the involuntary retrograde passage of gastric contents into the esophagus,with or without regurgitation or vomiting.It is a well-recognized condition,typical of infants,with an incidence of 85%,which usually resolves after physiological maturation of the lower esophageal sphincter and lengthening of the intra-abdominal esophagus,in the first few months after birth.Although the exact cause of abnormal esophageal function in congenital defects is not clearly understood,it has been hypothesized that common(increased intra-abdominal pressure after closure of the abdominal defect) and/or specific(e.g.,motility disturbance of the upper gastrointestinal tract,damage of esophageal peristaltic pump) pathological mechanisms may play a role in the etiology of GER in patients with birth defects.Improvement of knowledge could positively impact the long-term prognosis of patients with surgical congenital diseases.The present manuscript provides a literature review focused on pathological and clinical characteristics of GER in patients who have undergone surgical treatment for congenital abdominal malformations.