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01-09-2008 | Original Article

Scheduled preterm delivery for gastroschisis improves postoperative outcome

Authors: Thomas Gelas, Daniela Gorduza, Simone Devonec, Pascal Gaucherand, Esther Downham, Olivier Claris, Rémi Dubois

Published in: Pediatric Surgery International | Issue 9/2008

Abstract

There are some evidence to suggest that careful antenatal monitoring, scheduled preterm delivery and immediate abdominal wall closure may reduce gastroschisis morbidity. We hypothesised that the advantages of a scheduled preterm delivery balance possible complications related to prematurity. A retrospective study was performed including all cases of gastroschisis born between 1990 and 2004 (n = 69). Cases were categorised in two groups. Group 1 contained gastroschisis cases born between 1990 and 1997. Group 2 contained cases occurring since 1997, when a new management pathway for gastroschisis was established: weekly evaluation of the foetal gut by ultrasound (>28 weeks), corticosteroids, and delivery by scheduled caesarean section at 35 weeks (before if evidence of bowel compromise was present). The primary endpoints of this study were the initiation of oral feeding and the number of re-operation for intestinal obstruction. There was a significantly faster initiation of oral feeding (P < 0.0001), however, duration of parenteral nutrition (34 vs. 38 days) and hospital discharge (53 vs. 58.5 days) was not reduced. There was no complication due to prematurity in group 2. Postoperative outcome was improved with less need for muscular stretching or prosthetic patch and less re-operation for intestinal obstruction (P < 0.05). Scheduled and elective preterm delivery facilitates surgical procedure and shortens the time to first feeding. A delivery at 35 weeks (preferring vaginal delivery) seems to be a good compromise between risks related to prematurity and complications related to intestinal peel.

Paré A (1634) “The works of that famous surgeon.” Th. Cotes & R. Young, London

Stoll C, Alembik Y, Dott B, Roth MP (2001) Risk factors in congenital abdominal wall defects (omphalocele and gastroschisis): a study in a series of 265,858 consecutive births. Ann Genet 44:201–208PubMed

Ergun O, Barksdale E, Ergun FS et al (2005) The timing of delivery of infants with gastroschisis influences outcome. J Pediatr Surg 40:424–428 1999,15:97–104PubMedCrossRef

Peiro JL, Guindos S, Lloret J et al (2005) New surgical strategy in gastroschisis: treatment simplification according to its physiopathology. Cir Pediatr 18:182–187PubMed

Vegunta RK, Wallace LJ, Leonardi MR et al (2005) Perinatal management of gastroschisis: analysis of a newly established clinical pathway. J Pediatr Surg 40:528–534PubMedCrossRef

Moir CR, Ramsey PS, Ogburn PL et al (2004) A prospective trial of elective preterm delivery for fetal gastroschisis. Am J Perinatol 21:289–294PubMedCrossRef

Serra A, Fitze G, Kamin G et al (2008) Preliminary report on elective preterm delivery at 34 weeks and primary abdominal closure for the management of gastroschisis. Eur J Pediatr Surg 18(1):32–37PubMedCrossRef

Stringel G (1993) Large gastroschisis: primary repair with Gore-Tex patch. J Pediatr Surg 28:653–655PubMedCrossRef

Laughon M, Meyer R, Bose C et al (2003) Rising birth prevalence of gastroschisis. J Perinatol 23:291–293PubMedCrossRef

10.

Singh SJ, Fraser A, Leditschke JF et al (2003) Gastroschisis: determinants of neonatal outcome. Pediatr Surg Int 19:260–265PubMedCrossRef

11.

Salihu HM, Emusu D, Aliyu ZY et al (2004) Mode of delivery and neonatal survival of infants with isolated gastroschisis. Obstet Gynecol 104:678–683PubMed

12.

Puri A, Bajpai M (1999) Gastroschisis and omphalocele. Indian J Pediatr 66:773–789PubMedCrossRef

13.

Kemp J, Davenport M, Pernet A (1998) Antenatally diagnosed surgical anomalies: the psychological effect of parental antenatal counseling. J Pediatr Surg 33:1376–1379PubMedCrossRef

14.

Moore TC, Stokes GE (1953) Gastroschisis; report of two cases treated by a modification of the gross operation for omphalocele. Surgery 33:112–120PubMed

15.

Correia-Pinto J, Tavares ML, Baptista MJ et al (2002) Meconium dependence of bowel damage in gastroschisis. J Pediatr Surg 37:31–35PubMedCrossRef

16.

Api A, Olguner M, Hakguder G et al (2001) Intestinal damage in gastroschisis correlates with the concentration of intraamniotic meconium. J Pediatr Surg 36:1811–1815PubMedCrossRef

17.

Kluck P, Tibboel D, van der Kamp AW, Molenaar JC (1983) The effect of fetal urine on the development of the bowel in gastroschisis. J Pediatr Surg 18:47–50PubMedCrossRef

18.

Morrison JJ, Klein N, Chitty LS et al (1998) Intra-amniotic inflammation in human gastroschisis: possible aetiology of postnatal bowel dysfunction. Br J Obstet Gynaecol 105:1200–1204PubMed

19.

Srinathan SK, Langer JC, Blennerhassett MG et al (1995) Etiology of intestinal damage in gastroschisis III: morphometric analysis of the smooth muscle and submucosa. J Pediatr Surg 30:379–383PubMedCrossRef

20.

Kidd JN Jr, Jackson RJ, Smith SD, Wagner CW (2003) Evolution of staged versus primary closure of gastroschisis. Ann Surg 237:759–764 discussion 764–755PubMedCrossRef

21.

Amoury RA, Beatty EC, Wood WG et al (1988) Histology of the intestine in human gastroschisis—relationship to intestinal malfunction: dissolution of the “peel” and its ultrastructural characteristics. J Pediatr Surg 23:950–956PubMedCrossRef

22.

Tibboel D, Vermey-Keers C, Kluck P et al (1986) The natural history of gastroschisis during fetal life: development of the fibrous coating on the bowel loops. Teratology 33:267–272PubMedCrossRef

23.

Molik KA, Gingalewski CA, West KW et al (2001) Gastroschisis: a plea for risk categorization. J Pediatr Surg 36:51–55PubMedCrossRef

24.

Draper ES, Manktelow B, Field DJ et al (1999) Prediction of survival for preterm births by weight and gestational age: retrospective population based study. BMJ 23:1093–1097

25.

Blakelock RT, Upadhyay V, Pease PW, Harding JE (1997) Are babies with gastroschisis small for gestational age? Pediatr Surg Int 12:580–582PubMedCrossRef

26.

Charlesworth P, Njere I, Allotey J et al (2007) Postnatal outcome in gastroschisis: effect of birth weight and gestational age. J Pediatr Surg 42(5):815–818PubMedCrossRef

27.

Logghe HL, Mason GC, Thornton JG, Stringer MD (2005) A randomized controlled trial of elective preterm delivery of fetuses with gastroschisis. J Pediatr Surg 40:1726–1731PubMedCrossRef

28.

Moore TC, Collins DL, Catanzarite V, Hatch EI Jr (1999) Pre-term and particularly pre-labor cesarean section to avoid complications of gastroschisis. Pediatr Surg Int 15(2):97–104PubMedCrossRef

29.

Driver CP, Bowen J, Doig CM et al (2001) The influence of delay in closure of the abdominal wall on outcome in gastroschisis. Pediatr Surg Int 17:32–34PubMedCrossRef

30.

Minkes RK, Langer JC, Mazziotti MV et al (2000) Routine insertion of a silastic spring-loaded silo for infants with gastroschisis. J Pediatr Surg 35:843–846PubMedCrossRef

31.

Bianchi A, Dickson AP, Alizai NK (2002) Elective delayed midgut reduction. No anaesthesia for gastroschisis. J Ped Surg 37(9):1334–1336CrossRef

32.

Eggink BH, Richardson CJ, Malloy MH, Angel CA (2006) Outcome of gastroschisis: a 20-year case review of infants with gastroschisis born in Galveston, Texas. J Pediatr Surg 41:1103–1108PubMedCrossRef

33.

Lopez de Torre B, Tovar JA, Uriarte S, Aldazabal P (1991) Transperitoneal exchanges of water and solutes in the fetus with gastroschisis. Experimental study in the chick embryo. Eur J Pediatr Surg 1:346–352PubMedCrossRef

34.

Fasching G, Mayr J, Sauer H (1996) The effect of mode of delivery on outcome in fetuses with gastroschisis. Pediatr Surg Int 11:100–102

35.

Vilela PC, Ramos De Amorim MM, Falbo GH, Santos LC (2001) Risk factors for adverse outcome of newborns with gastroschisis in a Brazilian hospital. J Pediatr Surg 36:559–564PubMedCrossRef

36.

Blessed WB, Coughlin JP, Johnson MP et al (1993) Immediate delivery room repair of fetal abdominal wall defects. Fetal Diagn Ther 8:203–208PubMedCrossRef

37.

Driver CP, Bowen J, Doig CM et al (2001) The influence of delay in closure of the abdominal wall on outcome in gastroschisis. Pediatr Surg Int 17:32–34PubMedCrossRef

38.

Komuro H, Imaizumi S, Hirata A, Matsumoto M (1998) Staged silo repair of gastroschisis with preservation of the umbilical cord. J Pediatr Surg 33:485–488PubMedCrossRef

39.

How HY, Harris BJ, Pietrantoni M et al (2000) Is vaginal delivery preferable to elective cesarean delivery in fetuses with a known ventral wall defect? Am J Obstet Gynecol 182:1527–1534PubMedCrossRef

40.

Lenke RR, Hatch EI Jr (1986) Fetal gastroschisis: a preliminary report advocating the use of cesarean section. Obstet Gynecol 67:395–398PubMed

41.

Swift RI, Singh MP, Ziderman DA et al (1992) A new regime in the management of gastroschisis. J Pediatr Surg 27:61–63PubMedCrossRef

42.

Quirk JG Jr, Fortney J, Collins HB 2nd et al (1996) Outcomes of newborns with gastroschisis: the effects of mode of delivery, site of delivery, and interval from birth to surgery. Am J Obstet Gynecol 174:1134–1138 discussion 1138–1140PubMedCrossRef

43.

Dunn JC, Fonkalsrud EW, Atkinson JB (1999) The influence of gestational age and mode of delivery on infants with gastroschisis. J Pediatr Surg 34:1393–1395PubMedCrossRef

44.

Segel SY, Marder SJ, Parry S, Macones GA (2001) Fetal abdominal wall defects and mode of delivery: a systematic review. Obstet Gynecol 98:867–873PubMedCrossRef

45.

Landon MB, Hauth JC, Leveno KJ et al (2004) Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. N Engl J Med 351:2581–2589 Epub 2004 Dec 2514PubMedCrossRef

46.

Blackwell SC, Redman ME, Tomlinson M et al (2001) Labor induction for the preterm severe pre-eclamptic patient: is it worth the effort? J Matern Fetal Med 10:305–311PubMedCrossRef

47.

Chappuis JP, Takvorian P, Philibert M et al (1984) Current aspects of laparoschisis. Apropos of 22 cases. Pediatrie 39:437–444PubMed

48.

Guo W, Swaniker F, Fonkalsrud EW et al (1995) Effect of intraamniotic dexamethasone administration on intestinal absorption in a rabbit gastroschisis model. J Pediatr Surg 30:983–986 discussion 986–987PubMedCrossRef

49.

Yu J, Gonzalez-Reyes S, Diez-Pardo JA, Tovar JA (2004) Local dexamethasone improves the intestinal lesions of gastroschisis in chick embryos. Pediatr Surg Int 19:780–784PubMedCrossRef

Title: Scheduled preterm delivery for gastroschisis improves postoperative outcome
Authors: Thomas Gelas
Daniela Gorduza
Simone Devonec
Pascal Gaucherand
Esther Downham
Olivier Claris
Rémi Dubois
Publication date: 01-09-2008
Publisher: Springer-Verlag
Published in: Pediatric Surgery International / Issue 9/2008
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-008-2204-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Scheduled preterm delivery for gastroschisis improves postoperative outcome

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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