Novel multidisciplinary approach to monitor and treat fetuses with gastroschisis using the Svetliza Reducibility Index and the EXIT-like procedure

Autor: Antonio Hélio Oliani, Denise Araújo Lapa Pedreira, Humberto Liedtke Junior, Denise Cristina Mós Vaz-Oliani, Gustavo Henrique de Oliveira, Javier Svetliza
Rok vydání: 2017
Předmět:
Male
Gastroschisis/surgery
lcsh:Medicine
Aftercare
Enteral administration
Umbilical cord
0302 clinical medicine
Pregnancy
Parede abdominal/anormalidades
Prospective Studies
Gastroschisis
Fetal Therapies
030219 obstetrics & reproductive medicine
Gestational age
Fetal diagnosis
Diagnóstico fetal
General Medicine
Fetal Diseases
medicine.anatomical_structure
Treatment Outcome
Terapias fetais
Female
Original Article
Dilatation
Pathologic
Maternal Age
medicine.medical_specialty
Feto/cirurgia
Prenatal diagnosis
Gestational Age
Ultrasonography
Prenatal
03 medical and health sciences
Fetus
030225 pediatrics
Intensive care
Abdominal wall/abnormalities
medicine
Humans
Retrospective Studies
Patient Care Team
business.industry
Cesarean Section
Abdominal wall defect
lcsh:R
Infant
Newborn
Fetus/surgery
medicine.disease
Surgery
Parenteral nutrition
Fetal therapies
Intensive Care
Neonatal
Gastrosquise/cirurgia
business
Zdroj: Einstein
Einstein (São Paulo), Vol 15, Iss 4, Pp 395-402
einstein (São Paulo) v.15 n.4 2017
Einstein (São Paulo)
Instituto Israelita de Ensino e Pesquisa Albert Einstein (IIEPAE)
instacron:IIEPAE
ISSN: 2317-6385
Popis: Objective: To describe our initial experience with a novel approach to follow-up and treat gastroschisis in “zero minute” using the EXITlike procedure. Methods: Eleven fetuses with prenatal diagnosis of gastroschisis were evaluated. The Svetliza Reductibility Index was used to prospectively evaluate five cases, and six cases were used as historical controls. The Svetliza Reductibility Index consisted in dividing the real abdominal wall defect diameter by the larger intestinal loop to be fitted in such space. The EXIT-like procedure consists in planned cesarean section, fetal analgesia and return of the herniated viscera to the abdominal cavity before the baby can fill the intestines with air. No general anesthesia or uterine relaxation is needed. Exteriorized viscera reduction is performed while umbilical cord circulation is maintained. Results: Four of the five cases were performed with the EXIT-like procedure. Successful complete closure was achieved in three infants. The other cases were planned deliveries at term and treated by construction of a Silo. The average time to return the viscera in EXIT-like Group was 5.0 minutes, and, in all cases, oximetry was maintained within normal ranges. In the perinatal period, there were significant statistical differences in ventilation days required (p = 0.0169), duration of parenteral nutrition (p=0.0104) and duration of enteral feed (p=0.0294). Conclusion: The Svetliza Reductibility Index and EXIT-like procedure could be new options to follow and treat gastroschisis, with significantly improved neonatal outcome in our unit. Further randomized studies are needed to evaluate this novel approach.
Databáze: OpenAIRE
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