Perinatal management of gastroschisis: analysis of a newly established clinical pathway
| Autor: | Michael R. Leonardi, J. Stephen Marshall, Tom L. Gross, Howard Cohen, Ravindra K. Vegunta, Sue E. Clark, Lizabeth J. Wallace, Richard H. Pearl, Susan Ramiro, Yolanda Renfroe, Kamlesh S. Macwan, James R. Hocker |
|---|---|
| Rok vydání: | 2005 |
| Předmět: |
Adult
Male medicine.medical_specialty Parenteral Nutrition Esthetics Umbilicus (mollusc) medicine.medical_treatment Gestational Age Infant Premature Diseases Ultrasonography Prenatal Enteral Nutrition Postoperative Complications Fetal Organ Maturity Pregnancy medicine Humans Abnormalities Multiple Hospital Mortality Lung Mechanical ventilation Gastroschisis Obstetrics business.industry Cesarean Section Abdominal wall defect Infant Newborn Gestational age Cosmesis General Medicine Length of Stay medicine.disease Respiration Artificial Surgery Treatment Outcome Elective Surgical Procedures Pregnancy Trimester Second Pediatrics Perinatology and Child Health Female Elective Surgical Procedure business Case Management Infant Premature |
| Zdroj: | Journal of pediatric surgery. 40(3) |
| ISSN: | 1531-5037 |
| Popis: | Purpose The authors developed a clinical pathway for optimal management after antenatal diagnosis of gastroschisis. This is the outcomes analysis of our first 30 consecutive patients. Method Antenatal counseling was provided for all families with in-utero diagnosis of gastroschisis. Bowel dilatation, thickness, motility, amniotic fluid volume, and fetal development were followed by ultrasonography every 4 weeks. Babies were delivered by cesarean section between 36 and 38 weeks gestation if the lungs were mature or earlier for bowel complications. Gastroschisis repair was scheduled 90 minutes after birth. Primary repair was attempted in all through the abdominal wall defect without an additional incision, resulting in an umbilicus with no abdominal scar. Results Primary repair was achieved in 83%. Babies needed assisted ventilation for 3 days, reached full feeds by 19 days, and were discharged by 24 days (all medians). There were 3 (10%) deaths, all after staged repair. Conclusions Our new protocol of both scheduled elective cesarean section and early gastroschisis repair resulted in a higher proportion of primary repair, shorter duration of mechanical ventilation, earlier full feeds, and shorter length of stay. There was no increase in mortality or morbidity. The primary-repair babies had no mortality and had excellent cosmesis. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect