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[Gastroschisis prenatally and postnatally]
Hanna Bułhak-Guz1, Andrzej Chilarski, Krzysztof Szaflik
1Klinika Chirurgii i Urologii Dzieciecej, Instytutu Centrum Zdrowia Matki Polki, Rzgowska. klinikachirdziec@poczta.onet.pl
Insights
Improved prenatal diagnosis and collaborative care significantly reduced gastroschisis surgical mortality from 30% to 5.4%. This highlights the impact of early detection and multidisciplinary teamwork in managing this congenital defect.
Area of Science:
- Pediatric Surgery
- Neonatalogy
- Prenatal Diagnosis
Context:
- Gastroschisis is a congenital defect with significant mortality.
- Surgical treatment and prenatal diagnosis have evolved over time.
- Multidisciplinary care is crucial for managing complex congenital anomalies.
Purpose:
- To evaluate the progress in surgical treatment of gastroschisis between 1990 and 2004.
- To assess the impact of prenatal diagnosis on gastroschisis outcomes.
- To analyze mortality rates and coexisting congenital abnormalities in gastroschisis cases.
Summary:
- A study of 108 gastroschisis cases (1990-2004) divided patients into non-operated (31) and operated (77) groups.
- Prenatal diagnosis rates increased from 30% to 70% after 1999, coinciding with improved surgical outcomes.
- Post-1999, mortality in operated newborns decreased to 5.4%, primarily due to prematurity in twin deliveries.
Impact:
- Enhanced prenatal diagnosis and collaborative care between specialists significantly reduced surgical mortality for gastroschisis.
- The study demonstrates a marked improvement in survival rates for neonates undergoing surgical repair.
- Understanding associated congenital defects is vital for non-operated cases, where mortality is linked to other severe anomalies.
Objective:
The aims of the study were: 1) evaluation of progress in surgical treatment of gastroschisis between 1990 and 2004 including the impact of prenatal diagnosis; 2) evaluation of mortality and coexisting congenital abnormalities in fetuses and newborns with gastroschisis.
Material And Methods:
Between 1990 and 2004 in Polish Mother's Health Institute gastroschisis was diagnosed in 108 cases. Basing on information from the Department of Pathology, Department of Pediatric Surgery and Department of Fetal Therapy, the patients were divided into 2 groups: 1) miscarried fetuses, still born neonates and non-operated live newborns who died within several hours after delivery (31 cases); 2) live born operated on newborns (77 cases).
Results:
Until 1999 gastroschisis was diagnosed prenatally only in 30% of patients, while after 1999 the defect was diagnosed in 70% of cases. From the year 2000, due to close cooperation with obstetricians, newborns with gastroschisis have been operated on directly after delivery at the same theatre. In this period there were only 2 deaths due to prematurity (both twin deliveries)--5,4%. Main causes of deaths were: in group I--congenital defects of the cardiovascular and respiratory tracts and multiple defects; in group II--peritonitis, ileus due to adhesions and multiorgan failure.
Conclusions:
1. Prenatal diagnostics and close cooperation between gyneacologists, obstetricians, neonatologists and pediatric surgeons significantly decreased mortality of newborns operated for gastroschisis in our Institute from 30% in 1990-1999 to 5,4 % in 2000-2004. 2. If miscarried or premature deliveries and deaths prior to operation are included, the mortality is 41%. 3. Deaths in the group of non-operated patients were caused by serious congenital defects not connected with gastroschisis.
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