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[Impact in our environment of a gastroschisis therapeutic management protocol]
J J Vila-Carbó1, E Hernández, L Ayuso
1Servicio de Cirugía Pediátrica, Hospital Universitario Infantil La Fe, Valencia. vila_jjo@gva.es
Insights
A new management protocol for gastroschisis, involving weekly ultrasounds and scheduled C-sections, significantly reduces fetal intestinal damage. This approach minimizes complications and allows for normal gestation, improving neonatal outcomes.
Area of Science:
- Fetal Surgery and Neonatal Care
- Pediatric Surgery
- Maternal-Fetal Medicine
Background:
- Gastroschisis in fetuses causes intestinal inflammation and edema, complicating surgical repair and neonatal outcomes.
- Hipoperistalsis and prolonged parenteral nutrition are common challenges in neonates with gastroschisis.
- Current management often necessitates staged repair due to intestinal compromise.
Purpose of the Study:
- To evaluate the effectiveness of a novel multidisciplinary management protocol for prenatally diagnosed gastroschisis.
- To assess the impact of the protocol on fetal intestinal health and neonatal outcomes.
- To determine if the protocol can minimize complications associated with gastroschisis.
Main Methods:
- A prospective descriptive study included six fetuses with prenatally diagnosed gastroschisis.
- The protocol involved weekly maternal ultrasound monitoring and elective Cesarean section at 39 weeks.
- Intervention was triggered by early signs of intestinal compromise (e.g., bowel diameter > 17 mm).
Main Results:
- Mean gestational age at delivery was 36.3 weeks.
- Bowel loops showed near-normal appearance in most cases, with reduced chronic inflammation.
- No cases of intestinal obstruction were observed postoperatively; mean parenteral nutrition was 28 days.
Conclusions:
- Weekly ultrasound monitoring enables early detection of fetal intestinal distress.
- The prenatal management protocol supports near-normal gestation, minimizing prematurity complications.
- This protocol effectively mitigates the negative consequences of gastroschisis on neonatal intestinal health.
Introduction:
Continuous exposure to amniotic in fetus with gastroschisis, leads to inflammation and edema of intestinal loops, hindering intestinal return to abdomen and making staged repair necessary in many cases. Furthermore, intestinal loops are hipoperistaltic, which leads to oral toleration difficulties, large periods of parenteral nutrition and an increase of hospital stay. The objective of this study is to evaluate the results in our environment, of a new multidisciplinary management protocol in patients with a prenatal diagnosis of gastroschisis.
Patients And Methods:
Between January 2003 and May 2006, six cases of prenatal diagnosis of gastroschisis were included in the protocol. This consisted in a weekly ultrasound monitorization of the gestants which showed prenatal diagnosis of gastroschisis and elective delivery by caesarean section on the 39th week and if early signs of intestinal suffering appear (bowel diameter > 17 mm or wall thickening > 3 mm), in order to prevent harm to intestinal loops and its consequences in the neonatal period. After birth, bowel reduction through the defect was performed under general anaesthesia in the operating room. Gestational age at delivery, bowel appearance, associated anomalies, incidence of sepsis and intestinal obstruction in the postoperative period, PN and hospital stay are analyzed in a prospective descriptive study.
Results:
Mean gestational age at delivery was 36,3 weeks (range 35-38). In all the cases, except one, bowel loops presented a nearly normal appearance, without signs of chronic inflammation. As associated anomalies we found two cases of intraabdominal testis and one of hypertrophic pyloric stenosis. No evidence of intestinal atresia in any case. Mean time of PN was 28 days. Two patients developed sepsis with good outcome with intravenous antibiotics treatment. No cases of intestinal obstruction in the immediate or late postoperative period were observed. Mean time of hospital stay was 38,8 days, with mean stay in neonatal care unit of 4 days.
Conclusions:
. Weekly ultrasound monitorization assessment in cases of prenatally-diagnosed gastroschisis allows early detection of bowel suffering signs, before chronic inflammatory damage of the herniated intestinal loops. The application of this prenatal gastroschisis management protocol permits normal gestation without having to anticipate delivery in practically all cases, minimizing consequences of prematurity.