Abstract

LACARRUBBA, José et al. Gastroschisis: the Experience of the Last 30 Months. Pediatr. (Asunción) [online]. 2013, vol.40, n.3, pp.217-225. ISSN 1683-9803.

Introduction: Gastroschisis is a congenital abnormality of the abdominal wall in which the contents of the cavity herniate and remain outside the wall, in contact with the amniotic fluid. It shows low association with other abnormalities, but involves extended hospitalization and a high rate of complications related to NICU care. Treatment is multidisciplinary, involving obstetricians, neonatologists, and pediatric surgeons, and can include elective cesarean section, reduction of herniated organs, immediate or deferred closure of the defect, parenteral nutrition, and intensive care until intestinal transit and enteral feeding are achieved. Objective: We sought to analyze the experience of the most recent 30 months in patients with gastroschisis treated in a high-complexity facility. Materials and Methods: We conducted a descriptive, retrospective, and observational study based on the records of patients with anterior wall defects between February of 2011 and July 2013. Results: In that period, 36 patients were born with abdominal wall defects, including 27 newborns (75%) diagnosed with gastroschisis, a prevalence of 0.4% of total live births in that period. We excluded 5 patients: 1 with multiple birth defects, 1 extremely premature newborn, and 3 with incomplete records. We analyzed 22 cases in which maternal, prenatal, delivery, surgical, and progression characteristics in the NICU were described. Noteworthy were the proportions of young primiparous mothers (21 years) and those with prenatal ultrasound diagnosis (81%), prenatal care ≥ 4 (86%), cesarean deliveries (72%), daytime deliveries (63%), males (63%), late pre-term gestational age (36 weeks), and an average weight of 2400 g. Some 77% underwent intervention in the first 2 hours of life, immediate closure was performed on 63%, and only 3 patients, all with concomitant intestinal atresia, experienced surgical complications. Clinical evolution in the first 24 hours: metabolic acidosis was common, along with oliguria, requirement for high volumes of liquids (175 mL/K/day), bicarbonate, and inotropic agents. Average duration of MV was 7.5 days and start of parenteral nutrition was at 1.3 days of life, with a duration among survivors of 20 days (range: 13-66 days), while the average start of enteral feeding was 13 days (5-22 days), reaching quantities of 80 mL/K/day in an average of 21 days (14-35 days). Fifteen patients (68%) were discharged to their homes after an average hospital stay of 28 days (15-39 days). Of the 7 patients (32%) who died, 2 died in the first week of causes related to perinatal asphyxia, while the remaining deaths were tied to treatment-related infections. Conclusion: An elevated number of pregnancies complicated by gastroschisis were observed, and tended to increase over time. Mothers were primarily young and primiparous, which was associated with intrauterine growth restriction. Surgical complications associated were those significantly related to mortality.

Keywords : Gastroschisis; diagnosis; treatment; congenital abnormalities.

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