Document Detail


Gastroschisis closure--does method really matter?
MedLine Citation:
PMID:  18485957     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND/PURPOSE: Management of gastroschisis varies. This study aims to determine which aspects of practice influence outcomes. METHODS: All cases of simple gastroschisis (N = 99) in the Canadian Pediatric Surgery Network database were analyzed looking at methods of preoperative bowel protection, timing of closure, and closure techniques; and outcome measures included time to onset of enteral feeds, duration of parenteral nutrition (PN), and length of stay (LOS). RESULTS: One third of infants had initial bowel protection using a spring-loaded silo, which was significantly associated with a delay (beyond 24 hours) in establishing primary closure. Neither preoperative bowel protection methods nor defect closure techniques conferred any significant effects on success at establishing primary closure or functional outcomes. After adjusting for all covariates, only failure to establish primary closure was associated with impaired outcomes with significantly delayed initiation of enteral feeds and prolonged LOS. Low birth weight (<2000 g) and younger gestational age (<36 weeks) were associated with a 3-fold increased risk of longer PN dependence and 5-fold risk of extended LOS, respectively. Babies undergoing the sutureless spontaneous closure technique had significant delays in initiating enteral feeds but no increased requirements for PN or LOS. CONCLUSIONS: Modes of preoperative bowel protection and techniques of abdominal wall closure ultimately have no association with functional outcomes in infants with gastroschisis. Failure to establish primary closure, however, is significantly associated with delays in establishing intestinal function and subsequent time to discharge.
Authors:
Robert L Weinsheimer; Natalie L Yanchar; Sarah B Bouchard; Peter K Kim; Jean-Martin Laberge; Erik D Skarsgard; S K Lee; Douglas McMillan; Peter von Dadelszen;
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of pediatric surgery     Volume:  43     ISSN:  1531-5037     ISO Abbreviation:  J. Pediatr. Surg.     Publication Date:  2008 May 
Date Detail:
Created Date:  2008-05-19     Completed Date:  2008-08-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0052631     Medline TA:  J Pediatr Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  874-8     Citation Subset:  IM    
Affiliation:
Division of Pediatric General Surgery, IWK Health Centre, Dalhousie University, Halifax, Canada B3K 6R8.
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MeSH Terms
Descriptor/Qualifier:
Abdominal Wall / surgery*
Enteral Nutrition
Female
Gastroschisis / mortality,  surgery*,  therapy
Gestational Age
Humans
Infant
Infant, Newborn
Maternal Age
Parenteral Nutrition
Pregnancy
Survival Rate
Suture Techniques
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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