Document Detail


Ward reduction of gastroschisis in a single stage without general anaesthesia may increase the risk of short-term morbidities: Results of a retrospective audit.
MedLine Citation:
PMID:  19490405     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Background:  Ward reduction of gastroschisis in a single stage without the need for general inhalational anaesthesia (ward reduction) has been reported by some authors to be effective and safe. We introduced this practice to our neonatal unit 2 years ago. Aim:  To compare the short-term outcomes of this new practice with the standard procedure of reduction under general anaesthesia (GA). Methods:  Retrospective case series of all infants with gastroschisis between January 2004 and January 2008. Results:  Twenty-seven infants were managed with the traditional approach and 11 infants underwent ward reduction without GA. Infants in the ward reduction group had an increased frequency for all the three major adverse events (ischemic necrosis of bowel: 27.3% vs. 3.7%, odds ratio (OR) 10.72, 95% confidence interval (CI): 0.72, 159.6; need for total parenteral nutrition (TPN) more than 60 days: 18% vs. 3.7%, OR 4.13, 95% CI: 0.28, 61.55; and unplanned return to theatre: 27.3% vs. 7.4%, OR 3.88, 95% CI: 0.44, 34.08), although none of these events reached statistical significance. There were no significant differences between the groups for the outcomes of time to reach full feeds, duration of hospital stay and number of days on antibiotics. Conclusions:  These results raise concerns over the role of ward reduction of gastroschisis in a single sitting without the use of GA. Randomised trials with appropriate design and sample size are needed before embracing this method as a standard practice.
Authors:
Shripada C Rao; Simon Pirie; Corrado Minutillo; Ian Gollow; Jan E Dickinson; Peter Jacoby
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Publication Detail:
Type:  Journal Article     Date:  2009-05-28
Journal Detail:
Title:  Journal of paediatrics and child health     Volume:  45     ISSN:  1440-1754     ISO Abbreviation:  J Paediatr Child Health     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2012-04-25     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9005421     Medline TA:  J Paediatr Child Health     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  384-8     Citation Subset:  IM    
Copyright Information:
© 2009 The Authors. Journal compilation © 2009 Paediatrics and Child Health Division (Royal Australasian College of Physicians).
Affiliation:
Department of Neonatology, King Edward Memorial Hospital for Women, Departments of Neonatology and Paediatric Surgery, Princess Margaret Hospital for Children, School of Women's and Infants' Health, The University of Western Australia and Department of Biostatistics, Telethon Institute of Child Health and Research, Perth, Western Australia, Australia.
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