[Preliminary results of a multidisciplinary approach to gastroschisis]. / Resultados iniciales de un protocolo de manejo terapéutico de la gastrosquisis.

INTRODUCTION: In gastroschisis, premature birth may avoid the development of intestinal peel and favour the primary closure. We present the preliminary results obtained after following a multidisciplinary approach to gastroschisis. After prenatal ultrasound diagnosis, preterm caesarean delivery at 34-35 weeks of gestation is programmed. METHODS: Prospective design of a study, where we included all prenatal diagnosed gastrosquisis neonates, from July 2007 to January 2012. RESULTS: We followed 9 infants (3 male). Average weight at birth: 1,927 gr. (+/- 370). Primary closure was successfully accomplished in the first 3 hours of life all cases. We found two cases of slight peel. We found no associated intestinal malformations, except for one small bowel stenosis. No significant neonatal distress respiratory syndrome developed. Mean parenteral nutrition time was 13.9 days (+/- 3.8). 4 neonates developed central line associated infection. No surgical site infection developed. Enteral nutrition was started at day 8th (+/- 2.8). Enteral requirements were fulfilled at day 15th (+/- 3.6). Mean hospital stay was 31 days (+/- 10). Mean follow-up was 30 months. 4 cases developed a small (< 5 mm) umbilical hernia CONCLUSION: Programming premature cesarean section delivery at 34 weeks of gestation was beneficial to the neonates with gastroschisis, yet it avoided peel development, and rendered primary closure without serious difficulties possible. This diminishes hypoperistalsis time and allows rapid instauration of enteral feeding, so hospital stays may be shorter.

Resultados iniciales de un protocolo de manejo terapéutico de la gastrosquisis / Preliminary results of a multidisciplinary approach to gastroschisis

Objetivos. En la gastrosquisis, el parto pretérmino podría evitar el fenómeno de peel y favorecer el cierre primario. Presentamos los resultados obtenidos tras la implantación de un protocolo de manejo multidisciplinario de la gastrosquisis en nuestro centro: tras el diagnóstico y seguimiento ecográfico de la malformación se programa la cesárea en la semana 34 de gestación. Material y Métodos. Estudio prospectivo de todos los casos diagnosticados antenatalmente de gastrosquisis desde julio de 2007 hasta enero de 2012. Resultados. Se siguieron 9 niños (3 varones). Peso medio: 1.927 gramos (± 370). La intervención, cierre primario siempre, se realizó en quirófano en las primeras 3 horas de vida. Encontramos 2 casos de peel leve. El defecto fue pequeño en todos. No hubo malformaciones intestinales asociadas, salvo un caso de estenosis en un asa. No hubo enfermedad de membrana hialina ni patología atribuible a prematuridad. Duración media de nutrición parenteral: 13,9 días (± 3,8). 4 casos presentaron bacteriemia asociada a catéter central. No hubo infección de herida quirúrgica. Se inició nutrición enteral al 8º día (media 8,4, rango 4-13). Se logró alimentación enteral completa al 15º día (media 15,6, rango 11-22). Estancia media: 31 días (± 10, rango 20-56). Mediana de seguimiento: 30 meses. 4 casos presentan pequeña debilidad umbilical menor de 0,5 cm. discusión. El adelantamiento del parto a la semana 34 mediante cesárea electiva impide el desarrollo de peel, permite la reintroducción de las asas en la cavidad peritoneal, disminuye el tiempo de hipoperistalsis y permite la instauración precoz de la alimentación enteral con menor estancia hospitalaria (AU)

Introduction. In gastroschisis, premature birth may avoid the development of intestinal peel and favour the primary closure. We present the preliminary results obtained after following a multidisciplinary approach to gastroschisis. After prenatal ultrasound diagnosis, preterm caesarean delivery at 34-35 weeks of gestation is programmed. Methods. Prospective design of a study, where we included all prenatal diagnosed gastrosquisis neonates, from july 2007 to january 2012.Results. We followed 9 infants (3 male). Average weight at birth: 1,927 gr. (± 370). Primary closure was successfully accomplished in the first 3 hours of life all cases. We found two cases of slight peel. We found no associated intestinal malformations, except for one small bowel stenosis. No significant neonatal distress respiratory syndrome developed. Mean parenteral nutrition time was 13.9 days (± 3.8). 4 neonates developed central line associated infection. No surgical site infection developed. Enteral nutrition was started at day 8th (± 2.8). Enteral requirements were fulfilled at day 15th (± 3.6). Mean hospital stay was 31 days (± 10). Mean follow-up was 30 months. 4 cases developed a small (< 5 mm) umbilical hernia Conclusion. Programming premature cesarean section delivery at 34 weeks of gestation was beneficial to the neonates with gastroschisis, yet it avoided peel development, and rendered primary closure without serious difficulties possible. This diminishes hypoperistalsis time and allows rapid instauration of enteral feeding, so hospital stays may be shorter (AU)