Download PDF
CC BY-NC-ND 4.0 · AJP Rep 2023; 13(01): e17-e20
DOI: 10.1055/a-2028-7890
Case Report

Therapeutic Hypothermia Treatment for an Infant with Hypoxic-Ischemic Encephalopathy and Gastroschisis: A Case Report

Nicole Flores-Fenlon 
1   Division of Neonatology, Children's Hospital of Orange County, Orange, California
2   Division of Neonatal Medicine, University of California, Irvine School of Medicine, Irvine, California
,
Grant Shafer 
1   Division of Neonatology, Children's Hospital of Orange County, Orange, California
2   Division of Neonatal Medicine, University of California, Irvine School of Medicine, Irvine, California
,
Saeed Awan
3   Division of Pediatric Surgery, Children's Hospital of Orange County, Orange, California
4   Department of Surgery, University of California, Irvine School of Medicine, Irvine, California
,
Irfan Ahmad
1   Division of Neonatology, Children's Hospital of Orange County, Orange, California
2   Division of Neonatal Medicine, University of California, Irvine School of Medicine, Irvine, California
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Gastroschisis is a congenital, typically isolated, full-thickness abdominal wall defect in which the abdominal contents, usually only the small intestine, remain outside the abdominal cavity. It is commonly detected on fetal ultrasonography, and has generally excellent survival and outcomes, though these can be decreased in cases of complicated gastroschisis. We present the case of a female infant with a prenatal diagnosis of gastroschisis who required a prolonged and complex resuscitation after delivery. In addition to her gastroschisis, she presented with a history and physical examination consistent with severe hypoxic-ischemic encephalopathy and was treated with therapeutic hypothermia (TH) without further compromise to her bowel. In addition, careful consideration of neuroprotection, fluid status, bowel viability, and hemodynamics were undertaken in her care. She was discharged home on full enteral feeds, with only mild language and gross motor delays at 6 months of age. To our knowledge, there are no reports in the literature of the use of TH in the setting of unrepaired simple gastroschisis.

Keywords

gastroschisis - hypoxic-ischemic encephalopathy - therapeutic hypothermia - neonatal intensive care unit - pediatric surgery


Publication History

Received: 21 October 2022

Accepted: 12 January 2023

Accepted Manuscript online:
10 February 2023

Article published online:
15 March 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Skarsgard ED. Management of gastroschisis. Curr Opin Pediatr 2016; 28 (03) 363-369
    CrossrefPubMedGoogle Scholar
  • 2 Haddock C, Al Maawali AG, Ting J, Bedford J, Afshar K, Skarsgard ED. Impact of multidisciplinary standardization of care for gastroschisis: treatment, outcomes, and cost. J Pediatr Surg 2018; 53 (05) 892-897
    CrossrefPubMedGoogle Scholar
  • 3 Slater BJ, Pimpalwar A. Abdominal wall defects. Neoreviews 2020; 21 (06) e383-e391
    CrossrefPubMedGoogle Scholar
  • 4 Youssef F, Laberge JM, Puligandla P, Emil S. Canadian Pediatric Surgery Network (CAPSNet). Determinants of outcomes in patients with simple gastroschisis. J Pediatr Surg 2017; 52 (05) 710-714
    CrossrefPubMedGoogle Scholar
  • 5 Douglas-Escobar M, Weiss MD. Hypoxic-ischemic encephalopathy: a review for the clinician. JAMA Pediatr 2015; 169 (04) 397-403
    CrossrefPubMedGoogle Scholar
  • 6 Tagin MA, Woolcott CG, Vincer MJ, Whyte RK, Stinson DA. Hypothermia for neonatal hypoxic ischemic encephalopathy: an updated systematic review and meta-analysis. Arch Pediatr Adolesc Med 2012; 166 (06) 558-566
    CrossrefPubMedGoogle Scholar
  • 7 Sakhuja P, More K, Ting JY. et al. Gastrointestinal hemodynamic changes during therapeutic hypothermia and after rewarming in neonatal hypoxic-Ischemic encephalopathy. Pediatr Neonatol 2019; 60 (06) 669-675
    CrossrefPubMedGoogle Scholar
  • 8 Jacobs SE, Berg M, Hunt R, Tarnow-Mordi WO, Inder TE, Davis PG. Cooling for newborns with hypoxic ischaemic encephalopathy. Cochrane Database Syst Rev 2013; 2013 (01) CD003311
    PubMedGoogle Scholar
  • 9 Rhee CJ, da Costa CS, Austin T, Brady KM, Czosnyka M, Lee JK. Neonatal cerebrovascular autoregulation. Pediatr Res 2018; 84 (05) 602-610
    CrossrefPubMedGoogle Scholar
  • 10 Jansen LA, Safavi A, Lin Y, MacNab YC, Skarsgard ED. Canadian Pediatric Surgery Network (CAPSNet). Preclosure fluid resuscitation influences outcome in gastroschisis. Am J Perinatol 2012; 29 (04) 307-312
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Segar JL, Chock VY, Harer MW, Selewski DT, Askenazi DJ. Newborn Brain Society Guidelines and Publications Committee. Fluid management, electrolytes imbalance and renal management in neonates with neonatal encephalopathy treated with hypothermia. Semin Fetal Neonatal Med 2021; 26 (04) 101261
    CrossrefPubMedGoogle Scholar
  • 12 Tanigasalam V, Plakkal N, Vishnu Bhat B, Chinnakali P. Does fluid restriction improve outcomes in infants with hypoxic ischemic encephalopathy? A pilot randomized controlled trial. J Perinatol 2018; 38 (11) 1512-1517
    CrossrefPubMedGoogle Scholar
  • 13 Petrosyan M, Sandler AD. Closure methods in gastroschisis. Semin Pediatr Surg 2018; 27 (05) 304-308
    CrossrefPubMedGoogle Scholar
  • 14 Gurien LA, Dassinger MS, Burford JM, Saylors ME, Smith SD. Does timing of gastroschisis repair matter? A comparison using the ACS NSQIP pediatric database. J Pediatr Surg 2017; 52 (11) 1751-1754
    CrossrefPubMedGoogle Scholar
  • 15 Kunz SN, Tieder JS, Whitlock K, Jackson JC, Avansino JR. Primary fascial closure versus staged closure with silo in patients with gastroschisis: a meta-analysis. J Pediatr Surg 2013; 48 (04) 845-857
    CrossrefPubMedGoogle Scholar
  • 16 Hawkins RB, Raymond SL, St Peter SD. et al. Immediate versus silo closure for gastroschisis: results of a large multicenter study. J Pediatr Surg 2020; 55 (07) 1280-1285
    CrossrefPubMedGoogle Scholar
  • 17 Suominen J, Rintala R. Medium and long-term outcomes of gastroschisis. Semin Pediatr Surg 2018; 27 (05) 327-329
    CrossrefPubMedGoogle Scholar
  • 18 Landisch RM, Massoumi RL, Christensen M, Wagner AJ. Infectious outcomes of gastroschisis patients with intraoperative hypothermia. J Surg Res 2017; 215: 93-97
    CrossrefPubMedGoogle Scholar