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Gastroschisis: Impact of Bedside Closure on Ventilator-Associated Outcomes
Aim In our practice, preformed silos are routine rather than reserved for difficult cases. We aimed to identify whether silo and bedside closure can minimize: general anesthetic (GA) exposure, need for intubation and ventilation, or days intubated for neonates with simple gastroschisis (SG).
Methods After approval, patients were identified via the neonatal discharge log (April 2010 to April 2019). Data were collected by case-note review and analyzed with respect to GA, ventilation, and core outcomes.
Results Of 104 patients (50 female, mean birth weight 2.43 kg, mean gestational age 36 + 2 weeks), 85 were SG and 19 complex. Silo application was initial management in 70 SG, 57 completed successful bedside closure (by day 4 of life—median). Fifteen SG had initial operative closure.
Of the 70 SG managed with silo, 46 (66%) had no GA as neonates. Twelve required GA for line insertion. Thirteen patients with initial silo had closure in theater (7 opportunistic at time of GA for line). Nine required intubation and ventilation out-with the operating theater during neonatal management. Seven had already been intubated at delivery; 3 because of meconium aspiration.
One-hundred percent of those treated with operative closure had GA, 1 patient subsequently required surgery for subglottic stenosis. Time to full feeds did not differ between groups.
Conclusion Silo and bedside closure allow the majority of SG neonates to avoid GA or intubation in the neonatal period, without increased risk of complication. However, it is important that the nursing expertise required to manage these patients safely is not underestimated.
Received: 18 July 2021
Accepted: 18 November 2021
10 January 2022 (online)
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Georg Thieme Verlag KG
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- 1 Owen A, Marven S, Johnson P. et al; BAPS-CASS. Gastroschisis: a national cohort study to describe contemporary surgical strategies and outcomes. J Pediatr Surg 2010; 45 (09) 1808-1816
- 2 Bruzoni M, Jaramillo JD, Dunlap JL. et al. Sutureless vs sutured gastroschisis closure: a prospective randomized controlled trial. J Am Coll Surg 2017; 224 (06) 1091-1096.e1
- 3 Witt RG, Zobel M, Padilla B, Lee H, MacKenzie TC, Vu L. Evaluation of clinical outcomes of sutureless vs sutured closure techniques in gastroschisis repair. JAMA Surg 2019; 154 (01) 33-39
- 4 Allin BSR, Hall NJ, Ross AR, Marven SS, Kurinczuk JJ, Knight M. NETS1G collaboration. Development of a gastroschisis core outcome set. Arch Dis Child Fetal Neonatal Ed 2019; 104 (01) F76-F82
- 5 Thomas RE, Rao SC, Minutillo C, Vijayasekaran S, Nathan EA. Severe acquired subglottic stenosis in neonatal intensive care graduates: a case-control study. Arch Dis Child Fetal Neonatal Ed 2018; 103 (04) F349-F354
- 6 Wilder RT, Flick RP, Sprung J. et al. Early exposure to anesthesia and learning disabilities in a population-based birth cohort. Anesthesiology 2009; 110 (04) 796-804
- 7 Owen A, Marven S, Jackson L. et al. Experience of bedside preformed silo staged reduction and closure for gastroschisis. J Pediatr Surg 2006; 41 (11) 1830-1835
- 8 Jevtovic-Todorovic V, Hartman RE, Izumi Y. et al. Early exposure to common anesthetic agents causes widespread neurodegeneration in the developing rat brain and persistent learning deficits. J Neurosci 2003; 23 (03) 876-882
- 9 Brambrink AM, Evers AS, Avidan MS. et al. Isoflurane-induced neuroapoptosis in the neonatal rhesus macaque brain. Anesthesiology 2010; 112 (04) 834-841
- 10 McCann ME, De Graaff JC, Dorris L. et al. Neurodevelopmental outcome at 5 years of age after general anaesthesia or awake-regional anaesthesia in infancy (GAS): an international, multicentre, randomised, controlled equivalence trial. The Lancet 16 393 (10172): 664-677 2019;
- 11 Warner DO, Zaccariello MJ, Katusic SK. et al. Neuropsychological and behavioral outcomes after exposure of young children to procedures requiring general anesthesia: the MASK study. Anesthesiology 2018; 129 (01) 89
- 12 DeUgarte DA, Calkins KL, Guner Y. et al; University of California Fetal Consortium. Adherence to and outcomes of a university-consortium gastroschisis pathway. J Pediatr Surg 2020; 55 (01) 45-48
- 13 Lap CC, Brizot ML, Pistorius LR. et al. Outcome of isolated gastroschisis; an international study, systematic review and meta-analysis. Early Hum Dev 2016; 103: 209-218
- 14 Stanger J, Mohajerani N, Skarsgard ED. Canadian Pediatric Surgery Network (CAPSNet). Practice variation in gastroschisis: factors influencing closure technique. J Pediatr Surg 2014; 49 (05) 720-723
- 15 Mueller C, Bouchard S. Incidence and treatment of adhesive bowel obstruction after gastroschisis closure. Annals of Pediatric Surgery 2017; 13 (01) 14-16
- 16 De Bie F, Swaminathan V, Johnson G, Monos S, Adzick NS, Laje P. Long-term core outcomes of patients with simple gastroschisis. J Pediatr Surg 2021; 56 (08) 1365-1369
- 17 McHoney M, Munro F. Intestinal ischemia secondary to volvulus of gastroschisis within a silo: detection, confirmation and reversal of near infra-red spectroscopy detected O2 saturation. Pediatr Surg Int 2014; 30 (11) 1173-1176
- 18 Ryckman J, Aspirot A, Laberge JM, Shaw K. Intestinal venous congestion as a complication of elective silo placement for gastroschisis. Semin Pediatr Surg 2009; 18 (02) 109-112
- 19 Schlueter RK, Azarow KS, Hines AG. et al. Identifying strategies to decrease infectious complications of gastroschisis repair. J Pediatr Surg 2015; 50 (01) 98-101