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Identifying prenatal ultrasound predictors and the ideal neonatal management of closing gastroschisis: the key is prevention

Journal of Perinatology volume 41, pages 2789–2794 (2021)Cite this article

Subjects

Abstract

Objective

To evaluate the optimal approaches to initial surgical management and the potential for prenatal ultrasound detection of patients with closing gastroschisis.

Study design

We performed a retrospective analysis of patients born with gastroschisis to determine clinical and surgical outcomes and the ability to determine prognosis by prenatal imaging. Data collected included operative findings and postoperative outcome, as well as prenatal imaging features from a subset of cases with and without closing gastroschisis. Statistical analyses were performed as appropriate.

Results

We included 197 patients with gastroschisis. No statistical significance was seen in outcomes between closing gastroschisis patients undergoing resection versus intracorporeal parking (n = 18). Ultrasound review was performed on 33 of these patients, 11 with closing gastroschisis, and 22 without. Significantly more closing gastroschisis patients had imaging indicative of progressive defect narrowing and defect diameter ≤8 mm after 30 weeks of gestation versus non-closing patients (p = 0.002).

Conclusion

Parking of extruded bowel offers potential for intestinal remodeling. In addition, prenatal ultrasound may be useful in detection of closing gastroschisis in utero.

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Fig. 1: Pre and postnatal images of closing gastroschisis.
Fig. 2: Postnatal outcomes of parked extracorporeal tissue versus resected.

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Funding

Funding for this project was provided by Meharry Medical College as a part of their Medical Student Research Experience Program.

Author information

Authors and Affiliations

  1. Meharry Medical College School of Medicine, Nashville, TN, USA

    Jason P. Field

  2. Monroe Carell Jr. Children’s Hospital at Vanderbilt, Surgical Outcomes Center for Kids, Nashville, TN, USA

    Jason P. Field, Shilin Zhao & Brittany E. Lipscomb

  3. Vanderbilt University Medical Center, Department of Obstetrics and Gynecology, Nashville, TN, USA

    Lisa C. Zuckerwise

  4. Beaumont Children’s Hospital, Department of Pediatric Surgery, Royal Oak, MI, USA

    Alex M. DeMare & Nathan M. Novotny

  5. Vanderbilt University Medical Center, Department of Pediatric Surgery, Nashville, TN, USA

    Muhammad Aanish Raees, Sonal Walia, Harold N. Lovvorn & Nathan M. Novotny

Authors
  1. Jason P. Field
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  2. Lisa C. Zuckerwise
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  3. Alex M. DeMare
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  4. Shilin Zhao
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  5. Brittany E. Lipscomb
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  6. Muhammad Aanish Raees
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  7. Sonal Walia
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  8. Harold N. Lovvorn
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  9. Nathan M. Novotny
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Contributions

Study conception and design by ADM, HNL, NMN, and LCZ. Acquisition of data by ADM and JF. Analysis and interpretation of data by BL, HNL, NMN, SZ, and LCZ. Drafting of manuscript by JF. Critical revision of manuscript by HNL, NMN, and LCZ.

Corresponding author

Correspondence to Nathan M. Novotny.

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The authors declare no competing interests.

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Field, J.P., Zuckerwise, L.C., DeMare, A.M. et al. Identifying prenatal ultrasound predictors and the ideal neonatal management of closing gastroschisis: the key is prevention. J Perinatol 41, 2789–2794 (2021). https://doi.org/10.1038/s41372-021-01006-9

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  • DOI: https://doi.org/10.1038/s41372-021-01006-9

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