Gillian E Pet1, Rebecca A Stark2, John J Meehan3, Patrick J Javid4. 1. Department of Pediatrics, University of Washington, School of Medicine, Seattle Children's Hospital, Seattle, WA, USA. 2. Department of Surgery, University of California-Davis, Davis, CA, USA. 3. Division of Pediatric General and Thoracic Surgery, University of Washington, School of Medicine, Seattle Children's Hospital, Seattle, WA, USA. 4. Division of Pediatric General and Thoracic Surgery, University of Washington, School of Medicine, Seattle Children's Hospital, Seattle, WA, USA. Electronic address: patrick.javid@seattlechildrens.org.
Abstract
INTRODUCTION: Newborns with gastroschisis have historically undergone surgical repair under general anesthesia. Our institution recently transitioned to the sutureless umbilical closure for gastroschisis. We sought to evaluate the feasibility of bedside gastroschisis repair without endotracheal intubation. METHODS: A retrospective review was performed of neonates with gastroschisis who underwent sutureless umbilical closure from 2011 to 2015. Clinical characteristics and outcomes between groups were compared. RESULTS: In total, 53 infants underwent sutureless umbilical closure. Closure without endotracheal intubation was attempted in 23 (43%) babies and was successful in 15 (65%) infants. Two of the 8 patients who required intubation needed a temporary silo. Neonates successfully repaired without intubation were more premature (p < 0.01), smaller at birth (p = 0.01), and repaired nearly an hour sooner (p < 0.01). There were no differences in time to full enteral nutrition, length of stay, bowel ischemia, or sepsis. CONCLUSION: Bedside sutureless umbilical closure without intubation is feasible and effective in newborns with gastroschisis. The procedure decreases time to gastroschisis closure. Smaller and more premature neonates were more likely to be successfully closed without intubation.
INTRODUCTION: Newborns with gastroschisis have historically undergone surgical repair under general anesthesia. Our institution recently transitioned to the sutureless umbilical closure for gastroschisis. We sought to evaluate the feasibility of bedside gastroschisis repair without endotracheal intubation. METHODS: A retrospective review was performed of neonates with gastroschisis who underwent sutureless umbilical closure from 2011 to 2015. Clinical characteristics and outcomes between groups were compared. RESULTS: In total, 53 infants underwent sutureless umbilical closure. Closure without endotracheal intubation was attempted in 23 (43%) babies and was successful in 15 (65%) infants. Two of the 8 patients who required intubation needed a temporary silo. Neonates successfully repaired without intubation were more premature (p < 0.01), smaller at birth (p = 0.01), and repaired nearly an hour sooner (p < 0.01). There were no differences in time to full enteral nutrition, length of stay, bowel ischemia, or sepsis. CONCLUSION: Bedside sutureless umbilical closure without intubation is feasible and effective in newborns with gastroschisis. The procedure decreases time to gastroschisis closure. Smaller and more premature neonates were more likely to be successfully closed without intubation.
Authors: Russell G Witt; Michael Zobel; Benjamin Padilla; Hanmin Lee; Tippi C MacKenzie; Lan Vu Journal: JAMA Surg Date: 2019-01-01 Impact factor: 14.766
Authors: Maria V Fraga; Pablo Laje; William H Peranteau; Holly L Hedrick; Nahla Khalek; Juliana S Gebb; Julie S Moldenhauer; Mark P Johnson; Alan W Flake; N Scott Adzick Journal: Pediatr Surg Int Date: 2018-02-07 Impact factor: 1.827
Authors: G H Callejas; R L Figueira; F L L Gonçalves; F A P Volpe; A W Zuardi; J A Crippa; J E Hallak; L Sbragia Journal: Braz J Med Biol Res Date: 2018-03-15 Impact factor: 2.590