Related Factors in Necrotizing Enterocolitis after Gastroschisis Repair
Keywords:
closure of abdominal wall defect, gastroschisis, necrotizing enterocolitisAbstract
Background/Objectives: Necrotizing enterocolitis (NEC) has been documented as a complication ininfants after repair of gastroschisis. Previous studies showed that the etiology of NEC might be multi-factorial.
The aim of this study was to review the experience in the management of neonates with gastroschisis and to
identify the risk factors of NEC after gastroschisis repair.
Methods: A retrospective case analysis was performed on neonates with gastroschisis treated at the
Queen Sirikit National Institute of Child Health between 1998 and 2007. Information data including relevant
demography, perioperative data, intravenous parenteral nutrition and enteral feeding were reviewed. The study
focused on related factors that might induce NEC after gastroschisis repair. Data were analyzed by the Chi-square
and student t-test. Statistically significant difference was considered at the level of a p-value less than 0.05.
Results: Four hundred and sixty-six neonates with gastroschisis were treated by definitive operation
during the study period. Forty cases died and 11 of these had evidence of NEC (27.5%). Of the total 466 patients,
44 cases (9.4%) developed NEC after gastroschisis repair. The mean of birth weight was significantly different
between the NEC and non-NEC groups (2,016.4 ± 658.2g vs. 2,234.2 ± 1,165.5g, p = 0.001). Neonates in the NEC
group underwent additional operation due to associated GI anomalies or complications more than the non-NEC
group with statistical significance (9/44 vs. 17/422, p <0.001). Regarding sepsis complications, the NEC group
had also more common than those of the non-NEC neonates (11/44 vs. 31/422, p = 0.003). There was no
difference in associated GI abnormalities between both groups (4/44 vs. 32/422; p = 0.148), except for intestinal
atresia. Surprisingly, neonates in the non-NEC group had significantly more early initiating enteral feeding than
the NEC group (15.3 ± 11.2 days vs. 18.0 ± 10.5 days; p = 0.007)
Conclusions: Low birth weight, underlying compromised bowel, additional operation due to complications
and associated GI anomalies especially intestinal atresia were the important predisposing factors for NEC after
gastroschisis repair. Delayed initiating enteral feeding is unable to prevent NEC after gastroschisis repair.
References
1. Jager CL, Heij H. Factor determining outcome in gastroschisis:
clinical experience over 18 years. Pediatr Surg Int 2007;23:
731-6.
2. Niramis R, Watanatittan S, Anuntkosol M, et al. Abdominal
wall defect: a 12-year experience. Thai J Surg 1998;19:121-
8.
3. Havanonda S. Omphalocele and gastroschisis. Bangkok:
Unity Publication; 1989. p. 39-42 (in Thai).
4. Lewis JE Jr, Kraeger RR, Danis RK. Gastroschisis: ten-year
review. Arch Surg 1973;107:218-2.
5. DiLorenza M, Yazbeck S, Duchame JC. Gastroschisis: an 18-
year review. J Pediatr Surg 1987;22: 710-2.
6. Jayanthi S, Seymour P, Puntis JWL, et al. Necrotizing
enterocolitis after gastroschisis repair: a preventable
complication. J Pediatr Surg 1998; 33 :705-7.
7. Amoury RA, Goodwin CD, McGill CW, et al. Necrotizing
enterocolitis following operation in the neonatal period. J
Pediatr Surg 1980;15:1-8.
8. Oldham KT, Coran AG, Drongowski RA, et al. The
development of necrotizing enterocolitis following repair of
gastroschisis : a surprisingly high incidence. J Pediatr Surg
1988;23:945-9.
9. Sangkhathat S, Patrapinyokul S, Chiengkriwate P, et al.
Infectious complications in infants with gastroschisis: an 11-
year review from a referral hospital in southern Thailand. J
Pediatr Surg 2008;43:473-8.
10. Bell MJ, Ternberg JL, Feigin RD, et al. Neonatal necrotizing
enterocolitis : therapeutic dieision based on clinical staging.
Ann Surg 1978;187:1-7.
11. Baerg J, Kaban G, Pahwa TP, et al. Gastroschisis : a sixteenyear
review. J Pediatr Surg 2003;38:771-4.
12. Abdullah F, Arnold MA, Nabaweesi R, et al. Gastroschisis in
the United States 1988-2003: analysis and risk categorization
of 4344 patients. J Perinatol 2007;27:50-5.
13. Eggink BH, Richardson CJ, Malloy MH, et al. Outcome of
gastroschisis : a 20-year review of infants with gastroschisis
born in Galveston,Texas. J Pediatr Surg 2006;41:1103-8.
14. Penman DG, Fisher RM, Noblett HR, et al. Increase in
incidence of gastroschisis in the South West of England in
1995. Br J Obstet Gynaecol 1998;105:328-31.
15. Goldbaum G, Dailing J, Milham S. Risk factors for gastroschisis.
Teratology 1990;42:397-403.
16. Torfs CP, Katz EA, Bateson TF, et al. Maternal medications
and environmental exposures as risk factors for gastroschisis.
Teratology 1996;54:84-92.
17. Werler MM, Sheehan JE, Mitchell AA. Maternal medication
use and risks of gastroschisis and small intestinal atresia. Am
J Epidemiol 2002;155:26 -31.
18. Nichols CR, Dickinson JE, Pemberton PJ. Rising incidence of
gastroschisis in teenage pregnancies. J Matern Fetal Med
1997;6:225-9.
19. Snyder CL. Outcome analysis for gastroschisis. J Pediatr
Surg1999;34:1253-6.
20. Vilela PC, Ramos de Amorim MM, Falbo GH, et al. Risk
factors for adverse outcome of newborns with gastroschisis
in a Brazilian hospital. J Pediatr Surg 2001;36:559-64.
21. Morrison JJ, Klein N, Chitty LS, et al. Intra-amniotic
inflammation in human gastroschisis: possible aetiology of
postnatal bowel dysfunction. Br J Obstet Gynaecol 1998;
105:1200-4.
22. Api A, Olguner M, Hakgqder G, et al. Intestinal damage in
gastroschisis correlates with the concentration of
intraamniotic meconium. J Pediatr Surg 2001;36:1811-5.
23. Correia-Pinto J, Tavares ML, Baptista MJ, et al. Meconium
dependence of bowel damage in gastroschisis. J Pediatr
Surg 2002;37:31-5.
24. Fleet MS, de la Hunt MN. Intestinal atresia with gastroschisis
: a selective approach to management. J Pediatr Surg
2000;35:1323-5.
25. Snyder CL, Miller KA, Sharp RJ, et al. Management of
intestinal atresia in patients with gastroschisis. J Pediatr Surg
2001;36:1542-5.
26. Jayanthi S, Seymour P, Puntis JWL, et al. Necrotizing
enterocolitis after gastroschisis repair : a preventable
complication? J Pediatr Surg 1998;33:705-7.
27. Walter-Nicolet E , Rousseau V, Kieffer F, et al. Neonatal
outcome of gastroschisis is mainly influenced by nutritional
management. J Pediatr Gastroenterol Nutr 2009;48:612-7.
28. Burrin D, Guan X, Stoll B, et al. Glucagon-like peptide 2: a key
link between nutrition and intestinal adaptation in neonates.
J Nutr 2003;133:3712-6.
29. Vogler SA, Fenton SJ, Scaife ER, et al. Closed gastroschisis :
total parenteral nutrition - free survival with aggressive
attempts at bowel preservation and intestinal adaptation.
J Pediatr Surg 2008;43:1006-10.
clinical experience over 18 years. Pediatr Surg Int 2007;23:
731-6.
2. Niramis R, Watanatittan S, Anuntkosol M, et al. Abdominal
wall defect: a 12-year experience. Thai J Surg 1998;19:121-
8.
3. Havanonda S. Omphalocele and gastroschisis. Bangkok:
Unity Publication; 1989. p. 39-42 (in Thai).
4. Lewis JE Jr, Kraeger RR, Danis RK. Gastroschisis: ten-year
review. Arch Surg 1973;107:218-2.
5. DiLorenza M, Yazbeck S, Duchame JC. Gastroschisis: an 18-
year review. J Pediatr Surg 1987;22: 710-2.
6. Jayanthi S, Seymour P, Puntis JWL, et al. Necrotizing
enterocolitis after gastroschisis repair: a preventable
complication. J Pediatr Surg 1998; 33 :705-7.
7. Amoury RA, Goodwin CD, McGill CW, et al. Necrotizing
enterocolitis following operation in the neonatal period. J
Pediatr Surg 1980;15:1-8.
8. Oldham KT, Coran AG, Drongowski RA, et al. The
development of necrotizing enterocolitis following repair of
gastroschisis : a surprisingly high incidence. J Pediatr Surg
1988;23:945-9.
9. Sangkhathat S, Patrapinyokul S, Chiengkriwate P, et al.
Infectious complications in infants with gastroschisis: an 11-
year review from a referral hospital in southern Thailand. J
Pediatr Surg 2008;43:473-8.
10. Bell MJ, Ternberg JL, Feigin RD, et al. Neonatal necrotizing
enterocolitis : therapeutic dieision based on clinical staging.
Ann Surg 1978;187:1-7.
11. Baerg J, Kaban G, Pahwa TP, et al. Gastroschisis : a sixteenyear
review. J Pediatr Surg 2003;38:771-4.
12. Abdullah F, Arnold MA, Nabaweesi R, et al. Gastroschisis in
the United States 1988-2003: analysis and risk categorization
of 4344 patients. J Perinatol 2007;27:50-5.
13. Eggink BH, Richardson CJ, Malloy MH, et al. Outcome of
gastroschisis : a 20-year review of infants with gastroschisis
born in Galveston,Texas. J Pediatr Surg 2006;41:1103-8.
14. Penman DG, Fisher RM, Noblett HR, et al. Increase in
incidence of gastroschisis in the South West of England in
1995. Br J Obstet Gynaecol 1998;105:328-31.
15. Goldbaum G, Dailing J, Milham S. Risk factors for gastroschisis.
Teratology 1990;42:397-403.
16. Torfs CP, Katz EA, Bateson TF, et al. Maternal medications
and environmental exposures as risk factors for gastroschisis.
Teratology 1996;54:84-92.
17. Werler MM, Sheehan JE, Mitchell AA. Maternal medication
use and risks of gastroschisis and small intestinal atresia. Am
J Epidemiol 2002;155:26 -31.
18. Nichols CR, Dickinson JE, Pemberton PJ. Rising incidence of
gastroschisis in teenage pregnancies. J Matern Fetal Med
1997;6:225-9.
19. Snyder CL. Outcome analysis for gastroschisis. J Pediatr
Surg1999;34:1253-6.
20. Vilela PC, Ramos de Amorim MM, Falbo GH, et al. Risk
factors for adverse outcome of newborns with gastroschisis
in a Brazilian hospital. J Pediatr Surg 2001;36:559-64.
21. Morrison JJ, Klein N, Chitty LS, et al. Intra-amniotic
inflammation in human gastroschisis: possible aetiology of
postnatal bowel dysfunction. Br J Obstet Gynaecol 1998;
105:1200-4.
22. Api A, Olguner M, Hakgqder G, et al. Intestinal damage in
gastroschisis correlates with the concentration of
intraamniotic meconium. J Pediatr Surg 2001;36:1811-5.
23. Correia-Pinto J, Tavares ML, Baptista MJ, et al. Meconium
dependence of bowel damage in gastroschisis. J Pediatr
Surg 2002;37:31-5.
24. Fleet MS, de la Hunt MN. Intestinal atresia with gastroschisis
: a selective approach to management. J Pediatr Surg
2000;35:1323-5.
25. Snyder CL, Miller KA, Sharp RJ, et al. Management of
intestinal atresia in patients with gastroschisis. J Pediatr Surg
2001;36:1542-5.
26. Jayanthi S, Seymour P, Puntis JWL, et al. Necrotizing
enterocolitis after gastroschisis repair : a preventable
complication? J Pediatr Surg 1998;33:705-7.
27. Walter-Nicolet E , Rousseau V, Kieffer F, et al. Neonatal
outcome of gastroschisis is mainly influenced by nutritional
management. J Pediatr Gastroenterol Nutr 2009;48:612-7.
28. Burrin D, Guan X, Stoll B, et al. Glucagon-like peptide 2: a key
link between nutrition and intestinal adaptation in neonates.
J Nutr 2003;133:3712-6.
29. Vogler SA, Fenton SJ, Scaife ER, et al. Closed gastroschisis :
total parenteral nutrition - free survival with aggressive
attempts at bowel preservation and intestinal adaptation.
J Pediatr Surg 2008;43:1006-10.
Downloads
Published
2011-12-30
How to Cite
1.
Suttiwongsing A, Sriworarak R, Buranakitjaroen V, Niramis R. Related Factors in Necrotizing Enterocolitis after Gastroschisis Repair. Thai J Surg [Internet]. 2011 Dec. 30 [cited 2024 Nov. 23];32(4). Available from: https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/227292
Issue
Section
Original Articles
License
Articles must be contributed solely to The Thai Journal of Surgery and when published become the property of the Royal College of Surgeons of Thailand. The Royal College of Surgeons of Thailand reserves copyright on all published materials and such materials may not be reproduced in any form without the written permission.
