Omphalocele and gastroschisis: comparison of outcome and challenges in management in a resource limited center Md Samiul Hasan 1 , Ashrarur Rahman 2 , Ayub Ali 3 , KMN Ferdous 4 , Umama Huq 5
Introduction Omphalocele and gastroschisis are the commonest anterior abdominal wall defect in neonates. These congenital defects still pose significant problem to pediatric & neonatal surgeons.
Introduction
Introduction Neonates with gastroschisis are expected to have better prognosis than omphalocele as the later is commonly associated with other anomalies. But in our center, we experience the opposite scenario.
Objective To compare the outcome of omphalocele and gastroschisis in our center. To identify the factors influencing the outcome.
Methodology Type : Prospective observational study Place : Dhaka Shishu (Children) Hospital Duration : June 2017 to November 2017. Inclusion: All neonates admitted with omphalocele and gastroschisis during the study period were included.
Data analysis SPSS 22 software used. Continuous data were tested by ‘student t’ test. Categorical data were analyzed by ‘Chi square’ test. P <.05 considered significant.
Results : Table 1: Demographic variables Variables Omphalocele (n=24) Gastroschisis (n= 14) p Birth weight (Kg) 2.62±58 2.17±27 .06 Gestational age (weeks) 36.16±1.65 35.78±1.36 .26 Maternal age (years) 22.00±2.90 20.71±3.79 .70 Gender (M/F) M-12, F-12 M-9, F-5 .50 Antenatal USG 1.83± .64 1.92± .92 .70 Antenatal diagnosis Nil Nil
Results: Table 2: Associated anomaly & Treatment Omphalocele minor Omphalocele Ruptured Gastroschisis p (11) major (n=9) omphalocele (n=14) (n=4) Associated Meckels band-2 Cardiac Not evaluated Ileal atresia- 1 <.01 anomaly Intestinal atresia- 3 anomaly- 9 Cardiac anomaly- 11 Treatment Primary repair – 10 Escharosant – 9 Reposition – 3 Silo- 5 Escharosant- 1 Silo – 1 Repair – 7 No -2 Mortality 4 2 4 12 <.01
Result 100 80 Expired 60 40 Survived 20 58.33% P < .01 0 14.29% Omphalocele Gastroschisis
Discussion Unfortunately, not a single baby was diagnosed during antenatal checkup, though every mother had at least one ultrasound scan during pregnancy. Similar finding was reported by Abdur-Rahman L O et al from Nigeria, while in developed countries, almost 100% cases are detected prenatally.
Discussion Demographic data showed no statistically significant difference. Watanabe S et al found this difference noteworthy in his study. Many authors identified low maternal age as a risk factor for gastroschisis. On the contrary, in our study it exhibited irrelevancy, which precisely matches with Abdur-Rahman LO et al.
Discussion Associated anomalies are significantly higher in neonates with omphalocele that is consistent with most studies. Non-operative management of omphalocele major is encouraged in resource limited centers to avoid post operative complications arising from raised intra abdominal pressure.
Discussion Most of the babies with gastroschisis presented to us more than 12 hours after delivery exposed edematous viscera. hypovolemic, hypothermic even in shock. After reposition these babies developed respiratory failure and ultimately died as we don’t have facilities for elective ventilation.
Discussion: How better results are achieved at developed centers: Prenatal diagnosis & planned delivery Reposition of gut within 5 hour Elective ventilation with TPN in post operative period.
Discussion What we need to do: Awareness to increase prenatal diagnosis & planned delivery Appropriate postnatal care. Cover the viscera immediately Nasogastric decompression IV fluid Emergency transportation Easy access to NICU care.
Discussion Increasing incidence of anterior abdominal wall defect has been reported from around the world. An integrated protocol has become a crying need to provide quality care to these newborn babies.
Conclusion Omphalocele has better outcome than gastroschisis in our center. Inappropriate perinatal management including absence of prenatal diagnosis is responsible for poor outcome. Neonatal surgical ICU is also of utmost importance.
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