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CC BY 4.0 · Rev Bras Ginecol Obstet 2022; 44(01): 010-018
DOI: 10.1055/s-0041-1736299
Original Article
Fetal Medicine

Short and Medium-term Outcomes of Omphalocele and Gastroschisis: A Survey from a Tertiary Center

Resultados a curto e médio prazo do onfalocelo e gastrosquisis: uma investigação de um centro terciário
Alexandra Tavares Marques 
1   Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
,
José Estevão-Costa 
1   Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
2   Pediatric Surgery Department, Centro Hospitalar Universitário de São João, Porto, Portugal
,
Henrique Soares 
3   Department of Pediatrics, Division of Neonatology, Faculty of Medicine of Porto, Centro Hospitalar Universitário de São João, Porto, Portugal
,
Ana Catarina Fragoso 
1   Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
2   Pediatric Surgery Department, Centro Hospitalar Universitário de São João, Porto, Portugal
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Abstract

Objective To characterize and compare the outcomes of omphalocele and gastroschisis from birth to 2 years of follow-up in a recent cohort at a tertiary center.

Methods This is a retrospective clinical record review of all patients with gastroschisis and omphalocele admitted to the Neonatal Intensive Care Unit between January 2009 and December 2019.

Results There were 38 patients, 13 of whom had omphalocele, and 25 of whom had gastroschisis. Associated anomalies were present in 6 patients (46.2%) with omphalocele and in 10 (41.7%) patients with gastroschisis. Compared with patients with omphalocele, those with gastroschisis had younger mothers (24.7 versus 29.6 years; p = 0.033), were born earlier (36 versus 37 weeks, p = 0.006), had lower birth weight (2365 ± 430.4 versus 2944.2 ± 571.9 g; p = 0.001), and had a longer hospital stay (24 versus 9 days, p = 0.001). The neonatal survival rate was 92.3% for omphalocele and 91.7% for gastroschisis. Thirty-four patients were followed-up over a median of 24 months; 13 patients with gastroschisis (59.1%) and 8 patients with omphalocele (66.7%) had at least one adverse event, mainly umbilical hernia (27.3% vs 41.7%), intestinal obstruction (31.8% vs 8.3%), or additional surgical interventions (27.3% vs 33.3%).

Conclusion Despite the high proportion of prematurity, low birth weight, and protracted recovery, gastroschisis and omphalocele (without chromosomal abnormalities) may achieve very high survival rates; on the other hand, complications may develop in the first years of life. Thus, a very positive perspective in terms of survival should be transmitted to future parents, but they should also be informed that substantial morbidity may occur in the medium term.

Resumo

Objetivo Caracterizar e comparar os desfechos do onfalocelo e gastrosquisis desde o nascimento até aos 2 anos de seguimento numa coorte recente de um centro terciário.

Métodos Este é um estudo retrospectivo em que foi feita uma revisão dos registos clínicos de todos os pacientes com gastrosquisis e onfalocelo que foram internados na unidade de cuidados intensivos neonatais, entre janeiro de 2009 e dezembro de 2019.

Resultados Identificamos 38 pacientes, 13 dos quais tinham onfalocelo e 25 dos quais tinham gastrosquisis. Anomalias associadas estavam presentes em 6 pacientes (46.2%) com onfalocelo e 10 (41.7%) com gastrosquisis. Comparativamente com os pacientes com onfalocelo, os pacientes com gastrosquisis tinham mães mais jovens (24.7 versus 29.6 anos; p = 0.033), nasceram mais precocemente (36 versus 37 semanas, p = 0.006), com menor peso ao nascimento (2,365 ± 430.4 versus 2,944.2 ± 571.9 g; p = 0.001), e o internamento teve uma duração mais longa (24 versus 9 dias, p = 0.001). A taxa de sobrevivência neonatal foi de 92.3% para o onfalocelo e 91.7% para a gastrosquisis. Trinta e quatro pacientes foram seguidos durante um tempo mediano de seguimento de 24 meses: 13 com gastrosquisis (59.1%) e 8 com onfalocelo (66.7%) apresentaram pelo menos um evento adverso, sobretudo hérnia umbilical (27.3% vs 41.7%), obstrução intestinal (31.8% vs 8.3%) ou intervenções cirúrgicas adicionais (27.3% vs 33.3%).

Conclusão Apesar da alta proporção de prematuridade, de baixo peso e de recuperação lenta, os gastrosquisis, assim como os onfalocelos (sem anomalias cromossómicas), podem ter uma taxa de sobrevivência muito alta; por outro lado, nos primeiros anos de vida, podem surgir complicações não desprezíveis. Assim, aos futuros pais pode ser transmitida uma perspectiva muito positiva em termos de sobrevivência, embora eles também devam ser informados de que pode ocorrer morbidade substancial no médio prazo.

Keywords

omphalocele - gastroschisis - anomalies - abdominal-wall defect - morbidity

Palavras-chave

onfalocele - gastrosquisis - anomalias - defeito da parede abdominal - morbidade

Contributors

All the authors participated in the concept and design of the present study. Marques A. T. and Estevão-Costa J. have performed the analysis and interpretation of data and the writing of the article. All the authors contributed to critical review of the intellectual content and have approved the manuscript as submitted.


* Both authors have contributed equally to this work and share first authorship.


Supplementary Material



Publication History

Received: 19 February 2021

Accepted: 09 August 2021

Article published online:
29 January 2022

© 2022. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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