A 25-year study of gastroschisis outcomes in a middle-income country
Autor(a) principal: | |
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Data de Publicação: | 2019 |
Outros Autores: | , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UFMG |
Texto Completo: | http://hdl.handle.net/1843/53216 |
Resumo: | Background: Survival of newborns with gastroschisis is significantly higher in high-income versus low and middle-income countries. We reviewed treatment and outcomes of gastroschisis in a middle-income country setting with increasing protocolized management. Methods: All newborns with gastroschisis treated during the period 1989–2013 at a single Brazilian academic surigical service were studied retrospectively. Protocolized diagnosis, delivery, nutrition, medical interventions, and surgical interventions were introduced in 2002. Outcomes before and after protocol introduction were studied using univariate and multivariate analysis. Results: One hundred fifty-six newborns were treated for gastroschisis: 35 (22.4%) and 121 (77.6%) before and after 2002, respectively. When compared to the earlier cohort, patients treated after 2002 had higher rates of pre natal diagnosis (90.9% vs. 60.0%, p b 0.001), delivery at a tertiary center (90.9% vs. 62.9%, p b 0.001), early closure (65.3% vs. 33.3%, p = 0.001), primary repair (55.4% vs. 31.4%, p = 0.013), monitoring of bladder pressure (62.0% vs. 2.9%, p = 0.001), PICC placement (71.1% vs. 25.7%, p b 0.001), early initiation of enteral feeding (54.5% vs.20.0%, p b 0.001), and lower rates of electrolyte disturbances (53.7% vs. 85.7%, p = 0.001). Mortality decreased from 34.3% before 2002 to 24.8% (p = .27) after 2002 despite an increase in the complex gastroschisis rate from 11.4% to 15.7% during the same period. Conclusions: Gastroschisis outcomes in a middle-income country can be gradually improved through targeted interventions and management protocols. Type of Study: Therapeutic. Level of Evidence:III |
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2023-05-12T19:18:39Z2023-05-12T19:18:39Z2019-02-175471481148610.1016/j.jpedsurg.2019.02.02000223468http://hdl.handle.net/1843/53216Background: Survival of newborns with gastroschisis is significantly higher in high-income versus low and middle-income countries. We reviewed treatment and outcomes of gastroschisis in a middle-income country setting with increasing protocolized management. Methods: All newborns with gastroschisis treated during the period 1989–2013 at a single Brazilian academic surigical service were studied retrospectively. Protocolized diagnosis, delivery, nutrition, medical interventions, and surgical interventions were introduced in 2002. Outcomes before and after protocol introduction were studied using univariate and multivariate analysis. Results: One hundred fifty-six newborns were treated for gastroschisis: 35 (22.4%) and 121 (77.6%) before and after 2002, respectively. When compared to the earlier cohort, patients treated after 2002 had higher rates of pre natal diagnosis (90.9% vs. 60.0%, p b 0.001), delivery at a tertiary center (90.9% vs. 62.9%, p b 0.001), early closure (65.3% vs. 33.3%, p = 0.001), primary repair (55.4% vs. 31.4%, p = 0.013), monitoring of bladder pressure (62.0% vs. 2.9%, p = 0.001), PICC placement (71.1% vs. 25.7%, p b 0.001), early initiation of enteral feeding (54.5% vs.20.0%, p b 0.001), and lower rates of electrolyte disturbances (53.7% vs. 85.7%, p = 0.001). Mortality decreased from 34.3% before 2002 to 24.8% (p = .27) after 2002 despite an increase in the complex gastroschisis rate from 11.4% to 15.7% during the same period. Conclusions: Gastroschisis outcomes in a middle-income country can be gradually improved through targeted interventions and management protocols. Type of Study: Therapeutic. Level of Evidence:IIIengUniversidade Federal de Minas GeraisUFMGBrasilMED - DEPARTAMENTO DE CIRURGIAJournal of Pediatric SurgeryGastrosquiseBrasilPaíses DesenvolvidosPaíses em DesenvolvimentoRecém-nascidoGastroschisisMiddle incomeOutcomesInterventionsResourcesA 25-year study of gastroschisis outcomes in a middle-income countryinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articlehttps://www.sciencedirect.com/science/article/pii/S002234681930137X?via%3DihubMarcelo EllermirandaSherif EmilRicardo de Mattos PaixãoClécio PiçarroPaulo Custódio Furtado CruzeiroBernardo Almeida CamposAndrey Kaliff PontesEdson Samesima Tatsuoapplication/pdfinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFMGinstname:Universidade Federal de Minas Gerais (UFMG)instacron:UFMGLICENSELicense.txtLicense.txttext/plain; charset=utf-82042https://repositorio.ufmg.br/bitstream/1843/53216/1/License.txtfa505098d172de0bc8864fc1287ffe22MD51ORIGINALA 25-years of gastroschisis outcomes in a middle-income country pdfa.pdfA 25-years of gastroschisis outcomes in a middle-income country pdfa.pdfapplication/pdf363231https://repositorio.ufmg.br/bitstream/1843/53216/2/A%2025-years%20of%20gastroschisis%20outcomes%20in%20a%20middle-income%20country%20pdfa.pdfc62207b062e857443b6329398430ec73MD521843/532162023-05-12 19:02:19.908oai:repositorio.ufmg.br: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Repositório de PublicaçõesPUBhttps://repositorio.ufmg.br/oaiopendoar:2023-05-12T22:02:19Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG)false |
dc.title.pt_BR.fl_str_mv |
A 25-year study of gastroschisis outcomes in a middle-income country |
title |
A 25-year study of gastroschisis outcomes in a middle-income country |
spellingShingle |
A 25-year study of gastroschisis outcomes in a middle-income country Marcelo Ellermiranda Gastroschisis Middle income Outcomes Interventions Resources Gastrosquise Brasil Países Desenvolvidos Países em Desenvolvimento Recém-nascido |
title_short |
A 25-year study of gastroschisis outcomes in a middle-income country |
title_full |
A 25-year study of gastroschisis outcomes in a middle-income country |
title_fullStr |
A 25-year study of gastroschisis outcomes in a middle-income country |
title_full_unstemmed |
A 25-year study of gastroschisis outcomes in a middle-income country |
title_sort |
A 25-year study of gastroschisis outcomes in a middle-income country |
author |
Marcelo Ellermiranda |
author_facet |
Marcelo Ellermiranda Sherif Emil Ricardo de Mattos Paixão Clécio Piçarro Paulo Custódio Furtado Cruzeiro Bernardo Almeida Campos Andrey Kaliff Pontes Edson Samesima Tatsuo |
author_role |
author |
author2 |
Sherif Emil Ricardo de Mattos Paixão Clécio Piçarro Paulo Custódio Furtado Cruzeiro Bernardo Almeida Campos Andrey Kaliff Pontes Edson Samesima Tatsuo |
author2_role |
author author author author author author author |
dc.contributor.author.fl_str_mv |
Marcelo Ellermiranda Sherif Emil Ricardo de Mattos Paixão Clécio Piçarro Paulo Custódio Furtado Cruzeiro Bernardo Almeida Campos Andrey Kaliff Pontes Edson Samesima Tatsuo |
dc.subject.por.fl_str_mv |
Gastroschisis Middle income Outcomes Interventions Resources |
topic |
Gastroschisis Middle income Outcomes Interventions Resources Gastrosquise Brasil Países Desenvolvidos Países em Desenvolvimento Recém-nascido |
dc.subject.other.pt_BR.fl_str_mv |
Gastrosquise Brasil Países Desenvolvidos Países em Desenvolvimento Recém-nascido |
description |
Background: Survival of newborns with gastroschisis is significantly higher in high-income versus low and middle-income countries. We reviewed treatment and outcomes of gastroschisis in a middle-income country setting with increasing protocolized management. Methods: All newborns with gastroschisis treated during the period 1989–2013 at a single Brazilian academic surigical service were studied retrospectively. Protocolized diagnosis, delivery, nutrition, medical interventions, and surgical interventions were introduced in 2002. Outcomes before and after protocol introduction were studied using univariate and multivariate analysis. Results: One hundred fifty-six newborns were treated for gastroschisis: 35 (22.4%) and 121 (77.6%) before and after 2002, respectively. When compared to the earlier cohort, patients treated after 2002 had higher rates of pre natal diagnosis (90.9% vs. 60.0%, p b 0.001), delivery at a tertiary center (90.9% vs. 62.9%, p b 0.001), early closure (65.3% vs. 33.3%, p = 0.001), primary repair (55.4% vs. 31.4%, p = 0.013), monitoring of bladder pressure (62.0% vs. 2.9%, p = 0.001), PICC placement (71.1% vs. 25.7%, p b 0.001), early initiation of enteral feeding (54.5% vs.20.0%, p b 0.001), and lower rates of electrolyte disturbances (53.7% vs. 85.7%, p = 0.001). Mortality decreased from 34.3% before 2002 to 24.8% (p = .27) after 2002 despite an increase in the complex gastroschisis rate from 11.4% to 15.7% during the same period. Conclusions: Gastroschisis outcomes in a middle-income country can be gradually improved through targeted interventions and management protocols. Type of Study: Therapeutic. Level of Evidence:III |
publishDate |
2019 |
dc.date.issued.fl_str_mv |
2019-02-17 |
dc.date.accessioned.fl_str_mv |
2023-05-12T19:18:39Z |
dc.date.available.fl_str_mv |
2023-05-12T19:18:39Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/1843/53216 |
dc.identifier.doi.pt_BR.fl_str_mv |
10.1016/j.jpedsurg.2019.02.020 |
dc.identifier.issn.pt_BR.fl_str_mv |
00223468 |
identifier_str_mv |
10.1016/j.jpedsurg.2019.02.020 00223468 |
url |
http://hdl.handle.net/1843/53216 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.ispartof.none.fl_str_mv |
Journal of Pediatric Surgery |
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info:eu-repo/semantics/openAccess |
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openAccess |
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application/pdf |
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Universidade Federal de Minas Gerais |
dc.publisher.initials.fl_str_mv |
UFMG |
dc.publisher.country.fl_str_mv |
Brasil |
dc.publisher.department.fl_str_mv |
MED - DEPARTAMENTO DE CIRURGIA |
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Universidade Federal de Minas Gerais |
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reponame:Repositório Institucional da UFMG instname:Universidade Federal de Minas Gerais (UFMG) instacron:UFMG |
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