Md Samiul Hasan 1 , Ashrarur Rahman 2 , Ayub Ali 3 , KMN Ferdous 4 , - - PowerPoint PPT Presentation

Omphalocele and gastroschisis: comparison of

• utcome and challenges in management in a

resource limited center Md Samiul Hasan1, Ashrarur Rahman2, Ayub Ali3, KMN Ferdous4 , Umama Huq5

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

• mphalocele 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 (11) Omphalocele major (n=9) Ruptured

• mphalocele

(n=4) Gastroschisis (n=14) p Associated anomaly Meckels band-2 Intestinal atresia- 3 Cardiac anomaly- 11 Cardiac anomaly- 9 Not evaluated Ileal atresia- 1 <.01 Treatment Primary repair – 10 Escharosant- 1 Escharosant – 9 Reposition – 3 Silo – 1 Silo- 5 Repair – 7 No -2 Mortality 4 2 4 12 <.01

Result

20 40 60 80 100

Omphalocele Gastroschisis

Expired Survived P < .01 58.33% 14.29%

Discussion

Unfortunately, not a single baby was diagnosed

during antenatal checkup, though every mother had at least

• ne

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

• utcome

than gastroschisis in our center.

Inappropriate perinatal management including

absence of prenatal diagnosis is responsible for poor outcome.

Neonatal

surgical ICU is also

• f

utmost importance.