Advertisement

Gastroschisis prognostic score successfully identifies Brazilian newborns with high-risk gastroschisis

  • Fabio Botelho
    Affiliations
    Harvey E. Beardmore Division of Pediatric Surgery | The Montreal Children's Hospital, McGill University Health Centre, 1001, Decarie Boulevard, Montreal, QC, Canada, H4A 3J1

    Serviço de Cirurgia Pediátrica, Hospital das Clínicas da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 110 - Santa Efigênia, Belo Horizonte, MG, Brazil, 30130-100
    Search for articles by this author
  • Renan Farias Rolim Viana
    Affiliations
    Serviço de Cirurgia Pediátrica, Hospital das Clínicas da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 110 - Santa Efigênia, Belo Horizonte, MG, Brazil, 30130-100
    Search for articles by this author
  • Sherif Emil
    Affiliations
    Harvey E. Beardmore Division of Pediatric Surgery | The Montreal Children's Hospital, McGill University Health Centre, 1001, Decarie Boulevard, Montreal, QC, Canada, H4A 3J1
    Search for articles by this author
  • Pramod Puligandla
    Affiliations
    Harvey E. Beardmore Division of Pediatric Surgery | The Montreal Children's Hospital, McGill University Health Centre, 1001, Decarie Boulevard, Montreal, QC, Canada, H4A 3J1
    Search for articles by this author
  • Clecio Piçarro
    Affiliations
    Serviço de Cirurgia Pediátrica, Hospital das Clínicas da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 110 - Santa Efigênia, Belo Horizonte, MG, Brazil, 30130-100

    Departamento de Cirurgia, Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190 - Santa Efigênia, Belo Horizonte, MG, Brazil, 30130-100
    Search for articles by this author
  • Paulo Custódio Furtado Cruzeiro
    Affiliations
    Serviço de Cirurgia Pediátrica, Hospital das Clínicas da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 110 - Santa Efigênia, Belo Horizonte, MG, Brazil, 30130-100

    Departamento de Cirurgia, Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190 - Santa Efigênia, Belo Horizonte, MG, Brazil, 30130-100
    Search for articles by this author
  • Bernardo Almeida Campos
    Affiliations
    Serviço de Cirurgia Pediátrica, Hospital das Clínicas da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 110 - Santa Efigênia, Belo Horizonte, MG, Brazil, 30130-100

    Departamento de Cirurgia, Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190 - Santa Efigênia, Belo Horizonte, MG, Brazil, 30130-100
    Search for articles by this author
  • Vivian Resende
    Affiliations
    Departamento de Cirurgia, Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190 - Santa Efigênia, Belo Horizonte, MG, Brazil, 30130-100
    Search for articles by this author
  • Marcelo Eller Miranda
    Correspondence
    Corresponding author at: Serviço de Cirurgia Pediátrica, Hospital das Clínicas da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 110 - Santa Efigênia, Belo Horizonte, MG, Brazil, 30130-100.
    Affiliations
    Serviço de Cirurgia Pediátrica, Hospital das Clínicas da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 110 - Santa Efigênia, Belo Horizonte, MG, Brazil, 30130-100

    Departamento de Cirurgia, Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190 - Santa Efigênia, Belo Horizonte, MG, Brazil, 30130-100
    Search for articles by this author
Published:February 23, 2022DOI:https://doi.org/10.1016/j.jpedsurg.2022.02.009

      Highlights

      • The Gastroschisis Prognostic Score (GPS) is a simple and accurate risk stratification and prognostic tool for gastroschisis. The GPS had never been tested previously in low- and middle-income countries.
      • In a Brazilian center, the GPS reliably predicted several important clinical outcomes, including duration of parenteral nutrition, mechanical ventilation, and length of stay.

      Abstract

      Background

      The Gastroschisis Prognostic Score (GPS) stratifies patients as high or low risk based on the visual assessment of intestinal matting, atresia, perforation, or necrosis. Despite being a simple score, its applicability to low and middle-income countries (LMICs) remains unknown. We tested the hypothesis that GPS can predict outcomes in LMICs, by assessing the prognostic value of the GPS in a middle-income country.

      Methods

      This prospective study followed all newborns with gastroschisis in a Brazilian neonatal unit based in a public hospital from 2015–2019. Infants were stratified into low and high-risk cohorts based on the GPS. In addition to basic demographics, data collected included duration of parenteral nutrition (TPN), mechanical ventilation (MV), length of stay (LOS), suspicion of infection that led to the use of antibiotics, and mortality. Univariate and multivariate analyses were conducted to identify which outcomes the GPS independently predicted.

      Results

      Sixty-one newborns with gastroschisis were treated during the study period. The mean birth weight, gestational age, and 5ʼ Apgar score were 2258 g, 36 weeks, and 9. Twenty-four infants (39.3%) were identified as low-risk (GPS < 2) and 37 (60.7%) as high-risk (GPS > 2). The high-risk group presented with prolonged TPN use (p<0.001), MV (p<0.001), and LOS (p:0.002). GPS did not predict antibiotic therapy or mortality.

      Conclusion

      In the first study in a middle-income country, the GPS predicted several important clinical outcomes. The GPS is a reliable tool for parental counseling and resource allocation in diverse settings.

      Level of evidence

      II.c (cohort prospective)

      Graphical abstract

      Keywords

      Abbreviations:

      CAPSNet (Canadian Pediatric Surgery Network), HC-UFMG (Hospital das Clínicas of Federal University of Minas Gerais), GPS (Gastroschisis Prognostic Score), LMICs (low- and middle-income countries (LMICs)), LOS (Length of Stay), MV (Mechanical Ventilation), TPN (Parenteral Nutrition)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Pediatric Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Islam S.
        Congenital abdominal wall defects. Gastroschisis and omphalocele.
        in: Holcomb III, GW Murphy JP St Peter SD Gatti JM Holcomb and Ashcraft's pediatric surgery. Elsevier, 2020: 763-779
        • Youssef F.
        • Laberge J.M.
        • Baird R.J.
        • Canadian Pediatric Surgery Network (CAPSNet)
        The correlation between the time spent in utero and the severity of bowel matting in newborns with gastroschisis.
        J Pediatr Surg. 2015; 50: 755-759
        • Brown N.
        • Nardi M.
        • Greer R.M.
        • Petersen S.
        • Thomas J.
        • Gardener G.
        • et al.
        Prenatal extra-abdominal bowel dilatation is a risk factor for intrapartum fetal compromise for fetuses with gastroschisis.
        Prenat Diagn. 2015; 35: 529-533
        • Miranda M.E.
        • Emil S.
        • de Mattos Paixão R.
        • Piçarro C.
        • Cruzeiro P.C.F.
        • Campos B.A.
        • et al.
        A 25-year study of gastroschisis outcomes in a middle-income country.
        J Pediatr Surg. 2019; 54: 1481-1486
        • D’Antonio F.
        • Virgone C.
        • Rizzo G.
        • Khalil A.
        • Baud D.
        • Cohen-Overbeek T.E.
        • et al.
        Prenatal risk factors and outcomes in gastroschisis: a meta-analysis.
        Pediatrics. 2015; 136: e159-e169
        • Bergholz R.
        • Boettcher M.
        • Reinshagen K.
        • Wenke K.
        Complex gastroschisis is a different entity to simple gastroschisis affecting morbidity and mortality—a systematic review and meta-analysis.
        J Pediatr Surg. 2014; 49: 1527-1532
        • Marinović V.
        • Lukac M.
        • Miković Ž.
        • Grujić B.
        • Milickovic M.
        • Samardžija G.
        • et al.
        Outcome differences between simple and complex gastroschisis.
        Ann Ital Chir. 2016;
        • Cowan K.N.
        • Puligandla P.S.
        • Laberge J.-.M.
        • Skarsgard E.D.
        • Bouchard S.
        • Yanchar N.
        • et al.
        The gastroschisis prognostic score: reliable outcome prediction in gastroschisis.
        J Pediatr Surg. 2012; 47: 1111-1117
        • Tosello B.
        • Zahed M.
        • Guimond F.
        • Baumstarck K.
        • Faure A.
        • Michel F.
        • et al.
        Management and outcome challenges in newborns with gastroschisis: a 6-year retrospective French study.
        J Matern Fetal Neonatal Med. 2017; 30: 2864-2870
        • Wissanji H.
        • Puligandla P.S.
        Risk stratification and outcome determinants in gastroschisis.
        Semin Pediatr Surg. 2018; 27: 300-303
        • Simmons C.P.L.
        • McMillan D.C.
        • McWilliams K.
        • Sande T.A.
        • Fearon K.C.
        • Tuck S.
        • et al.
        Prognostic tools in patients with advanced cancer: a systematic review.
        J Pain Symptom Manage. 2017; 53 (e10): 962-970
        • Puligandla P.S.
        • Baird R.
        • Skarsgard E.D.
        • Emil S.
        • Laberge J.-.M.
        • Canadian Pediatric Surgery Network (CAPSNet)
        Outcome prediction in gastroschisis - The gastroschisis prognostic score (GPS) revisited.
        J Pediatr Surg. 2017; 52: 718-721
        • Camara D.
        Minimizing risks associated with peripherally inserted central catheters in the NICU.
        MCN Am J Matern Child Nurs. 2001; 26 (quiz 22): 17-21
        • Miranda da Silva Alves F.
        • Miranda M.E.
        • de Aguiar M.J.B.
        • Bouzada Viana M.C.F
        Nutritional management and postoperative prognosis of newborns submitted to primary surgical repair of gastroschisis.
        J Pediatr. 2016; 92: 268-275