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Patrick J. Javid - One of the best experts on this subject based on the ideXlab platform.
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Variation in hospital costs for Gastroschisis closure techniques.
2020Co-Authors: Melissa Wong, Assaf P. Oron, Anna V Faino, Susan Stanford, Jennifer Stevens, Claudia S. Crowell, Patrick J. JavidAbstract:Abstract Background In newborns with Gastroschisis, both primary repair and delayed fascial closure with initial silo placement are considered safe with similar outcomes although cost differences have not been explored. Methods A retrospective review was performed of newborns admitted with Gastroschisis at a single center from 2011 to 2016. Demographic, clinical, and cost data during the initial hospitalization were collected. Differences between procedure costs and clinical endpoints were analyzed using multivariable linear regression adjusting for prematurity, complicated Gastroschisis, and performance of additional operations. Results 80 patients with Gastroschisis met inclusion criteria. Rates of primary fascial, primary umbilical cord closure, and delayed closure were 14%, 65%, and 21%, respectively. Delayed closure was associated with an increase in total hospital costs by 57% compared to primary repair (p Conclusion Delayed fascial closure was associated with significantly greater hospital costs during the index admission.
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outcomes of bedside sutureless umbilical closure without endotracheal intubation for Gastroschisis repair in surgical infants
2017Co-Authors: Gillian E Pet, John J Meehan, Rebecca Stark, Patrick J. JavidAbstract:Abstract Introduction Newborns with Gastroschisis have historically undergone surgical repair under general anesthesia. Our institution recently transitioned to the sutureless umbilical closure for Gastroschisis. We sought to evaluate the feasibility of bedside Gastroschisis repair without endotracheal intubation. Methods A retrospective review was performed of neonates with Gastroschisis who underwent sutureless umbilical closure from 2011 to 2015. Clinical characteristics and outcomes between groups were compared. Results In total, 53 infants underwent sutureless umbilical closure. Closure without endotracheal intubation was attempted in 23 (43%) babies and was successful in 15 (65%) infants. Two of the 8 patients who required intubation needed a temporary silo. Neonates successfully repaired without intubation were more premature (p Conclusion Bedside sutureless umbilical closure without intubation is feasible and effective in newborns with Gastroschisis. The procedure decreases time to Gastroschisis closure. Smaller and more premature neonates were more likely to be successfully closed without intubation.
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contemporary trends in the use of primary repair for Gastroschisis in surgical infants
2015Co-Authors: Assaf P. Oron, Patrick M Chesley, Daniel J Ledbetter, John J Meehan, Patrick J. JavidAbstract:Abstract Background Gastroschisis is a newborn anomaly requiring emergent surgical intervention. We review our experience with Gastroschisis to examine trends in contemporary surgical management. Methods Infants who underwent initial surgical management of Gastroschisis from 1996 to 2014 at a pediatric hospital were reviewed. Closure techniques included primary fascial repair using suture or sutureless umbilical closure, and staged repair using sutured or spring-loaded silo (SLS). Data were separated into 3 clinical eras: pre-SLS (1996 to 2004), SLS (2005 to 2008), and umbilical closure (2009 to 2014). Results In the pre-SLS era, 60% (34/57) of infants with Gastroschisis underwent primary repair. With the advent of SLS, there was a decrease in primary repair (15%, 10/68, P P P Conclusions Following introduction of a less invasive technique for Gastroschisis repair, most infants with Gastroschisis were able to be repaired primarily. Primary repair should be considered in all babies with Gastroschisis and favorable anatomy.
Allen A Mitchell - One of the best experts on this subject based on the ideXlab platform.
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association of vasoconstrictive exposures with risks of Gastroschisis and small intestinal atresia
2003Co-Authors: Martha M.werler, Jane E Sheehan, Allen A MitchellAbstract:Background Gastroschisis and small intestinal atresia are congenital anomalies that may arise from vascular disruption. It is hypothesized that maternal exposure to cocaine, amphetamines, decongestants and nicotine, all of which have vasoconstrictive actions, can contribute to these defects. The present study examined risks of Gastroschisis and small intestinal atresia associated with combined exposure to vasoconstrictive drugs and cigarette smoking. Methods This was a retrospective study conducted from 1995 to 1999 in 15 cities across the United States and Canada. Mothers of 205 Gastroschisis cases, 127 small intestinal atresia cases, 381 malformed controls and 416 nonmalformed controls were interviewed within 6 months of delivery. Results Reported vasoconstrictive drugs included pseudoephedrine, phenylpropanolamine, ephedrine and methylenedioxymethamphetamine. Combined exposure to vasoconstrictive drugs and cigarette smoking in the first 2.5 months of pregnancy was reported by 9% of Gastroschisis cases, 9% of small intestinal atresia cases and 4% of controls. Multivariate-adjusted odds ratios, controlling for the effects of age, education, income, other drug use and alcohol intake, were 2.1 (95% confidence interval = 1.0-4.4) for Gastroschisis and 2.8 (1.1-6.9) for small intestinal atresia. Risks of each defect increased with increasing level of cigarettes (P for trend = 0.019 and 0.012, respectively). Vasoconstrictive drug use among smokers of 20 or more cigarettes a day increased Gastroschisis risk 3.6-fold (1.3-10.3) and small intestinal atresia risk 4.2-fold (1.1-16.2). Conclusions These findings provide further evidence of vascular disruption as an etiology for Gastroschisis and small intestinal atresia.
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Maternal medication use and risks of Gastroschisis and small intestinal atresia
2002Co-Authors: Martha M.werler, Jane E Sheehan, Allen A MitchellAbstract:Gastroschisis and small intestinal atresia (SIA) are birth defects that are thought to arise from vascular disruption of fetal mesenteric vessels. Previous studies of Gastroschisis have suggested that risk is increased for maternal use of vasoactive over-the-counter medications, including specific analgesics and decongestants. This retrospective study evaluated the relation between maternal use of cough/cold/analgesic medications and risks of Gastroschisis and SIA. From 1995 to 1999, the mothers of 206 Gastroschisis cases, 126 SIA cases, and 798 controls in the United States and Canada were interviewed about medication use and illnesses. Risks of Gastroschisis were elevated for use of aspirin (odds ratio = 2.7, 95% confidence interval: 1.2, 5.9), pseudoephedrine (odds ratio = 1.8, 95% confidence interval: 1.0, 3.2), acetaminophen (odds ratio = 1.5, 95% confidence interval: 1.1, 2.2), and pseudoephedrine combined with acetaminophen (odds ratio = 4.2, 95% confidence interval: 1.9, 9.2). Risks of SIA were increased for any use of pseudoephedrine (odds ratio = 2.0, 95% confidence interval: 1.0, 4.0) and for use of pseudoephedrine in combination with acetaminophen (odds ratio = 3.0, 95% confidence interval: 1.1, 8.0). Reported fever, upper respiratory infection, and allergy were not associated with risks of either defect. These findings add more evidence that aspirin use in early pregnancy increases risk of Gastroschisis. Although pseudoephedrine has previously been shown to increase Gastroschisis risk, findings of this study raise questions about interactions between medications and possible confounding by underlying illness.
Daniel J Ledbetter - One of the best experts on this subject based on the ideXlab platform.
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contemporary trends in the use of primary repair for Gastroschisis in surgical infants
2015Co-Authors: Assaf P. Oron, Patrick M Chesley, Daniel J Ledbetter, John J Meehan, Patrick J. JavidAbstract:Abstract Background Gastroschisis is a newborn anomaly requiring emergent surgical intervention. We review our experience with Gastroschisis to examine trends in contemporary surgical management. Methods Infants who underwent initial surgical management of Gastroschisis from 1996 to 2014 at a pediatric hospital were reviewed. Closure techniques included primary fascial repair using suture or sutureless umbilical closure, and staged repair using sutured or spring-loaded silo (SLS). Data were separated into 3 clinical eras: pre-SLS (1996 to 2004), SLS (2005 to 2008), and umbilical closure (2009 to 2014). Results In the pre-SLS era, 60% (34/57) of infants with Gastroschisis underwent primary repair. With the advent of SLS, there was a decrease in primary repair (15%, 10/68, P P P Conclusions Following introduction of a less invasive technique for Gastroschisis repair, most infants with Gastroschisis were able to be repaired primarily. Primary repair should be considered in all babies with Gastroschisis and favorable anatomy.
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congenital abdominal wall defects and reconstruction in pediatric surgery Gastroschisis and omphalocele
2012Co-Authors: Daniel J LedbetterAbstract:The embryology, epidemiology, associated anomalies, prenatal course and the neonatal and surgical care of newborns with Gastroschisis and omphalocele are reviewed. For Gastroschisis temporary intestinal coverage is often done before a more definitive operative closure that may be immediate or delayed. Outcomes in Gastroschisis are determined by associated bowel injury. For omphalocele small defects are closed primarily while large defects are treated topically to allow initial skin coverage before a later definitive closure. Outcomes for omphalocele are determined mainly by the presence of associated anomalies.
Martha M.werler - One of the best experts on this subject based on the ideXlab platform.
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association of vasoconstrictive exposures with risks of Gastroschisis and small intestinal atresia
2003Co-Authors: Martha M.werler, Jane E Sheehan, Allen A MitchellAbstract:Background Gastroschisis and small intestinal atresia are congenital anomalies that may arise from vascular disruption. It is hypothesized that maternal exposure to cocaine, amphetamines, decongestants and nicotine, all of which have vasoconstrictive actions, can contribute to these defects. The present study examined risks of Gastroschisis and small intestinal atresia associated with combined exposure to vasoconstrictive drugs and cigarette smoking. Methods This was a retrospective study conducted from 1995 to 1999 in 15 cities across the United States and Canada. Mothers of 205 Gastroschisis cases, 127 small intestinal atresia cases, 381 malformed controls and 416 nonmalformed controls were interviewed within 6 months of delivery. Results Reported vasoconstrictive drugs included pseudoephedrine, phenylpropanolamine, ephedrine and methylenedioxymethamphetamine. Combined exposure to vasoconstrictive drugs and cigarette smoking in the first 2.5 months of pregnancy was reported by 9% of Gastroschisis cases, 9% of small intestinal atresia cases and 4% of controls. Multivariate-adjusted odds ratios, controlling for the effects of age, education, income, other drug use and alcohol intake, were 2.1 (95% confidence interval = 1.0-4.4) for Gastroschisis and 2.8 (1.1-6.9) for small intestinal atresia. Risks of each defect increased with increasing level of cigarettes (P for trend = 0.019 and 0.012, respectively). Vasoconstrictive drug use among smokers of 20 or more cigarettes a day increased Gastroschisis risk 3.6-fold (1.3-10.3) and small intestinal atresia risk 4.2-fold (1.1-16.2). Conclusions These findings provide further evidence of vascular disruption as an etiology for Gastroschisis and small intestinal atresia.
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Maternal medication use and risks of Gastroschisis and small intestinal atresia
2002Co-Authors: Martha M.werler, Jane E Sheehan, Allen A MitchellAbstract:Gastroschisis and small intestinal atresia (SIA) are birth defects that are thought to arise from vascular disruption of fetal mesenteric vessels. Previous studies of Gastroschisis have suggested that risk is increased for maternal use of vasoactive over-the-counter medications, including specific analgesics and decongestants. This retrospective study evaluated the relation between maternal use of cough/cold/analgesic medications and risks of Gastroschisis and SIA. From 1995 to 1999, the mothers of 206 Gastroschisis cases, 126 SIA cases, and 798 controls in the United States and Canada were interviewed about medication use and illnesses. Risks of Gastroschisis were elevated for use of aspirin (odds ratio = 2.7, 95% confidence interval: 1.2, 5.9), pseudoephedrine (odds ratio = 1.8, 95% confidence interval: 1.0, 3.2), acetaminophen (odds ratio = 1.5, 95% confidence interval: 1.1, 2.2), and pseudoephedrine combined with acetaminophen (odds ratio = 4.2, 95% confidence interval: 1.9, 9.2). Risks of SIA were increased for any use of pseudoephedrine (odds ratio = 2.0, 95% confidence interval: 1.0, 4.0) and for use of pseudoephedrine in combination with acetaminophen (odds ratio = 3.0, 95% confidence interval: 1.1, 8.0). Reported fever, upper respiratory infection, and allergy were not associated with risks of either defect. These findings add more evidence that aspirin use in early pregnancy increases risk of Gastroschisis. Although pseudoephedrine has previously been shown to increase Gastroschisis risk, findings of this study raise questions about interactions between medications and possible confounding by underlying illness.
Stephen B Shew - One of the best experts on this subject based on the ideXlab platform.
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impact of clinical factors on the intestinal microbiome in infants with Gastroschisis
2021Co-Authors: David J Lee, Nicole H Tobin, Grace M Aldrovandi, Stephen B Shew, Kara L CalkinsAbstract:BACKGROUND Infants with Gastroschisis require operations and lengthy hospitalizations due to intestinal dysmotility. Dysbiosis may contribute to these problems. Little is known on the microbiome of Gastroschisis infants. METHODS The purpose of this study was to investigate the fecal microbiome in Gastroschisis infants. Microbiome profiling was performed by sequencing the V4 region of the 16S rRNA gene. The microbiome of Gastroschisis infants was compared with the microbiome of healthy controls, and the effects of mode of birth delivery, gestational age, antibiotic duration, and nutrition type on microbial composition and diversity were investigated. RESULTS The microbiome of Gastroschisis infants (n = 13) was less diverse (Chao1, P < .001), lacked Bifidobacterium (P = .001), and had increased Staphylococcus (P = .007) compared with controls (n = 83). Mode of delivery (R2 = 0.04, P = .001), antibiotics duration ≥7 days (R2 = 0.03, P = .003), age at sample collection (R2 = 0.03, P = .009), and gestational age (R2 = 0.02, P = .035) explained a small portion of microbiome variation. In Gastroschisis infants, Escherichia-Shigella was the predominate genus, and those delivered via cesarean section had different microbial communities, predominantly Staphylococcus and Streptococcus, from those delivered vaginally. Although antibiotic duration contributed to the variation in microbiome composition, there were no significant differences in taxa distribution or α diversity by antibiotic duration or nutrition type. CONCLUSION The microbiome of Gastroschisis infants is dysbiotic, and mode of birth delivery, antibiotic duration, and gestational age appear to contribute to microbial variation.
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impact of societal factors and health care delivery systems on Gastroschisis outcomes
2018Co-Authors: Jordan S Taylor, Stephen B ShewAbstract:Care of infants with Gastroschisis is associated with a significant burden on health care delivery systems. Mortality rates in patients with Gastroschisis have significantly improved over the past few decades. However, the condition is still associated with significant short-term and potentially long-term morbidity. Significant variations in clinical outcomes and resource utilization may be explained by several factors including provider and hospital experience, level of neonatal intensive care, variations in hospital regionalization of care, and differences in healthcare delivery systems. Reviewing and assessing these hospital and healthcare system related factors are paramount in addressing variations in Gastroschisis care and improving outcomes for these vulnerable infants.
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is there a relationship between hospital volume and patient outcomes in Gastroschisis repair
2016Co-Authors: Greg D Sacks, Jesus G Ulloa, Stephen B ShewAbstract:Abstract Purpose Given the well-established relationship between surgical volume and outcomes for many surgical procedures, we examined whether the same relationship exists for Gastroschisis closure. Methods We conducted a retrospective analysis of infants who underwent Gastroschisis closure between 1999 and 2007 using a California birth-linked cohort. Hospitals were divided into terciles based on the number of Gastroschisis closures performed annually. Using regression techniques, we examined the effects of hospital volume on patient mortality and length of stay while controlling for patient and hospital confounders. Results We identified 1537 infants who underwent Gastroschisis repair at 55 hospitals, 4 of which were high-volume and 42 of which were low-volume. The overall in-hospital mortality rate was 4.8% and the median length of stay was 46.5days. After controlling for other factors, patients treated at high-volume hospitals had significantly lower odds of inpatient mortality (OR 0.40; 95% CI 0.21, 0.76). There was a near-significant trend towards shorter hospital length of stay at highvolume hospitals (p=0.066). Conclusions Patients who undergo Gastroschisis closure at high-volume hospitals in California experience lower odds of in-hospital mortality compared to those treated at low-volume hospitals. These findings offer initial evidence to support policies that limit the number of hospitals providing complex newborn surgical care.
