GASTROSCHISIS: A PROSPECTIVE COHORT OUTCOME STUDY

本子项目是利用由NIH/NCRR资助的中心赠款提供的资源的众多研究子项目之一。子项目和研究者（PI）可能已经从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。列出的机构是中心的，不一定是研究者的机构。胃裂的发生率约为1 / 5000。该缺陷的特征是位于脐带右侧的一个边缘光滑的开口，可能是由子宫内右脐静脉异常内陷引起的。最常见的是胃、小肠和结肠通过缺陷疝出。胃裂如果不及时治疗，就会与生活格格不入。所有患有胃裂的婴儿都需要切除疝出的肠并关闭腹壁缺损。胃裂婴儿的传统治疗包括在产房用无菌纱布包裹内脏，将婴儿转移到新生儿重症监护病房，并进行紧急手术。使用这种方法，肠道被缩小到腹部，腹壁缺损在手术室被封闭。胃裂婴儿的腹腔有时太小，无法容纳疝出的脏器，因为在胎儿发育期间肠道已经失去了“统治权”。疝出脏器的完全恢复和腹壁的初步闭合可导致腹内压力过高和肺偏移减少。当不可能完全减少内脏内容物时，这种情况发生20-25%，使用橡胶“筒仓”覆盖内脏肠。在重力、时间和轻微压力的作用下，内脏被送回腹部，这个过程通常需要3-10天。一旦复位成功，在第二次手术中移除筒仓并闭合腹部缺损。无论肠道如何缩小，胃裂的婴儿都有许多不良结局的风险，包括坏死性小肠结肠炎（NEC）、肠缺血、长时间肠梗阻、败血症、肝损伤、长时间插管和死亡。本研究的目的是前瞻性地回顾德克萨斯儿童医院或Ben Taub综合医院所有胃裂患儿的预后。评估的具体结果包括住院总时间、耐受喂养的时间、是否需要额外手术、是否发生坏死性小肠结肠炎或中央静脉感染等并发症。次要目的是收集试点数据，以确定低血清白蛋白水平和/或高CRP （c -反应蛋白）水平与不良预后之间是否存在相关性。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Gastroschisis occurs in approximately 1 in 5000 live births. The defect is is characterized by a smooth-edged opening located to the right of the umbilical cord, probably caused by abnormal involution of the right umbilical vein in utero. Most commonly the stomach, small intestine and colon are herniated through the defect. Gastroschisis is incompatible with life if left untreated. All infants with gastroschisis require reduction of the herniated intestine and closure of the adominal wall defect. Traditional treatment of the infant with gastroschisis consists of wrapping the eviscerated bowel in sterile gauze in the delivery room, transferring the baby to a neonatal intensive care unit, and performing emergent surgery. Using this approach, the bowel is reduced into the abdomen and the abdominal wall defect closed in the operating room. The abdominal cavity in infants with gastroschisis is occasionally too small to accommodate the return of herniated viscera because the bowel has lost its "right of domain" during fetal development. Complete return of herniated viscera and primary closure of the abdominal wall can lead to excessive intra-abdominal pressure and decreased pulmonary excursion. When complete reduction of the eviscerated contents is not possible, which occurs 20-25% of the time, a silastic "silo" is used to cover the eviscerated bowel. With gravity, time, and gentle pressure, the eviscerated bowel is returned to the abdomen, a process that usually takes 3-10 days. Once reduction is obtained, the silo is removed and the abdominal defect is closed in a second operation. Regardless of how the bowel is reduced, infants with gastroschisis are at risk for a number of poor outcomes including necrotizing enterocolitis (NEC), bowel ischemia, prolonged ileus, sepsis, liver injury, prolonged intubation, and death. pardThe purpose of this study is to prospectively review the outcome of all children with gastroschisis at Texas Children's Hospital or Ben Taub General Hospital. Specific outcomes that will be evaluated will include total time in the hospital, time until feedings are tolerated, need for additional surgery , and development of complications such as necrotizing enterocolitis or central line infections. A secondary purpose will be to collect pilot data on whether there is a correlation between low serum albumin levels and/or high CRP (C-reactive protein) levels and poor outcome.