Kuiper, G.A. (Gé-Ann) (2013) Operatieve behandeling van gastroschisis patiënten, op de operatiekamer of op de neonatale intensive care unit? thesis, Medicine.
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Abstract
Introduction: Gastroschisis is a defect of the abdominal wall of newborns with bowel and possible other organs protruding through the defect. As a result of the eviscerated bowel the newborn has an increased risk for heat and fluid loss and an increased risk for ischemia of the intestines. The traditional treatment of gastroschisis is primary fascial closure or utilisation of a silo in the operation room (OR). However, transporting patients to the OR occasionally causes a delay in surgical treatment. At that point based on the international literature suggesting advantages by reduction at the Neonatal Intensive Care Unit (NICU), the VU medical centre decided in 2007, to manage bowel reduction at the NICU instead of reduction in the OR. The aim of this study is to determine if bowel reduction at the NICU has advantages (i.e. reduced time to full enteral feeding, reduced length of hospital stay, reduced duration of oxygen therapy and reduced length of stay in the ICU) compared to reduction in the OR. Methods: A retrospective analysis was conducted on 25 patients with gastroschisis who underwent a bowel reduction between 2001 and 2011. The patients were divided by place of treatment; reduction at the NICU (NICU-group, n=11) and reduction in the operation room (OR-group, n=14). The surgical treatment was similar in both groups. For the administration of total parenteral nutrition patients in the NICU-group received a Silastic catheter and patients in de OR-group received a Broviac catheter. The Broviac catheter is placed in the OR under general anaesthesia. Results: The time to reduction is significantly shorter in the NICU group compared to the OR-group (median 2,4 hours vs. 4,1 hours, p=0,002). The median time to full enteral feeding (150 ml/kg/24h) in the NICU-group was 34,5 days compared to 29 days in the OR-group (p=0.784). The median length of hospital stay was 37 days in the NICU-group and 36 days in the OR-group (p=0.832). Patients in the NICU-group were significantly shorter intubated than patients in the OR-group (2 vs. 4 days, p=0.03). The median time of stay at the NICU or PICU was 6,5 days in the NICU group and 13 days in the OR group (p=0.077). Reduction was obtained in 9 out of 11 patients at the NICU. Of these 9 patients, 5 needed additional anaesthesia for the placement of the Broviac catheter. The median number of narcosis in the first hospital-stay is 2 in the NICU-group compared to 1 in the OR-group (p=0.344). Conclusion: Bowel reduction at the NICU significantly reduces time to reduction in newborns with gastroschisis and also reduces the duration of mechanical ventilation. However, it does not decrease time to full enteral feeding or length of hospital stay, and requires in some cases additional narcosis due to Broviac catheter placement. For this reason bowel reduction at the NICU should be reconsidered. A prospective randomized controlled trial with a greater sample size is necessary to confirm this thought.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Lopes Cardozo, Dr. M. |
| Supervisor name: | Bakx, Dr. R. and Laarman, Drs. ARC. and Kinderchirurgie en Neonatologie and VU medisch centrum Amsterdam |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:06 |
| Last Modified: | 25 Jun 2020 11:06 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2596 |
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