Gastroschisis: methods and early outcomes of surgical treatment

Introduction: Gastroschisis is a congenital anomaly in which loops of intestine are displaced outside the abdominal cavity through a defect in the abdominal wall. The incidence is steadily increasing. It is particularly attributed to young maternal age. The defect requires urgent surgical intervention after birth. Aim: The article aims to present the methods and early outcomes of surgical treatment of new-borns with gastroschisis in the context of pre- and postnatal examinations, and attempts to identify risk factors for the occurrence of the defect. Material and methods: The study used data derived from medical records of 18 patients of the Regional Specialist Children’s Hospital in Olsztyn. Prenatal, peri- and postoperative outcomes were analysed. The new-borns were classified with simple and complex gastroschisis. Results and discussion: The defect was diagnosed prenatally in 15 new-borns. In 16 cases, gestation was terminated by caesarean section. The mean maternal age at birth was 23 years; 14 woman were pregnant for the first time. All new-borns were operated on on day 1 of life. In 14 patients, primary closure of the abdominal wall was performed. The mean duration of mechanical ventilation was 13.31 days, of total parenteral nutrition – 29 day, to the first administration of enteral nutrition – 11.88 days and the mean length of hospital stay was 39.75 days, in the group of infants with simple gastroschisis. Conclusions: Gastroschisis is a severe anomaly causing an immediate threat to life. The optimal treatment procedure is the primary closure of the abdominal wall. The use of silastic sac enables the staged closure. Risk factors include young maternal age and primiparity.

Experience of Adolescent Mothers During Pregnancy: A Scoping Review

Background: Every year, around 14 million women and girls aged 15 to 19 (both married and unmarried) give birth. This age group might lead to negative outcomes of pregnancy and childbirth. This scoping review aimed to identify the outcomes of adolescent pregnancy and its contributing factors. Subjects and Method: A scoping review method was conducted in eight stages including (1) Identification of study problems; (2) Determining priority problem and study question; (3) Determining framework; (4) Literature searching; (5) Article selec­tion; (6) Critical appraisal; (7) Data extraction; and (8) Mapping. The research question was identified using population, exposure, and outcome(s) (PEOS) framework. The search included Wiley Online Library, EBSCO, ProQuest, and PubMed databases. The inclusion criteria were English-language and full-text articles published between 2009 and 2019. A total of 307 articles were obtained by the searched database. After the review process, seven articles were eligible for this review. The data were reported by the PRISMA flow chart. Results: Six articles from developing countries (Brazil, Mexico, Zambia, Malawi, and Romania) and one report from developed countries (Australia) met the inclusion criteria with qualitative, quantitative (cross-sectional), and descriptive studies. The existing studies stated that adolescent pregnancy had adverse effects on both mother and babies’ health and well-being. Young maternal age is associated with low parity, lack of prenatal care, premature, and low birth weight. Factors contributed to the increased adolescent pregnancy rate were early sexual initiation, low use of contraception, low educational level, low socioeconomic status, inadequate knowledge about sexual and reproductive health, and gender disparity. Conclusion: Young maternal age contributes to adverse pregnancy outcomes of both mothers and babies. Early sexual health education and health promotion on teenage girls may reduce the risk of adolescent pregnancy rates. Keywords: adolescent pregnancy, birth outcome, maternal age Correspondence: Sumarni. Universitas ‘Aisyiyah Yogyakarta. Jl. Siliwangi (Ringroad Barat) No. 63, Nogotirto, Gamping, Sleman, Yogyakarta, 55292. Email: [email protected]. Mobile: +6282346354512. DOI: https://doi.org/10.26911/the7thicph.02.28

DATA LINKAGE FOR EVALUATING MATERNAL INFLUENCES ON INFANT MORTALITY AND MALTREATMENT IN CANADA

BACKGROUND A number of social risk factors are reported to increase infant mortality rates and child maltreatment. Public health programs attempt to mitigate risk factors and improve outcomes for infants. This study aimed to explore the association of exposure factors in mothers with infant mortality and maltreatment in Ontario. OBJECTIVES Objectives for this study included: 1. Describe prevalence of infant mortality and maltreatment in Ontario. 2. Explore how maternal risk factors influence infant mortality and maltreatment. DESIGN/METHODS This was a population-based study of 845, 567 infants born between April 1, 2005 and March 31, 2015 using administrative and healthcare databases available at the Institute of Clinical Evaluative Sciences (ICES). Maternal risk factors were selected based on public health home visiting referral criteria. These exposures included, maternal adversity (substance abuse, intimate partner violence, homelessness), newcomer status (new to Canada in past 3 years) and young maternal age (less than 22 years of age). The primary outcome measure was all-cause mortality of infants less than 12 months age. The secondary outcome measures were combined fatal and non-fatal child maltreatment outcomes and were defined using International Classification of Diseases for maltreatment diagnoses. Baseline characteristics and outcomes were described. The association between maternal risk factors and infant mortality and maltreatment was analysed using multivariable logistic modelling, including analysis by type of maternal risk factors and number of risk factors. RESULTS All-cause deaths were present in 0.14% and combined fatal and non-fatal maltreatment outcomes were present in 0.05% of the study population. Young maternal age increased the risk of all-cause mortality 2.4 times (n 171, OR 2.4, 95% CI 2.0–3.0) and maltreatment 6.3 times (n 292, OR 6.3, 95% CI 5.0–7.8). Mental health diagnosis increased the odds of maltreatment by 90% (n 209, OR 1.9, 95% CI 1.5–2.4). Adversity increased the odds of maltreatment by 63% (n 40, OR 1.63, 95% CI 1.0–2.6). The risk of maltreatment also increased as the number of risk factors increased with an OR of 3.5 (95% CI 2.9–4.4) with one risk factor, an OR of 8.2 (95% CI 5.9–11.4) with two risk factors, and an OR of 10.9 (95% CI 5.7 20.7) with three or more risk factors. Newcomer status was not associated with increased risk of maltreatment and mortality. Gestational age showed increasing ORs as prematurity increased. Material deprivation was included as a covariate and was associated with increased risk of maltreatment with increased level of deprivation. CONCLUSION Young maternal age carried the greatest risk of death and maltreatment in infants. There was also an increasing risk of infant mortality and maltreatment with increasing number of risk factors. These findings are important for ensuring public health interventions are targeting the most vulnerable populations with the aim of preventing maltreatment.

Newborn with Gastroschisis associated with Limb Anomalies

Gastroschisis is often found together with other extra intestinal conditions such as limb, spine, cardiac, central nervous system and genitourinary abnormalities. There are reports of its association with young maternal age. The cases presented here highlight the association of gastroschisis with limbs anomalies and young maternal age.