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Omphalocele and gastroschisis are the most common types of abdominal wall defects. Comprehensive local experience helps parents to make decisions on the pregnancy and foresee the disease journey. A retrospective review of abdominal wall defect patients in all three pediatric surgical centers in Hong Kong between January 2003 and February 2023 was conducted. All patients consecutively diagnosed with omphalocele and gastroschisis were included, excluding other forms. Data of demographics and short- and long-term outcome parameters were collected. A total of 99 cases were reviewed and 85 patients met the inclusion criteria. Diagnoses include omphalocele major (n = 49, 57.6%), omphalocele minor (n = 22, 25.9%) and gastroschisis (n = 14, 16.5%), with mean gestational age 37 weeks (SD 2.2) and birth weight 2.7 kg (SD 0.6). Omphalocele is most commonly associated with cardiovascular (n = 28, 39.4%) and chromosomal defects (n = 11, 15.5%). Surgical procedures including primary repair (n = 38, 53.5%), staged closure (n = 30, 42.3%) with average 8.6 days (SD 4.7) of silo reduction, and conservative management (n = 3, 4.2%) were performed. The mortality rate was 14.1% (n = 10) and the complication rate was 36.6% (n = 26). The majority of patients had normal intellectual development (92.5%) and growth (79.2%) on the latest follow-up. For gastroschisis, one patient (7.1%) had intestinal atresia. Surgical procedures included primary repair (n = 9, 64.3%) and staged closure (n = 5, 35.7%) with average 8 days (SD 3.5) of silo reduction. Complication rate was 21.4% (n = 3), with one mortality (7.1%). All patients had normal intellectual development and growth. The mean follow-up time of this series is 76.9 months (SD 62.9). Most abdominal wall defects in our series were managed surgically with a good overall survival rate and long-term outcome. This information is essential during antenatal and postnatal counseling for parents.

Introduction: Gastroschisis mortality in Africa is high partly due to delays in care. In Uganda, skilled birth attendants (SBAs) are the first point‑of‑contact for most babies, and with proper training, may be willing to participate in surgical task‑sharing. Objective: Empower Ugandan skilled birth attendants with the knowledge and practical skills needed to care for babies with gastroschisis. Methods: Ugandan SBAs completed a one‑day gastroschisis course, and resident physicians also requested to participate. A pre‑ and post‑course test was administered to assess gastroschisis knowledge and confidence. Findings: A total of 69 SBAs (44 midwives, 25 nurses) and 17 residents participated. Participants were predominantly female (n = 64, 74%) with a median of 9 years of work experience. There was significant knowledge increase from pre‑ to post‑course regarding differentiating gastroschisis from omphalocele (SBA 39% to 70%, p < 0.001; resident 48% to 77%, p < 0.001), gastroschisis incidence and outcomes (SBA 56% to 87%, p < 0.001; resident 65% to 89%, p < 0.001), risk factors (SBA 66% to 89%, p < 0.001; resident 67% to 86%, p < 0.0026), treatment (SBA 57% to 84%, p < 0.001; resident 63% to 79%, p < 0.001), and importance of community education (SBA 54% to 59%, p < 0.006; resident 56% to 65%, p < 0.0413). Only SBAs showed a significant increase in prenatal diagnosis (74% to 88%, p < 0.001). There was a significant boost in SBA clinical management confidence from 39% to 88%. Conclusion: A one‑day training course can enable Ugandan SBAs to serve as task‑sharers for babies with gastroschisis. While residents benefited, a future course should be developed for their learning needs. Continuing education is needed to ensure knowledge retention and clinical preparedness. Assessment of gastroschisis outcomes is necessary to determine if involving SBAs can improve survival.

We analyzed the capacity of urinary Intestinal fatty acid-binding protein (I-FABP) to quantify the degree of mucosal injury in neonates with gastroschisis (GS) and to predict the speed of their clinical recovery after surgery. In this prospective study, we collected urine during the first 48h after surgery from neonates operated between 2012 and 2015 for GS. Neonates with surgery that did not include gut mucosa served as controls for simple GS and neonates with surgery for intestinal atresia served as control for complex GS patients. The I-FABP levels were analyzed by ELISA. Urinary I-FABP after the surgery is significantly higher in GS newborns than in control group; I-FABP in complex GS is higher than in simple GS. I-FABP can predict subsequent operation for ileus in patients with complex GS. Both ways of abdominal wall closure (i.e. primary closure and stepwise reconstruction) led to similar levels of I-FABP. None of the static I-FABP values was useful for the outcome prediction. The steep decrease in I-FABP after the surgery is associated with faster recovery, but it cannot predict early start of minimal enteral feeding, full enteral feeding or length of hospitalization. Urinary I-FABP reflects the mucosal damage in gastroschisis but it has only a limited predictive value for patients' outcome.

Objective To follow up on previously reported associations between periconceptional use of selective serotonin reuptake inhibitors (SSRIs) and specific birth defects using an expanded dataset from the National Birth Defects Prevention Study. Design Bayesian analysis combining results from independent published analyses with data from a multicenter population based case-control study of birth defects. Setting 10 centers in the United States. Participants 17 952 mothers of infants with birth defects and 9857 mothers of infants without birth defects, identified through birth certificates or birth hospitals, with estimated dates of delivery between 1997 and 2009. Exposures Citalopram, escitalopram, fluoxetine, paroxetine, or sertraline use in the month before through the third month of pregnancy. Posterior odds ratio estimates were adjusted to account for maternal race/ethnicity, education, smoking, and prepregnancy obesity. Main outcome measure 14 birth defects categories that had associations with SSRIs reported in the literature. Results Sertraline was the most commonly reported SSRI, but none of the five previously reported birth defects associations with sertraline was confirmed. For nine previously reported associations between maternal SSRI use and birth defect in infants, findings were consistent with no association. High posterior odds ratios excluding the null value were observed for five birth defects with paroxetine (anencephaly 3.2, 95% credible interval 1.6 to 6.2; atrial septal defects 1.8, 1.1 to 3.0; right ventricular outflow tract obstruction defects 2.4, 1.4 to 3.9; gastroschisis 2.5, 1.2 to 4.8; and omphalocele 3.5, 1.3 to 8.0) and for two defects with fluoxetine (right ventricular outflow tract obstruction defects 2.0, 1.4 to 3.1 and craniosynostosis 1.9, 1.1 to 3.0). Conclusions These data provide reassuring evidence for some SSRIs but suggest that some birth defects occur 2-3.5 times more frequently among the infants of women treated with paroxetine or fluoxetine early in pregnancy.

Objective To describe one year outcomes for a national cohort of infants with gastroschisis.Design Population based cohort study of all liveborn infants with gastroschisis born in the United Kingdom and Ireland from October 2006 to March 2008. Setting All 28 paediatric surgical centres in the UK and Ireland.Participants 301 infants (77%) from an original cohort of 393.Main outcome measures Duration of parenteral nutrition and stay in hospital; time to establish full enteral feeding; rates of intestinal failure, liver disease associated with intestinal failure, unplanned reoperation; case fatality.Results Compared with infants with simple gastroschisis (intact, uncompromised, continuous bowel), those with complex gastroschisis (bowel perforation, necrosis, or atresia) took longer to reach full enteral feeding (median difference 21 days, 95% confidence interval 9 to 39 days); required a longer duration of parenteral nutrition (median difference 25 days, 9 to 46 days) and a longer stay in hospital (median difference 57 days, 29 to 95 days); were more likely to develop intestinal failure (81% (25 infants) v 41% (102); relative risk 1.96, 1.56 to 2.46) and liver disease associated with intestinal failure (23% (7) v 4% (11); 5.13, 2.15 to 12.3); and were more likely to require unplanned reoperation (42% (13) v 10% (24); 4.39, 2.50 to 7.70). Compared with infants managed with primary fascial closure, those managed with preformed silos took longer to reach full enteral feeding (median difference 5 days, 1 to 9) and had an increased risk of intestinal failure (52% (50) v 32% (38); 1.61, 1.17 to 2.24). Event rates for the other outcomes were low, and there were no other significant differences between these management groups. Twelve infants died (4%).Conclusions This nationally representative study provides a benchmark against which individual centres can measure outcome and performance. Stratifying neonates with gastroschisis into simple and complex groups reliably predicts outcome at one year. There is sufficient clinical equipoise concerning the initial management strategy to embark on a multicentre randomised controlled trial comparing primary fascial closure with preformed silos in infants suitable at presentation for either treatment to determine the optimal initial management strategy and define algorithms of care.

Children with gastroschisis are at high risk of morbidity in early life, which could affect long-term outcomes. We determined parent-reported outcomes in school-aged children born in 2000–2012, using paper questionnaires. Parent-perceived child vulnerability and motor function were compared with the Dutch reference data; parent-rated data on cognition, health status, quality of life, and behavior were compared with those of controls matched for age, gender, and maternal education level. Of 77 eligible participants, 31 (40%) returned the questionnaires. Parent-reported motor function was normal in 23 (74%) children. Total scores on health status, quality of life, and behavior did not differ significantly from those of matched controls. Children with gastroschisis had lower scores on cognition (median (interquartile range); 109 (87–127)) than their matched controls (124 (113–140); p = 0.04). Neonatal intestinal failure and increased parent-perceived vulnerability were associated with lower scores on cognition (β − 25.66 (95% confidence interval − 49.41, − 1.91); − 2.76 (− 5.27, − 0.25), respectively).Conclusion: Parent-reported outcomes of school-aged children with gastroschisis were mainly reassuring. Clinicians and parents should be aware of the higher risk of cognitive problems, especially in those with neonatal intestinal failure or increased parent-perceived vulnerability. We recommend multidisciplinary follow-up at school age of children with gastroschisis and neonatal intestinal failure.What is Known:• Many infants with gastroschisis experience morbidity in early life.• Data on developmental outcomes and daily functioning in children with gastroschisis beyond the age of 5 years are scarce and conflicting.What is New:• Parents of school-aged children treated for gastroschisis report normal motor function, health status, quality of life, and behavior.• Children with gastroschisis, especially those with intestinal failure, may be at risk for cognitive problems at school age. Parents who reported their child as being more vulnerable also reported more cognitive problems at school age.

Objectives The aetiology of gastroschisis is considered multifactorial. We conducted a systematic review and meta-analysis to assess whether the use of medications during pregnancy, is associated with the risk of gastroschisis in offspring. Methods PubMed, EMBASE, and Scopus were searched from 1st January 1990 to 31st December 2020 to identify observational studies examining the association between medication use during pregnancy and the risk of gastroschisis. The Newcastle–Ottawa Scale was used for the quality assessment of the individual studies. We pooled adjusted measures using a random-effect model to estimate relative risk [RR] and the 95% confidence interval [CI]. I 2 statistic for heterogeneity and publication bias was calculated. Results Eighteen studies providing data on 751,954 pregnancies were included in the meta-analysis. Pooled RRs showed significant associations between aspirin (RR 1.66, 95% CI 1.16–2.38; I 2  = 58.3%), oral contraceptives (RR 1.52, 95% CI 1.21–1.92; I 2  = 22.0%), pseudoephedrine and phenylpropanolamine (RR 1.51, 95% CI 1.16–1.97; I 2  = 33.2%), ibuprofen (RR 1.42, 95% CI 1.26–1.60; I 2  = 0.0%), and gastroschisis. No association was observed between paracetamol and gastroschisis (RR 1.16, 95% CI 0.96–1.41; I 2  = 39.4%). Conclusions These results suggest that the exposure in the first trimester of pregnancy to over the counter medications (OTC) such as aspirin, ibuprofen, pseudoephedrine and phenylpropanolamine as well as to oral contraceptives, was associated with an increased risk of gastroschisis. However, these associations are significant only in particular subgroups defined by geographic location, adjustment variables and type of control. Therefore, further research is needed to investigate them as potential risk factors for gastroschisis, to assess their safety in pregnancy and to develop treatment strategies to reduce the risk of gastroschisis in offspring. PROSPERO registration number: CRD42021287529.

This population-based study aimed to analyze the annual incidence and case fatality trends, and the clinical-epidemiological profile of gastroschisis in the state of Paraná, Brazil, between 2013 and 2024. Specifically, temporal trends in annual incidence and mortality rates related to gastroschisis were examined. Maternal, gestational, and neonatal characteristics were analyzed. Data from the Live Birth Information System and the Mortality Information System were analyzed using polynomial regression modeling. During the study period, 1,798,727 live births were recorded, including 491 cases of gastroschisis and 179 related deaths. The mean incidence was 2.73 per 10,000 live births. A significant 39.5% decrease over the study period was observed (p < 0.001). The case fatality rate was 36.5%. The mothers of children with gastroschisis were: young mothers (<25 years old; 77%), with low education (87.7%) and no partner (59.1%). High frequencies of cesarean deliveries (84.3%), prematurity (57.3%), low birth weight (63.7%), and low Apgar scores were also observed. The profiles of the mothers and children at birth were unfavorable when compared to the population of live births. Gastroschisis incidence in Paraná declined significantly from 2013 to 2024. While the annual incidence showed a decreasing trend, mortality fluctuated. The persistently high case fatality rate underscores the need for public policies focused on prenatal care and specialized neonatal management.

Background: Closing/closed gastroschisis (CGS) accounts for approximately 6% of gastroschisis cases globally. Currently, no consensus exists regarding: antenatal predictors of CGS types, optimal antenatal management (ultrasound screening frequency, indications for early delivery), or standardized surgical strategies tailored to CGS type (staging/timing of procedures, enterostomy necessity/level). Methods: Five neonates with CGS were enrolled and classified according to Perrone’s classification: two patients with type B (40%), one with type C (20%), one with type D (20%), one patient was classified as unclear (20%). Gender distribution—80% female (n = 4), 20% male (n = 1); gestational age—median 35 weeks (IQR 35–38); preterm birth rate—80% (n = 4); birth weight—median 2620 g (IQR 2310–3850). Results: Three patients (60%) developed antenatal intestinal obstruction signs at the third trimester, including two who postnatally demonstrated viable intestinal loops. Two patients (40%) with necrosis of eviscerated intestine demonstrated onset of antenatal intestinal obstruction signs at the second trimester. Patients with CGS type B were managed using a staged surgical approach; patients with types C and D received single-stage repair. Patient with CGS type B achieved complete clinical recovery. Three patients (60%) with CGS types C and D developed short bowel syndrome. Conclusions: The appearance of sonographic signs of intestinal obstruction in the second trimester may be a predictor for a high risk of subsequent significant vascular compromise of the eviscerated bowel, leading to more severe types of CGS (C and D). For patients with CGS type B, a staged surgical approach is advisable to maximize bowel length preservation.

Major congenital abdominal wall defects (gastroschisis and omphalocele) may account for up to 21% of emergency neonatal interventions in low- and middle-income countries. In many low- and middle-income countries, the reported mortality of these malformations is 30–100%, while in high-income countries, mortality in infants with major abdominal wall reaches less than 5%. This review highlights the challenges faced in the management of newborns with major congenital abdominal wall defects in the resource-limited setting. Current high-income country best practice is assessed and opportunities for appropriate priority setting and collaborations to improve outcomes are discussed.