Despite the high incidence of fetal growth restriction (FGR) in gastroschisis (GS) associated with placental fetal vascular malperfusion (FVM), the underlying mechanism remains unclear. We aimed to investigate whether umbilical vein (UV) stenosis at the abdominal wall defect impairs fetoplacental circulation, leading to FGR. A single-center retrospective review of magnetic resonance imaging (MRI) scans in fetuses with GS was performed. The presence of FGR and complex GS was recorded after birth. Systematic measurements of UV diameter were collected, as well as placental characteristics. Multivariable analysis identified in-utero risk factors for FGR. Area under the receiver-operating-characteristics curves (AUC) for the predictive performance of predictors of FGR was calculated. In addition, 1:1 age-matched omphalocele and healthy control cases were included for comparison with GS cases with and without FGR, examining UV diameter, placental features and T2* signal intensity (SI) differences between the left and right hepatic lobes. Co-occurrence network analysis integrated prenatal MRI findings with postnatal outcomes. A total of 86 GS cases, 27 omphalocele cases and 27 age-matched healthy control cases were included. The incidence of FGR was 66.3% (57/86) in all GS cases, 86.7% (26/30) in complex GS cases and 18.5% (5/27) in omphalocele cases. Multivariable analysis identified the following independent risk factors for FGR: Z-score of UV diameter at the defect (adjusted odds ratio (aOR), 0.76 (95% CI, 0.65-0.89); P = 0.001); placental thickness (aOR, 1.57 (95% CI, 1.13-2.05); P = 0.015); placental lobulation (aOR, 1.84 (95% CI, 1.45-2.32); P = 0.026); and the presence of complex GS (aOR, 2.33 (95% CI, 1.85-2.96); P = 0.003). The Z-score of the UV diameter at the abdominal wall defect had an AUC of 0.81 (95% CI, 0.73-0.84) for the presence of FGR. Compared to the GS without FGR, omphalocele and healthy control groups, the GS with FGR group exhibited significantly reduced UV diameter at the abdominal wall defect, greater placental thickness, increased placental lobulation and larger T2* SI differences between the left and right hepatic lobes, reflecting hypoxia-driven circulatory redistribution. Network analysis demonstrated interdependencies among UV stenosis, FGR, placental FVM and adverse outcomes. There is strong association between UV stenosis at the abdominal wall defect and the development of FGR in cases of GS. UV diameter measurements and placental assessment may constitute important imaging biomarkers for FGR prediction in cases of GS. Ultimately, future research is required to evaluate potential benefits of fetal intervention to reduce severe UV stenosis. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

To describe experiences of expectant mothers in gaining information and knowledge about diagnoses and surgical management, following prenatal diagnosis of a surgically correctable congenital anomaly (SCCA). Using semi-structured interviews, we studied women with pregnancies associated with SCCA, including congenital diaphragmatic hernia (CDH), congenital pulmonary airway malformation (CPAM), gastroschisis (GS), omphalocele (OM), and myelomeningocele (MMC), from 2018-2023 that resulted in infant live birth and survival until discharge at a tertiary care center. Interviews were coded and analyzed using thematic analysis. Interviews with 22 participants were included. Diagnoses included CDH (n=8), CPAM (n=4), GS (n=4), OM (n=1), and MMC (n=5). Four thematic categories emerged: (i) prenatal care prior to fetal care center evaluation, (ii) maternal knowledge, (iii) information-gathering, and (iv) social networks. Prenatally, most participants had limited knowledge about SCCA and comfort with completing healthcare-related tasks. Multi-disciplinary fetal care was vital to their understanding of SCCA diagnosis and surgical management plan. Following prenatal diagnosis of SCCA, expectant mothers struggle with obtaining information that is at their literacy level and specific to their informational needs. Studies are needed to develop literacy-informed approaches to counseling after prenatal diagnosis of SCCA to meet parents' unique informational needs and prepare them for their infants' postnatal care.

Decreasing Length of Stay for Simple Gastroschisis: Analysis of the National Surgical Quality Improvement Program (NSQIP).

To (1) elucidate current practices of NICU developmental follow-up (NDFU) programs for gastroschisis (GS) patients, (2) identify potential gaps in knowledge and care, and (3) identify future directions for research and clinical care. An online survey was distributed to academic centers caring for GS patients who also participate in the Gastroschisis Outcomes of Delivery (GOOD) Study to evaluate practices of NDFU programs. There was an 89% response rate, with 18 centers participating. Sixty-one percent of NDFU programs did not routinely follow GS patients. The remaining 39% had variable guidelines for follow-up. Eligibility criteria, frequency of visits, gestational age cutoff for inclusion, and duration of follow-up were all inconsistent. Many NDFU programs do not routinely follow GS patients despite previous literature demonstrating they are at potentially elevated risk for worse developmental outcomes. Substantial variability in NDFU practice patterns demonstrates the need for quality long-term data.

Development and Validation of a Minimally Invasive Transuterine Experimental Model of Gastroschisis.

PurposeThe aim was to determine gastrointestinal (GI)-related QoL in children born with gastroschisis (GS).MethodsTotally, 58/83 families of children (aged 2–18 years) operated for GS at a tertiary pediatric surgical center accepted participation. Children aged 5–18 and one parent (child aged 2–18) completed the Swedish version of the PedsQL™ gastrointestinal symptoms module, evaluating GI-related QoL with 14 different GI-specific scales, norm values for Hirschsprung’s disease (HD), esophageal atresia (EA), and functional constipation (FC) that were used for comparison.ResultsChildren with GS had significantly lower parent-reported scores on “Gas and bloating” compared with children with EA (77.0 vs 85.5, p = 0.039). In the child report and in the parent report, scores on several GI scales were like those of children with EA. Parents of children with GS had higher scores for 8/14 scales compared to HD and higher scores for 12/14 scales compared to FC. Clinical GS-specific factors for worse GI-QoL were identified, including “Days in ventilator” and “Days with Silo and Patch”.ConclusionsGS has an impact on GI-related QoL, comparable to that in EA, but not to HD or FC. The GS-specific factors of worse QoL show the importance regarding a GS follow-up program including considering clinical factors.

BackgroundThe management of Gastroschisis in LMICs continues to be a challenge and is associated with very poor outcomes in contrast with HICs where survival rates near 100%. The purpose of this work is to provide an overview of survival over the past 8 years in a high-flow tertiary centre in Africa. It also investigates the effect of transfer-time and time-to-surgery on outcome.MethodsRetrospective case note review of all GS admissions. The variables assessed were gender, gestational age, weight, type of GS, transfer time, time to surgery and type of surgery. The primary outcome was survival.ResultsA total of 171 GS cases were identified: 148 simple, 23 complex. Seven died before surgery. The median age at surgical intervention was 8.5 h (range, 0–48). Closure options ranged from single-staged (primary fascial, skin, umbilical flap and sutureless closure) or a staged (silo) closure. Overall survival was 34.5%. Cases transferred under 8 h had a 46% survival. Surgery under 12 h of life had highest survival, 45%. Simple GS survived better than complex GS (40% vs 10%). Primary closure had a significantly better survival compared to staged closure (51% vs 18%).ConclusionsTransfer-time < 8 h plays a vital role in survival of GS cases. Surgical intervention within 12 h of birth showed a statistically significant improvement in outcome. Primary closure was associated with better survival rates.Level of EvidenceLevel III.

The primary cause of unsatisfactory outcomes in the treatment of gastroschisis (GS) is the pathological changes in eviscerated organs and their consequences. One preventive method against these pathological changes is the premature delivery of pregnant women with fetal GS, either by physiological means or cesarean section. Aim - to analyze and develop preventive measures for pathological changes in eviscerated organs in GS by optimizing the delivery timing and method in pregnant women, to improve outcomes in fetuses and neonates. Materials and methods. The study examined the impact of delivery timing and method on the condition of eviscerated organs in 118 neonates with isolated (uncomplicated) GS. Depending on the delivery method, patients were divided into two groups: Group I included 72 neonates born at the SI “Institute of Pediatrics, Obstetrics, and Gynecology named after Acad. O.M. Lukyanova of the NAMS of Ukraine” between 2006 and 2023 via cesarean section, with 80% of cases being premature (at 35-37 weeks gestation); Group II included 46 neonates delivered vaginally between 1987 and 2005, who were treated either at the Institute (n=23) or at the Mykolaiv Regional Children’s Clinical Hospital (n=23). Neonates with complicated GS forms were excluded from the study. According to the degree of pathological changes in the eviscerated organs, cases were classified as unchanged, moderately changed, or markedly changed. Results. The implementation of planned premature cesarean delivery for pregnant women with fetal GS effectively reduced the occurrence of marked changes of eviscerated organs by 49.1%. At the same time, there was a significant increase (49.2%) in cases with unchanged and moderately changed organ conditions. Conclusions. One of the preventive measures to reduce the frequency and degree of pathological changes in eviscerated organs in GS is planned premature cesarean delivery at 37 weeks gestation. This approach positively influences the condition of eviscerated organs in fetuses with GS, preventing marked pathological changes in two-thirds of cases and significantly increasing (by 49.2%) the occurrence of unchanged or moderately changed organs. The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the institution's Local Ethics Committee, and informed consent was obtained from the patients. Authors declare no conflict of interest.

Fetuses with gastroschisis (GS) exhibit a high incidence of Fetal growth restriction (FGR) while the reason remains elusive. This retrospective study aims to investigate the stenotic effects--umbilical vein (UV) compression within the hernial orifice and its correlation with placental fetal vascular malperfusion (FVM) and FGR. A single-centre retrospective review of MRI scans obtained in fetuses with gastroschisis was performed. Co-occurrence network analysis(NA) was utilised to discover phenotypic feature interconnections. Morphological measurements including abdominal wall defect size, maximum small intestine diameter, UV diameter, and placenta characteristics were subjected to PCA (Principal Component Analysis) for multivariate data classification between complex and simple GS, as well as between FGR and non-FGR phenotypes. Furthermore, 1:1 age-matched omphalocele cases were incorporated for comparison on the UV diameter, FVM, and T2* signal intensity (SI) differences between the left and right lobes of the liver. Totally 86 cases postnatally confirmed as GS were included, and 30/86 cases were classified as complex GS - presenting intestinal obstruction, volvulus, or perforation. NA displays robust connections between FGR and placenta FVM, umbilical vein stenosis at the defect, and intra-abdominal UV post-stenotic dilatation. FGR was observed in 66% of GS, and even higher in complex GS (85%). Placentas in the GS + FGR group were significantly thickened, accompanied by more frequent lobules and hemorrhages, associated with UV stenosis at the defect. And significant T2* SI differences between the left and right lobe of the liver were observed. PCA results showed different clustering patterns between gastroschisis-FGR, gastroschisis +FGR, and omphalocele groups. Our study demonstrates intricate connections between GS, FGR, UV stenosis at the defect, and placental FVM, revealing the hemodynamic heterogeneity associated with FGR. Severe UV compression might be used to identify high-risk candidates for prenatal surgery.

Gastroschisis (GS) and omphalocele (OC) are two prevalent congenital abdominal wall defects. This narrative review explores their global prevalence and the potential preventive role of maternal folic acid supplementation. The image includes clinical photographs (A, GS; C, OC) and schematic representations of inferior axial sections (B, GS; D, OC), illustrating key anatomical distinctions. Arrow indicates the abdominal wall membrane; I, intestine; K, kidney; UC, umbilical cord. image

Abstract Introduction Congenital abdominal wall defects (AWD) such as gastroschisis (GS) and omphalocele (OC) are malformations associated with morbidity, especially early in life. Our aim was to identify if screening instruments for mental health indicate elevated levels of difficulties. Method A systematic literature review complying with a PRISMA-protocol (PROSPERO, CRD42023443731) was undertaken. A search across five databases, focusing on mental health difficulties during childhood was conducted. Result Out of 450 articles identified, six were included, in total 168 children (median sample size; 31, range 16-38) covering an age range of 5-17 years. The studies were all cross- sectional, single-centre, originating in the Netherlands(n=3), Australia(n=2), and the USA(n=1),using parent’s reports of the instruments Strength and Difficulties Questionnaire (SDQ), (n=3), Child Behaviour Check List (CBCL), ( n=2) and Behaviour Assessment System for Children –Second Edition (BASC-2), (n=1). In most studies, the AWD group had a higher prevalence of mental health difficulties. Two studies showed that children with AWD had significantly higher levels of difficulties in at least one domain of mental health, while the other four studies found no significant differences. Discussion Screening instruments for mental health difficulties show different results regarding children born with an AWD. A subgroup reported mental health difficulties, but not always significantly more than in the healthy normative population, but previous studies have employed small sample sizes and have lacked the statistical power to detect differences. More research, preferably with larger samples from multiple centres is warranted.

There is an increase in the worldwide prevalence of congenital abdominal wall defects (CAWD), with gastroschisis (GS) and omphalocele (OC) being the most common. It is widely accepted that folic acid supplementation (FAS) in the maternal diet decreases the incidence of anomalies such as neural tube defects, but there is controversy regarding the possible beneficial role for other congenital malformations. Several epidemiological studies raise controversy regarding a possible relationship between vitamin supplementation with the occurrence of abdominal wall malformations. The aim of the present study is to obtain an updated review of the global frequency of CAWD in neonates and the relationship with FAS in the mothers. For this we have carried out a systematic search of epidemiological studies in different article databases between 2011 and 2022. The analysis of 25 studies conducted in different countries where cases of OC and/or GS are registered directly or together with other congenital defects shows that 60% inquire into the relationship of FAS with the incidence of CAWD. Half of them proposes a beneficial effect of FAS and the other half find no association, concluding that there is no unanimous evidence that FAS in the maternal diet decreases the incidence of CAWD. However, it seems that an influential factor to take into account is the nutritional habits of the mothers.

There are several case reports describing patients with both optic nerve hypoplasia/septo-optic-pituitary dysplasia (ONH/SOD) and gastroschisis (GS). Our aim was to investigate whether ONH/SOD is associated with GS. A retrospective population-based study was undertaken using the Population Research Data Repository at the Manitoba Center for Health Policy in Manitoba, Canada to investigate if any patient with ONH/SOD also had GS. In addition, Winnipeg's Surgical Database of Outcomes and Management (WiSDOM), a hospital-based paediatric surgical database, was searched to ascertain if any of the patients with GS also have ONH/SOD. Cases were 124 patients with ONH/SOD diagnosed during 1990-2019. None had GS. The surgical database had 188 patients from Manitoba with GS during 1991-2019. None had ONH/SOD. There does not appear to be an association between ONH/SOD and GS in our cohorts of patients with these two disorders.

Evaluation of quality of life (QoL) in paediatric surgical patients has not always received enough attention in the past. Our aim was to follow up patients with abdominal wall defects for a decade and (1) to analyse children's view on QoL and to analyse parent's view on QoL, (2) to evaluate satisfaction and psychological problems, (3) to assess present complaints including subjective aspects such as food intake, reduced appetite, pain in scar area and general abdominal pain and (4) verifiable clinical symptoms assessed through a physical examination and ultrasound. It was hypothesised that QoL would differ from gastroschisis (GS) and omphalocele (OC) children depending on the type of abdominal wall defect. A retrospective case-control design was used to compare children with GS ( n = 36) and OC ( n = 18). A clinical examination, including abdominal inspection, palpation and auscultation of bowel sounds with abdominal ultrasound, was offered, combined with a structured interview and specific QoL questionnaire (KINDL ® ). The focus was on QoL, child development, present complaints and satisfaction with the cosmetic outcome. During clinical examinations with ultrasound, GS children were significantly more likely to have bowel loops stuck at the scar area ( P = 0.008) with bowel malrotation and abnormal appendix position, compared to OC children ( P = 0.037). They were significantly more likely to report irregular stools ( P = 0.02) but were satisfied with the cosmetic outcome of the abdominal skin scar in 81% of cases. The KINDL ® evaluation showed in the dimensions of QoL, namely 'body awareness', 'mental health', 'self-esteem', 'family', 'friends' and 'school', that there were no significant differences to healthy children. OC/GS parents were satisfied with their children's physical development and QoL, noting no limitations in normal daily activities. Parents of OC children reported suffering from OC/GS-associated problems ( P = 0.028) at the time point of interview. Subjective QoL did not differ significantly between OC and GS children. The satisfaction with the cosmetic outcome of the abdominal skin scar was good. On ultrasound examination, adherent bowel loops and bowel malrotation with resulting stool irregularities affect GS children. OC children's parents reported suffering from OC/OS-associated problems, and all parents need to be educated about the symptoms of recurrent sub-ileus events or atypical appendicitis.

PurposeAbdominal wall closure in patients with giant omphalocele (GOC) and complicated gastroschisis (GS) remains to be a surgical challenge. To facilitate an early complete abdominal wall closure, we investigated the combination of a staged closure technique with continuous traction to the abdominal wall using a newly designed vertical traction device for newborns.MethodsFour tertiary pediatric surgery departments participated in the study between 04/2022 and 11/2023. In case primary organ reduction and abdominal wall closure were not amenable, patients underwent a traction-assisted abdominal wall closure applying fasciotens®Pediatric. Outcome parameters were time to closure, surgical complications, infections, and hernia formation.ResultsTen patients with GOC and 6 patients with GS were included. Complete fascial closure was achieved after a median time of 7 days (range 4–22) in GOC and 5 days (range 4–11) in GS. There were two cases of tear-outs of traction sutures and one skin suture line dehiscence after fascial closure. No surgical site infection or signs of abdominal compartment syndrome were seen. No ventral or umbilical hernia occurred after a median follow-up of 12 months (range 4–22).ConclusionTraction-assisted staged closure using fasciotens®Pediatric enabled an early tension-less fascial closure in GOC and GS in the newborn period.

Gastroschisis (GS) - is one of the most severe defects of newborns, which is characterized by congenital eventration of the abdominal organs outside the anterior abdominal wall into the amniotic fluid, due to a through defect of the anterior abdominal wall. The defect is adjacent to the normal, unaltered umbilical cord, usually to the right of the umbilicus, the umbilical ring is split, the eventrated organs are not covered by embryonic membranes or their remains. The frequency of gastroschisis is 0.31-4.72 per 10,000 births. Although, with the development of modern surgical approaches over the past 15 years, the mortality of newborns with gastroschisisis dynamically decreasing, however, this pathology remains a significant problem in neonatal and pediatric surgery, as it requires early surgery, associated with a significant risk of disability in children due to short bowel syndrome, abdominal cancer and recurrent esophageal disease, adhesive intestinal obstruction, etc. Purpose - to analyze, according to the literature, the prospects for the use of cellular technologies for the in utero treatment of inflammatory changes in the enteric organs in fetal GS in experimental conditions. The main reason for the unsatisfactory results of GS treatment is the pathological changes of the eventrated organs and their consequences. Therefore one of the ways to reduce mortality in GS is intrauterine treatment and the prevention of inflammatory changes of the eventrated organs in the fetuses. Modern regenerative medicine offers several new approaches for the treatment of fetal malformations, including the use of cell technology. Stem cells, from various sources, are one of the alternative therapies that can inhibit inflammatory processes in tissues, activate endogenous reparative mechanisms, and, ultimately, together with the implementation of preventive measures, reduce perinatal mortality and disability. The availability of domestic cell drugs, the development of technologies for their transplantation, and methods of delivery of pregnant women with GS in the fetus, with proven clinical efficacy, will significantly improve the comprehensive treatment of patients with congenital malformations, which is significant social and economic importance. Therefore, the study of regenerative potential and assessment of the prospects for the use of stem cells in obstetrics and perinatal medicine from various sources is of great scientific and practical interest. No conflict of interests was declared by the authors.

BackgroundThe study aimed to estimate the prevalence of major congenital anomalies of the alimentary system and the abdominal wall in Thailand using a nationwide hospital discharge database from the National...

Background: Birth defects remain a major contributor to infant mortality and lifelong disabilities. The epidemiology of congenital abnormalities varies around the world and little information is available from Latin America. Methods: This is an epidemiological, descriptive, cross-sectional study with data from the Department of Informatics of the Unified Health System (DATASUS) on Congenital diaphragmatic hernia (CDH), esophageal atresia (EA) and gastroschisis (GS) in South Brazil from 2009 to 2019. Results: The incidence of CDH is 0.93 cases, while EA is 0.47 and GS is 2.87, all per 10,000 live births. There is an association between all the malformations and premature birth, cesarean delivery, low birth weight, and low Apgar scores. Both EA and GS are associated with maternal age, EA with older, and GS with younger mothers. While EA is associated with multiple pregnancies, GS is associated with fewer years of maternal formal education, single parenting, and a lower number of prenatal consultations. CDH is associated with the male sex and black ethnicity. Conclusion: This large population-based study estimates the prevalence and demographic factors associated with CDH, EA, and GS, and extends the limited descriptive epidemiologic information available.

Surgical neonates in a low-resource setting: Baseline nutrition and outcome assessment

Pediatric surgery is a crucial pillar of health equity but is often not prioritized in the global health agenda, especially in low-and middle-income countries. Gastroschisis (GS) is a type of structural congenital anomaly that can be treated through surgical interventions. In Rwanda, neonatal surgical care is only available in one hospital. The experience of parents of children born with gastroschisis has not been previously studied in Rwanda. The objective of this study was to explore the lived experiences of parents of children diagnosed with GS in Rwanda. A qualitative study using a semi-structured interview guide was conducted. Parents who had children with gastroschisis and were discharged alive from the hospital in Rwanda were interviewed by trained data collectors, from May to July 2021. Data were transcribed, translated, and then coded using a structured code-book. Thematic analysis was conducted with the use of Dedoose software. Sixteen parents participated in the study. Five themes emerged from the data. They were: “GS diagnosis had a significant emotional impact on the parents”, “Parents were content with the life-saving medical care provided for their children despite some dissatisfaction due to the delayed initiation of care and shortage of medications”, “GS care was accompanied by financial challenges”, “support systems were important coping mechanisms” and “the impact of GS care extended into the post-discharge period”. Having a newborn with GS was an emotional journey. The lack of pre-knowledge about the condition created a shock to the parents. Parents found support from their faith and other parents with similar experiences. The experiences with the care received were mostly positive. The overall financial burden incurred from the medical treatment and indirect costs was high and extended beyond the hospital stay. Strengthening prenatal and hospital services, providing peer, spiritual and financial support could enhance the parents’ experience.