ĐẶC ĐIỂM LÂM SÀNG, CẬN LÂM SÀNG VÀ KẾT QUẢ ĐIỀU TRỊ HỞ THÀNH BỤNG Ở TRẺ SƠ SINH TẠI BỆNH VIỆN NHI ĐỒNG 1

Abstract

Background: Gastroschisis is a rare congenital abdominal wall defect caused by incomplete development, resulting in a defect in the abdominal wall located to one side of the umbilicus. In this condition, the intestines, and sometimes the stomach and/or liver, protrude into the amniotic cavity without being covered by the peritoneum. The digestive organs, constantly exposed to amniotic fluid, may develop edema, inflammation, and damage to the serosal-muscular layer^[3][5]. Globally, a significant study published in the Journal of Pediatric Surgery in 2023 reported the incidence of gastroschisis as 3.3 per 10,000 live births. In Vietnam, data on gastroschisis are limited^[4]. At Children’s Hospital 1, the ability to diagnose this condition early during pregnancy has improved, alongside advancements in surgical techniques and nutritional support, which may have significantly altered treatment outcomes over time. This study aims to describe the characteristics of gastroschisis in newborns. Objectives: To determine the percentage of clinical characteristics, and treatment outcomes of gastroschisis in newborns at Children’s Hospital 1. Methods: A case series study was conducted from January 1, 2020, to June 30, 2025, at Children’s Hospital 1. Results: There were 61 cases of gastroschisis in newborns during the study period. The male-to-female ratio was 1,1:1. The median gestational age was 36,0 weeks (35,0 – 37,0 weeks), median birth weight was 2140g (1900 – 2400 g). Cesarean delivery was performed in 50,8% of cases. Prenatal diagnosis of gastroschisis was made in 85,2% of patients. The median maternal age was 21,0 years (19,0 – 24,0 years), with 18% of cases referred from provincial hospitals. Bowel injury associated with gastroschisis was classified as follows: Grade I (86,9%), Grade II (9,9%), and Grade III (3,3%). Common associated anomalies included congenital heart defects (1,7%) and intestinal atresia (1,7%). Regarding the clinical characteristics at admission and the safety of transfer, they included respiratory distress (77,0%), shock (14,6%), hypothermia (85,2%), sterile plastic bagging (50,8%), sterile moist gauze dressing (42,6%), and no fluid resuscitation (70,5%). Regarding surgical management, the median duration of silo placement was 5,0 days (4,0 – 5,0 days). Silo placement without subsequent surgical closure occurred in 3,3% of cases. Postoperative complications included shock (33,9%), surgical site infection (22,0%), pneumonia (10,2%), bowel obstruction (10,2%), necrotizing enterocolitis (10,2%), and short bowel syndrome (3,4%). The median duration of postoperative mechanical ventilation was 4,0 days (3,0 – 5,0 days). Enteral feeding was initiated on postoperative day 7,0 ( 6,0 – 10,0 days), with full enteral feeding achieved by a median of 15,0 days (10,0 – 18,5 days). Parenteral nutrition was required for a median duration of 18,5 days (15,0 – 25,0 days). The median length of hospital stay was 30,0 days (23,0 – 40,0 days). The overall mortality rate was 3,3%, with causes of death including respiratory distress syndrome (1,7%) and sepsis (1,7%). Conclusion: Grade I bowel injury was the most common form of gastroschisis-related bowel damage (86,9%). The most frequently associated anomalies were congenital heart defects (1,7%) and intestinal atresia (1,7%). The overall mortality rate was 3,3%. Appropriate diagnostic and treatment strategies are needed to reduce the mortality rate in newborns with gastroschisis.