If you have a bowel that look pretty pristine, non-thickened, non-inflammatory, and only small amount of them being on the outside, and that's enough abdominal domain, you can actually push them all back very quickly and perform primary closure.
The main difference between gastroschisis and umphalocele is that umphalocele is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development.
If you have a bowel that look pretty pristine, non-thickened, non-inflammatory, only small amount of them being on the outside and that's enough abdominal domain, you can actually push them all back very quickly and perform primary closure
After you push the bowel back in, uh, you don't take these babies to the operating room to close that with suture, but rather put the umbilical cord over and then the dressing over. And a lot of times skin will grow over
Gastroschisis is a full thickness abdominal wall defect just to the right of the umbilicus, in which peritoneal contents, most often intestines, protrude through the abdomen without any membranous cover.
gastroschisis is a full thickness abdominal wall defect just to the right of the umbilicus, in which peritoneal contents, most often intestines, protrude through the abdomen without any membranous cover
Omphalocele and Gastroschisis With Dr. Foong-Yen Lim
▶Ep 25 · 0:55
clinicalOmphalocele is right through the middle of the umbilicus and has a membranous cover.↗
▶Ep 25 · 0:55
quoteumbilical is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development↗
▶Ep 25 · 0:55
quotegastroschisis is a full thickness abdominal wall defect just to the right of the umbilicus, in which peritoneal contents, most often intestines, protrude through the abdomen without any membranous cover↗
▶Ep 25 · 0:55
clinicalGastroschisis is a full thickness abdominal wall defect just to the right of the umbilicus, in which peritoneal contents, most often intestines, protrude through the abdomen without any membranous cover.↗
▶Ep 25 · 0:55
clinicalOmphalocele is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development.↗
▶Ep 25 · 1:54
clinicalFor gastroschisis, only ultrasound confirmed diagnosis is obtained without additional imaging.↗
▶Ep 25 · 1:54
clinicalFor omphalocele, besides ultrasound, MRI and echocardiogram are routinely obtained because these patients may have other associated anomalies.↗
▶Ep 25 · 1:54
clinicalFetal growth is tracked monthly in gastroschisis and omphalocele cases because there is concern for significant growth restriction.↗
▶Ep 25 · 1:54
clinicalVery high level of alpha fetal protein is associated with gastroschisis or omphalocele.↗
▶Ep 25 · 1:54
clinicalAlpha fetal protein (AFP) is a screening test, but ultrasound imaging is needed to definitively diagnose abdominal wall defects.↗
▶Ep 25 · 1:54
quoteIf you see a very high level of alpha fetal protein, think about um, gastroschisis or emphalaceal↗
▶Ep 25 · 2:56
clinicalBiophysical profile and non-stress testing are needed because intrauterine growth restriction and intrauterine fetal demise (IUFD) can occur in these patients.↗
▶Ep 25 · 2:56
clinicalIf surveillance imaging becomes worrisome enough regarding intrauterine fetal demise, the mother and fetus need to be admitted for continuous monitoring or emergent delivery.↗
▶Ep 25 · 2:56
quoteInutero growth restriction, as well as IUFD in utero fetal demise, uh, can occur in this patient↗
▶Ep 25 · 3:27
quoteIt's, uh, most common among babies born to young mother of low gravity and usually first pregnancy. And 75% of that is the first born↗
▶Ep 25 · 3:27
quotemore than 90% of these infants born less than 2,500 grams in weight↗
▶Ep 25 · 3:27
epidemiologicalGastroschisis is most common among babies born to young mothers of low gravidity, usually first pregnancy, with 75% being first born and 25% in second or subsequent pregnancies.↗
▶Ep 25 · 3:27
epidemiologicalMore than 90% of gastroschisis infants are born less than 2,500 grams in weight due to intrauterine growth restriction.↗
▶Ep 25 · 3:27
epidemiologicalPseudoephedrine has an odds ratio of 4.2 times for gastroschisis compared to aspirin alone at 2.7.↗
▶Ep 25 · 3:27
epidemiologicalOther risk factors for gastroschisis include acetaminophen, vitamin B deficiencies, drug use, and some genetic predispositions.↗
▶Ep 25 · 3:27
epidemiologicalNearly 60% of gastroschisis cases are premature.↗
▶Ep 25 · 4:19
epidemiologicalMothers with omphalocele are usually advanced in age compared to the gastroschisis group, with advanced maternal age having an odds ratio of 3.3.↗
▶Ep 25 · 4:19
epidemiologicalMajor risk factors for omphalocele are trisomy 13, 18, and 21, which occur in anywhere between 35 and 90% of patients with omphalocele.↗
▶Ep 25 · 5:02
quoteMinimizing heat loss and fluid loss in these babies. Otherwise they can show up, uh, extremely dehydrated as well as, um, being cold↗
▶Ep 25 · 5:02
clinicalCrucial immediate postnatal procedures include minimizing heat loss and fluid loss, otherwise babies can show up extremely dehydrated and cold.↗
▶Ep 25 · 5:02
clinicalThese babies can have significant acidosis and pulmonary hypertension.↗
▶Ep 25 · 5:34
quoteIf you have a bowel that look pretty pristine, non-thickened, non-inflammatory, only small amount of them being on the outside and that's enough abdominal domain, you can actually push them all back very quickly and perform primary closure↗
▶Ep 25 · 5:34
clinicalPrimary closure is considered if the bowel looks pristine, non-thickened, non-inflammatory, with only small amount outside and enough abdominal domain to push them all back very quickly.↗
▶Ep 25 · 6:07
quoteWe favor stage closure if the defect is large or, um, there's issue with the bowel↗
▶Ep 25 · 6:07
clinicalStaged closure is favored if the defect is large or there are issues with the bowel, including atresia, compromised bowel, or perforation.↗
▶Ep 25 · 6:07
clinicalSome patients develop intestinal perforation after only two to four days of enteral feeding.↗
▶Ep 25 · 6:58
clinicalIn sutureless closure, after pushing the bowel back in, babies are not taken to the operating room for suture closure; instead, the umbilical cord is placed over with dressing, and skin will grow over, although a small umbilical defect may remain that can close spontaneously over time.↗
▶Ep 25 · 6:58
quoteAfter you push the bowel back in, uh, you don't take these babies to the operating room to close that with suture, but rather put the umbilical cord over and then the dressing over. And a lot of times skin will grow over↗
▶Ep 25 · 7:29
clinicalFor small bowel atresia encountered during closure, management options include tapering the dilated portion of bowel or resecting the bowel before tapering.↗
▶Ep 25 · 7:57
clinicalFor omphalocele with no significant respiratory issues, sequential reduction using meshes is the best option, sewing meshes to the edges of the fascia without interrupting the membrane.↗
▶Ep 25 · 8:43
clinicalAfter sequential reduction with plastic clips, the patient is taken to the operating room for delayed primary closure of the fascia and skin.↗
Omphalocele & Gastroschisis
▶Ep 27 · 0:55
clinicalGastroschisis is a full thickness abdominal wall defect just to the right of the umbilicus, in which peritoneal contents, most often intestines, protrude through the abdomen without any membranous cover.↗
▶Ep 27 · 0:55
quoteThe main difference between gastroschisis and umphalocele is that umphalocele is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development.↗
▶Ep 27 · 0:55
quoteGastroschisis is a full thickness abdominal wall defect just to the right of the umbilicus, in which peritoneal contents, most often intestines, protrude through the abdomen without any membranous cover.↗
▶Ep 27 · 0:55
clinicalOmphalocele is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development.↗
▶Ep 27 · 0:55
clinicalOmphalocele is right through the middle of the umbilicus and has a membranous cover.↗
▶Ep 27 · 1:54
clinicalA very high level of alpha fetal protein should prompt consideration of gastroschisis or omphalocele.↗
▶Ep 27 · 1:54
clinicalAlpha fetal protein (AFP) is a great screening test, but ultrasound imaging is needed to definitively diagnose abdominal wall defects.↗
▶Ep 27 · 1:54
quoteIf you see a very high level of alpha fetal protein, think about um, gastroschisis or umphalocele.↗
▶Ep 27 · 2:51
clinicalIf surveillance imaging becomes worrisome enough regarding intrauterine fetal demise, the mother and fetus need to be admitted for continuous monitoring or the fetus delivered emergently.↗
▶Ep 27 · 2:51
quoteIn utero growth restriction as well as IUFD in utero fetal demise, uh, can occur in this patient.↗
▶Ep 27 · 2:51
clinicalBiophysical profile and non-stress testing are needed because in utero growth restriction as well as intrauterine fetal demise (IUFD) can occur in these patients.↗
▶Ep 27 · 3:27
epidemiologicalOther risk factors for gastroschisis include vitamin B deficiencies, drug use, and some genetic predispositions.↗
▶Ep 27 · 3:27
epidemiologicalAcetaminophen is identified as a risk factor for gastroschisis.↗
▶Ep 27 · 3:27
quoteIt's, uh, most common among babies born to young mother of low gravity and usually first pregnancy. And 75% of that is the first born.↗
▶Ep 27 · 3:27
epidemiologicalPseudoephedrine-containing pseudofed has an odds ratio of 4.2 times for gastroschisis compared to aspirin alone at 2.7.↗
▶Ep 27 · 3:27
epidemiologicalNearly 60% of gastroschisis infants are premature.↗
▶Ep 27 · 3:27
epidemiologicalMore than 90% of gastroschisis infants are born with intrauterine growth restriction, weighing less than 2500 grams.↗
▶Ep 27 · 3:27
epidemiologicalGastroschisis is most common among babies born to young mothers of low gravidity and usually first pregnancy, with 75% being first born.↗
epidemiologicalThe major risk factors for omphalocele are trisomy 13, 18, and 21, which occur in anywhere between 35 and 90% of patients with omphalocele.↗
▶Ep 27 · 4:21
epidemiologicalMothers of omphalocele babies are usually advanced in age compared to the gastroschisis group, with advanced maternal age having an odds ratio of 3.3.↗
▶Ep 27 · 5:02
clinicalMinimizing heat loss and fluid loss in these babies is crucial immediately after birth, otherwise they can show up extremely dehydrated as well as being cold.↗
▶Ep 27 · 5:02
quoteThese babies can have a significant acidosis and pulmonary hypertension.↗
▶Ep 27 · 5:02
quoteMinimizing heat loss and fluid loss in these babies. Otherwise they can show up, uh, extremely dehydrated as well as, um, being cold.↗
▶Ep 27 · 5:02
clinicalThese babies can have significant acidosis and pulmonary hypertension.↗
▶Ep 27 · 5:32
clinicalPrimary closure is considered if the bowel looks pristine, non-thickened, non-inflammatory, with only a small amount on the outside and enough abdominal domain to push them all back very quickly.↗
▶Ep 27 · 5:32
quoteIf you have a bowel that look pretty pristine, non-thickened, non-inflammatory, and only small amount of them being on the outside, and that's enough abdominal domain, you can actually push them all back very quickly and perform primary closure.↗
▶Ep 27 · 6:03
quoteWe favor stage closure if the defect is large or there's issue with the bowel.↗
▶Ep 27 · 6:03
clinicalSome patients develop intestinal perforation after only two to four days of enteral feeding.↗
▶Ep 27 · 6:03
clinicalStaged closure is favored if the defect is large or there's an issue with the bowel, including atresia, compromised bowel, or perforation.↗
▶Ep 27 · 6:46
clinicalThe majority of gastroschisis babies at Cincinnati Children's Hospital in the last four and a half years are managed using a sutureless closure.↗
▶Ep 27 · 6:46
clinicalIn the sutureless closure technique, after pushing the bowel back in, the umbilical cord is placed over the defect with dressing, and skin will grow over, with small umbilical defects closing spontaneously over time.↗
▶Ep 27 · 7:25
clinicalFor small bowel atresia encountered in gastroschisis, management options include tapering the dilated portion of bowel or resecting the bowel before tapering.↗
▶Ep 27 · 7:54
clinicalFor omphalocele babies without significant respiratory issues, sequential reduction using meshes is the best option, sewing meshes to the edges of the fascia without interrupting the membrane.↗
▶Ep 27 · 7:54
clinicalAt Cincinnati Children's, a Duoderm silo is formed on top of the skin of the patient with omphalocele, using plastic clips to sequentially clip it down until it's flush to the abdominal skin.↗
Fung's statements about Congenital Diaphragmatic Hernia23 statements
quoteThis animation shows a prenatal intervention of a congenital diaphragmatic hernia or CDH using phytoscopic endoluminal tracheal occlusion or fetal.↗
▶Ep 10 · 1:29
quoteOne thing to note is that it's difficult to determine with imaging exactly how large the hole in the diaphragm is.↗
▶Ep 10 · 1:29
clinicalIt is difficult to determine with imaging exactly how large the hole in the diaphragm is in CDH.↗
▶Ep 10 · 2:05
clinicalIn mild diaphragmatic hernia, the left lung starts to shrink in size.↗
▶Ep 10 · 2:11
clinicalIn moderate diaphragmatic hernia, the left lung gets smaller as the intestines and part of the liver push upwards.↗
▶Ep 10 · 2:24
clinicalIn the most severe CDH cases, the liver occupies a good portion of the chest, the left lung is very small, and even the right lung is shrinking.↗
▶Ep 10 · 2:44
guidelineThe tracheal occlusion procedure is commonly performed at gestational age between 27 weeks and 29 weeks 6 days.↗
▶Ep 10 · 2:53
clinicalAnesthesia for FETO is induced by ultrasound guidance with local anesthetic and numbing medication injected into the mother.↗
▶Ep 10 · 3:04
clinicalAn introducer is inserted into the amniotic space to allow placement of a fetoscope (small camera) through the introducer into the amniotic space.↗
▶Ep 10 · 3:16
clinicalThe fetoscope is advanced carefully into the fetal trachea once the baby's mouth is located.↗
▶Ep 10 · 3:27
quoteThe ideal position is in the main trachea below the vocal cords, but above the carina before the trachea splits into the two main bronchi.↗
▶Ep 10 · 3:27
clinicalThe ideal position for the fetoscope in FETO is in the main trachea below the vocal cords but above the carina, before the trachea splits into the two main bronchi.↗
▶Ep 10 · 3:38
clinicalA balloon is inserted into the fetal airway, inflated to completely occlude the trachea, then detached and left in place.↗
▶Ep 10 · 3:41
quoteThe balloon is inflated to completely occlude the trachea before it is detached and left in place.↗
▶Ep 10 · 4:12
clinicalThe balloon is left in place for a few weeks to accelerate lung growth.↗
▶Ep 10 · 4:12
quoteThe balloon is left in place for a few weeks to accelerate lung growth.↗
▶Ep 10 · 4:26
clinicalIf the baby is in proper position, the balloon can be punctured under ultrasound guidance.↗
▶Ep 10 · 4:33
clinicalThe deflated balloon is pushed out of the baby's trachea by lung fluids and poses no risk to the baby's health.↗
▶Ep 10 · 4:33
quoteThe deflated balloon is pushed out of the baby's trachea by the lung fluids and poses no risk to the baby's health.↗
▶Ep 10 · 4:40
clinicalIf the baby's position does not allow for needle puncture, a grasper is used to hold the balloon while a needle punctures it, and the deflated balloon is then removed from the airway using the grasper.↗
▶Ep 10 · 4:56
guidelineAfter balloon removal, the mother and fetus are monitored carefully for the remainder of the pregnancy.↗
▶Ep 10 · 5:02
quoteIdeally, the baby is delivered vaginally a term with a C-section reserved for the usual obstetrical reasons.↗
▶Ep 10 · 5:02
guidelineIdeally, the baby is delivered vaginally at term, with cesarean section reserved for the usual obstetrical reasons.↗
Fung's statements about Congenital Diaphragmatic Hernia23 statements
quoteThis animation shows a prenatal intervention of a congenital diaphragmatic hernia or CDH using phytoscopic endoluminal tracheal occlusion or fetal.↗
▶Ep 10 · 1:29
clinicalIt is difficult to determine with imaging exactly how large the hole in the diaphragm is in CDH.↗
▶Ep 10 · 1:29
quoteOne thing to note is that it's difficult to determine with imaging exactly how large the hole in the diaphragm is.↗
▶Ep 10 · 2:05
clinicalIn mild diaphragmatic hernia, the left lung starts to shrink in size.↗
▶Ep 10 · 2:11
clinicalIn moderate diaphragmatic hernia, the left lung gets smaller as the intestines and part of the liver push upwards.↗
▶Ep 10 · 2:24
clinicalIn the most severe CDH cases, the liver occupies a good portion of the chest, the left lung is very small, and even the right lung is shrinking.↗
▶Ep 10 · 2:44
guidelineThe tracheal occlusion procedure is commonly performed at gestational age between 27 weeks and 29 weeks 6 days.↗
▶Ep 10 · 2:53
clinicalAnesthesia for FETO is induced by ultrasound guidance with local anesthetic and numbing medication injected into the mother.↗
▶Ep 10 · 3:04
clinicalAn introducer is inserted into the amniotic space to allow placement of a fetoscope (small camera) through the introducer into the amniotic space.↗
▶Ep 10 · 3:16
clinicalThe fetoscope is advanced carefully into the fetal trachea once the baby's mouth is located.↗
▶Ep 10 · 3:27
clinicalThe ideal position for the fetoscope in FETO is in the main trachea below the vocal cords but above the carina, before the trachea splits into the two main bronchi.↗
▶Ep 10 · 3:27
quoteThe ideal position is in the main trachea below the vocal cords, but above the carina before the trachea splits into the two main bronchi.↗
▶Ep 10 · 3:38
clinicalA balloon is inserted into the fetal airway, inflated to completely occlude the trachea, then detached and left in place.↗
▶Ep 10 · 3:41
quoteThe balloon is inflated to completely occlude the trachea before it is detached and left in place.↗
▶Ep 10 · 4:12
clinicalThe balloon is left in place for a few weeks to accelerate lung growth.↗
▶Ep 10 · 4:12
quoteThe balloon is left in place for a few weeks to accelerate lung growth.↗
▶Ep 10 · 4:26
clinicalIf the baby is in proper position, the balloon can be punctured under ultrasound guidance.↗
▶Ep 10 · 4:33
quoteThe deflated balloon is pushed out of the baby's trachea by the lung fluids and poses no risk to the baby's health.↗
▶Ep 10 · 4:33
clinicalThe deflated balloon is pushed out of the baby's trachea by lung fluids and poses no risk to the baby's health.↗
▶Ep 10 · 4:40
clinicalIf the baby's position does not allow for needle puncture, a grasper is used to hold the balloon while a needle punctures it, and the deflated balloon is then removed from the airway using the grasper.↗
▶Ep 10 · 4:56
guidelineAfter balloon removal, the mother and fetus are monitored carefully for the remainder of the pregnancy.↗
▶Ep 10 · 5:02
guidelineIdeally, the baby is delivered vaginally at term, with cesarean section reserved for the usual obstetrical reasons.↗
▶Ep 10 · 5:02
quoteIdeally, the baby is delivered vaginally a term with a C-section reserved for the usual obstetrical reasons.↗
Fung's statements about Congenital Diaphragmatic Hernia23 statements
quoteThis animation shows a prenatal intervention of a congenital diaphragmatic hernia or CDH using phytoscopic endoluminal tracheal occlusion or fetal.↗
▶Ep 6 · 1:29
quoteOne thing to note is that it's difficult to determine with imaging exactly how large the hole in the diaphragm is.↗
▶Ep 6 · 1:29
clinicalIt is difficult to determine with imaging exactly how large the hole in the diaphragm is in CDH.↗
▶Ep 6 · 2:05
clinicalIn mild diaphragmatic hernia, the left lung starts to shrink in size.↗
▶Ep 6 · 2:11
clinicalIn moderate diaphragmatic hernia, the left lung gets smaller as the intestines and part of the liver push upwards.↗
▶Ep 6 · 2:24
clinicalIn the most severe CDH cases, the liver occupies a good portion of the chest, the left lung is very small, and even the right lung is shrinking.↗
▶Ep 6 · 2:44
guidelineThe tracheal occlusion procedure is commonly performed at gestational age between 27 weeks and 29 weeks 6 days.↗
▶Ep 6 · 2:53
clinicalAnesthesia for FETO is induced by ultrasound guidance with local anesthetic and numbing medication injected into the mother.↗
▶Ep 6 · 3:04
clinicalAn introducer is inserted into the amniotic space to allow placement of a fetoscope (small camera) through the introducer into the amniotic space.↗
▶Ep 6 · 3:16
clinicalThe fetoscope is advanced carefully into the fetal trachea once the baby's mouth is located.↗
▶Ep 6 · 3:27
clinicalThe ideal position for the fetoscope in FETO is in the main trachea below the vocal cords but above the carina, before the trachea splits into the two main bronchi.↗
▶Ep 6 · 3:27
quoteThe ideal position is in the main trachea below the vocal cords, but above the carina before the trachea splits into the two main bronchi.↗
▶Ep 6 · 3:38
clinicalA balloon is inserted into the fetal airway, inflated to completely occlude the trachea, then detached and left in place.↗
▶Ep 6 · 3:41
quoteThe balloon is inflated to completely occlude the trachea before it is detached and left in place.↗
▶Ep 6 · 4:12
clinicalThe balloon is left in place for a few weeks to accelerate lung growth.↗
▶Ep 6 · 4:12
quoteThe balloon is left in place for a few weeks to accelerate lung growth.↗
▶Ep 6 · 4:26
clinicalIf the baby is in proper position, the balloon can be punctured under ultrasound guidance.↗
▶Ep 6 · 4:33
quoteThe deflated balloon is pushed out of the baby's trachea by the lung fluids and poses no risk to the baby's health.↗
▶Ep 6 · 4:33
clinicalThe deflated balloon is pushed out of the baby's trachea by lung fluids and poses no risk to the baby's health.↗
▶Ep 6 · 4:40
clinicalIf the baby's position does not allow for needle puncture, a grasper is used to hold the balloon while a needle punctures it, and the deflated balloon is then removed from the airway using the grasper.↗
▶Ep 6 · 4:56
guidelineAfter balloon removal, the mother and fetus are monitored carefully for the remainder of the pregnancy.↗
▶Ep 6 · 5:02
quoteIdeally, the baby is delivered vaginally a term with a C-section reserved for the usual obstetrical reasons.↗
▶Ep 6 · 5:02
guidelineIdeally, the baby is delivered vaginally at term, with cesarean section reserved for the usual obstetrical reasons.↗
Fung's statements about Etiologies (Gastroschisis/NEC/Atresia/Volvulus)71 statements
Omphalocele and Gastroschisis With Dr. Foong-Yen Lim
▶Ep 37 · 0:55
clinicalOmphalocele is right through the middle of the umbilicus and has a membranous cover.↗
▶Ep 37 · 0:55
quotegastroschisis is a full thickness abdominal wall defect just to the right of the umbilicus, in which peritoneal contents, most often intestines, protrude through the abdomen without any membranous cover↗
▶Ep 37 · 0:55
quoteumbilical is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development↗
▶Ep 37 · 0:55
clinicalOmphalocele is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development.↗
▶Ep 37 · 0:55
clinicalGastroschisis is a full thickness abdominal wall defect just to the right of the umbilicus, in which peritoneal contents, most often intestines, protrude through the abdomen without any membranous cover.↗
▶Ep 37 · 1:54
clinicalFor gastroschisis, only ultrasound confirmed diagnosis is obtained without additional imaging.↗
▶Ep 37 · 1:54
clinicalFor omphalocele, besides ultrasound, MRI and echocardiogram are routinely obtained because these patients may have other associated anomalies.↗
▶Ep 37 · 1:54
clinicalFetal growth is tracked monthly in gastroschisis and omphalocele cases because there is concern for significant growth restriction.↗
▶Ep 37 · 1:54
quoteIf you see a very high level of alpha fetal protein, think about um, gastroschisis or emphalaceal↗
▶Ep 37 · 1:54
clinicalVery high level of alpha fetal protein is associated with gastroschisis or omphalocele.↗
▶Ep 37 · 1:54
clinicalAlpha fetal protein (AFP) is a screening test, but ultrasound imaging is needed to definitively diagnose abdominal wall defects.↗
▶Ep 37 · 2:56
clinicalBiophysical profile and non-stress testing are needed because intrauterine growth restriction and intrauterine fetal demise (IUFD) can occur in these patients.↗
▶Ep 37 · 2:56
quoteInutero growth restriction, as well as IUFD in utero fetal demise, uh, can occur in this patient↗
▶Ep 37 · 2:56
clinicalIf surveillance imaging becomes worrisome enough regarding intrauterine fetal demise, the mother and fetus need to be admitted for continuous monitoring or emergent delivery.↗
▶Ep 37 · 3:27
epidemiologicalPseudoephedrine has an odds ratio of 4.2 times for gastroschisis compared to aspirin alone at 2.7.↗
▶Ep 37 · 3:27
quoteIt's, uh, most common among babies born to young mother of low gravity and usually first pregnancy. And 75% of that is the first born↗
▶Ep 37 · 3:27
epidemiologicalOther risk factors for gastroschisis include acetaminophen, vitamin B deficiencies, drug use, and some genetic predispositions.↗
▶Ep 37 · 3:27
epidemiologicalMore than 90% of gastroschisis infants are born less than 2,500 grams in weight due to intrauterine growth restriction.↗
▶Ep 37 · 3:27
epidemiologicalGastroschisis is most common among babies born to young mothers of low gravidity, usually first pregnancy, with 75% being first born and 25% in second or subsequent pregnancies.↗
▶Ep 37 · 3:27
epidemiologicalNearly 60% of gastroschisis cases are premature.↗
▶Ep 37 · 3:27
quotemore than 90% of these infants born less than 2,500 grams in weight↗
▶Ep 37 · 4:19
epidemiologicalMothers with omphalocele are usually advanced in age compared to the gastroschisis group, with advanced maternal age having an odds ratio of 3.3.↗
▶Ep 37 · 4:19
epidemiologicalMajor risk factors for omphalocele are trisomy 13, 18, and 21, which occur in anywhere between 35 and 90% of patients with omphalocele.↗
▶Ep 37 · 5:02
clinicalThese babies can have significant acidosis and pulmonary hypertension.↗
▶Ep 37 · 5:02
quoteMinimizing heat loss and fluid loss in these babies. Otherwise they can show up, uh, extremely dehydrated as well as, um, being cold↗
▶Ep 37 · 5:02
clinicalCrucial immediate postnatal procedures include minimizing heat loss and fluid loss, otherwise babies can show up extremely dehydrated and cold.↗
▶Ep 37 · 5:34
quoteIf you have a bowel that look pretty pristine, non-thickened, non-inflammatory, only small amount of them being on the outside and that's enough abdominal domain, you can actually push them all back very quickly and perform primary closure↗
▶Ep 37 · 5:34
clinicalPrimary closure is considered if the bowel looks pristine, non-thickened, non-inflammatory, with only small amount outside and enough abdominal domain to push them all back very quickly.↗
▶Ep 37 · 6:07
quoteWe favor stage closure if the defect is large or, um, there's issue with the bowel↗
▶Ep 37 · 6:07
clinicalStaged closure is favored if the defect is large or there are issues with the bowel, including atresia, compromised bowel, or perforation.↗
▶Ep 37 · 6:07
clinicalSome patients develop intestinal perforation after only two to four days of enteral feeding.↗
▶Ep 37 · 6:58
quoteAfter you push the bowel back in, uh, you don't take these babies to the operating room to close that with suture, but rather put the umbilical cord over and then the dressing over. And a lot of times skin will grow over↗
▶Ep 37 · 6:58
clinicalIn sutureless closure, after pushing the bowel back in, babies are not taken to the operating room for suture closure; instead, the umbilical cord is placed over with dressing, and skin will grow over, although a small umbilical defect may remain that can close spontaneously over time.↗
▶Ep 37 · 7:29
clinicalFor small bowel atresia encountered during closure, management options include tapering the dilated portion of bowel or resecting the bowel before tapering.↗
▶Ep 37 · 7:57
clinicalFor omphalocele with no significant respiratory issues, sequential reduction using meshes is the best option, sewing meshes to the edges of the fascia without interrupting the membrane.↗
▶Ep 37 · 8:43
clinicalAfter sequential reduction with plastic clips, the patient is taken to the operating room for delayed primary closure of the fascia and skin.↗
Omphalocele & Gastroschisis
▶Ep 39 · 0:55
quoteThe main difference between gastroschisis and umphalocele is that umphalocele is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development.↗
▶Ep 39 · 0:55
quoteGastroschisis is a full thickness abdominal wall defect just to the right of the umbilicus, in which peritoneal contents, most often intestines, protrude through the abdomen without any membranous cover.↗
▶Ep 39 · 0:55
clinicalOmphalocele is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development.↗
▶Ep 39 · 0:55
clinicalOmphalocele is right through the middle of the umbilicus and has a membranous cover.↗
▶Ep 39 · 0:55
clinicalGastroschisis is a full thickness abdominal wall defect just to the right of the umbilicus, in which peritoneal contents, most often intestines, protrude through the abdomen without any membranous cover.↗
▶Ep 39 · 1:54
quoteIf you see a very high level of alpha fetal protein, think about um, gastroschisis or umphalocele.↗
▶Ep 39 · 1:54
clinicalAlpha fetal protein (AFP) is a great screening test, but ultrasound imaging is needed to definitively diagnose abdominal wall defects.↗
▶Ep 39 · 1:54
clinicalA very high level of alpha fetal protein should prompt consideration of gastroschisis or omphalocele.↗
▶Ep 39 · 2:51
clinicalBiophysical profile and non-stress testing are needed because in utero growth restriction as well as intrauterine fetal demise (IUFD) can occur in these patients.↗
▶Ep 39 · 2:51
clinicalIf surveillance imaging becomes worrisome enough regarding intrauterine fetal demise, the mother and fetus need to be admitted for continuous monitoring or the fetus delivered emergently.↗
▶Ep 39 · 2:51
quoteIn utero growth restriction as well as IUFD in utero fetal demise, uh, can occur in this patient.↗
▶Ep 39 · 3:27
epidemiologicalGastroschisis is most common among babies born to young mothers of low gravidity and usually first pregnancy, with 75% being first born.↗
▶Ep 39 · 3:27
epidemiologicalAcetaminophen is identified as a risk factor for gastroschisis.↗
▶Ep 39 · 3:27
epidemiologicalOther risk factors for gastroschisis include vitamin B deficiencies, drug use, and some genetic predispositions.↗
quoteIt's, uh, most common among babies born to young mother of low gravity and usually first pregnancy. And 75% of that is the first born.↗
▶Ep 39 · 3:27
epidemiologicalPseudoephedrine-containing pseudofed has an odds ratio of 4.2 times for gastroschisis compared to aspirin alone at 2.7.↗
▶Ep 39 · 3:27
epidemiologicalMore than 90% of gastroschisis infants are born with intrauterine growth restriction, weighing less than 2500 grams.↗
▶Ep 39 · 3:27
epidemiologicalNearly 60% of gastroschisis infants are premature.↗
▶Ep 39 · 4:21
epidemiologicalMothers of omphalocele babies are usually advanced in age compared to the gastroschisis group, with advanced maternal age having an odds ratio of 3.3.↗
▶Ep 39 · 4:21
epidemiologicalThe major risk factors for omphalocele are trisomy 13, 18, and 21, which occur in anywhere between 35 and 90% of patients with omphalocele.↗
▶Ep 39 · 5:02
clinicalThese babies can have significant acidosis and pulmonary hypertension.↗
▶Ep 39 · 5:02
quoteThese babies can have a significant acidosis and pulmonary hypertension.↗
▶Ep 39 · 5:02
clinicalMinimizing heat loss and fluid loss in these babies is crucial immediately after birth, otherwise they can show up extremely dehydrated as well as being cold.↗
▶Ep 39 · 5:02
quoteMinimizing heat loss and fluid loss in these babies. Otherwise they can show up, uh, extremely dehydrated as well as, um, being cold.↗
▶Ep 39 · 5:32
clinicalPrimary closure is considered if the bowel looks pristine, non-thickened, non-inflammatory, with only a small amount on the outside and enough abdominal domain to push them all back very quickly.↗
▶Ep 39 · 5:32
quoteIf you have a bowel that look pretty pristine, non-thickened, non-inflammatory, and only small amount of them being on the outside, and that's enough abdominal domain, you can actually push them all back very quickly and perform primary closure.↗
▶Ep 39 · 6:03
quoteWe favor stage closure if the defect is large or there's issue with the bowel.↗
▶Ep 39 · 6:03
clinicalSome patients develop intestinal perforation after only two to four days of enteral feeding.↗
▶Ep 39 · 6:03
clinicalStaged closure is favored if the defect is large or there's an issue with the bowel, including atresia, compromised bowel, or perforation.↗
▶Ep 39 · 6:46
clinicalIn the sutureless closure technique, after pushing the bowel back in, the umbilical cord is placed over the defect with dressing, and skin will grow over, with small umbilical defects closing spontaneously over time.↗
▶Ep 39 · 6:46
clinicalThe majority of gastroschisis babies at Cincinnati Children's Hospital in the last four and a half years are managed using a sutureless closure.↗
▶Ep 39 · 7:25
clinicalFor small bowel atresia encountered in gastroschisis, management options include tapering the dilated portion of bowel or resecting the bowel before tapering.↗
▶Ep 39 · 7:54
clinicalAt Cincinnati Children's, a Duoderm silo is formed on top of the skin of the patient with omphalocele, using plastic clips to sequentially clip it down until it's flush to the abdominal skin.↗
▶Ep 39 · 7:54
clinicalFor omphalocele babies without significant respiratory issues, sequential reduction using meshes is the best option, sewing meshes to the edges of the fascia without interrupting the membrane.↗
Fung's statements about Fetal Surgery57 statements
quoteThis animation shows a prenatal intervention of a congenital diaphragmatic hernia or CDH using phytoscopic endoluminal tracheal occlusion or fetal.↗
▶Ep 15 · 1:29
clinicalIt is difficult to determine with imaging exactly how large the hole in the diaphragm is in CDH.↗
▶Ep 15 · 1:29
quoteOne thing to note is that it's difficult to determine with imaging exactly how large the hole in the diaphragm is.↗
▶Ep 15 · 2:05
clinicalIn mild diaphragmatic hernia, the left lung starts to shrink in size.↗
▶Ep 15 · 2:11
clinicalIn moderate diaphragmatic hernia, the left lung gets smaller as the intestines and part of the liver push upwards.↗
▶Ep 15 · 2:24
clinicalIn the most severe CDH cases, the liver occupies a good portion of the chest, the left lung is very small, and even the right lung is shrinking.↗
▶Ep 15 · 2:44
guidelineThe tracheal occlusion procedure is commonly performed at gestational age between 27 weeks and 29 weeks 6 days.↗
▶Ep 15 · 2:53
clinicalAnesthesia for FETO is induced by ultrasound guidance with local anesthetic and numbing medication injected into the mother.↗
▶Ep 15 · 3:04
clinicalAn introducer is inserted into the amniotic space to allow placement of a fetoscope (small camera) through the introducer into the amniotic space.↗
▶Ep 15 · 3:16
clinicalThe fetoscope is advanced carefully into the fetal trachea once the baby's mouth is located.↗
▶Ep 15 · 3:27
quoteThe ideal position is in the main trachea below the vocal cords, but above the carina before the trachea splits into the two main bronchi.↗
▶Ep 15 · 3:27
clinicalThe ideal position for the fetoscope in FETO is in the main trachea below the vocal cords but above the carina, before the trachea splits into the two main bronchi.↗
▶Ep 15 · 3:38
clinicalA balloon is inserted into the fetal airway, inflated to completely occlude the trachea, then detached and left in place.↗
▶Ep 15 · 3:41
quoteThe balloon is inflated to completely occlude the trachea before it is detached and left in place.↗
▶Ep 15 · 4:12
quoteThe balloon is left in place for a few weeks to accelerate lung growth.↗
▶Ep 15 · 4:12
clinicalThe balloon is left in place for a few weeks to accelerate lung growth.↗
▶Ep 15 · 4:26
clinicalIf the baby is in proper position, the balloon can be punctured under ultrasound guidance.↗
▶Ep 15 · 4:33
quoteThe deflated balloon is pushed out of the baby's trachea by the lung fluids and poses no risk to the baby's health.↗
▶Ep 15 · 4:33
clinicalThe deflated balloon is pushed out of the baby's trachea by lung fluids and poses no risk to the baby's health.↗
▶Ep 15 · 4:40
clinicalIf the baby's position does not allow for needle puncture, a grasper is used to hold the balloon while a needle punctures it, and the deflated balloon is then removed from the airway using the grasper.↗
▶Ep 15 · 4:56
guidelineAfter balloon removal, the mother and fetus are monitored carefully for the remainder of the pregnancy.↗
▶Ep 15 · 5:02
guidelineIdeally, the baby is delivered vaginally at term, with cesarean section reserved for the usual obstetrical reasons.↗
▶Ep 15 · 5:02
quoteIdeally, the baby is delivered vaginally a term with a C-section reserved for the usual obstetrical reasons.↗
Fetoscopic Repair of Myelomeningocele (MMC)
▶Ep 16 · 1:13
quoteIn this fetus with spina bifida, you can see an opening in the back with an exposed spinal cord.↗
▶Ep 16 · 1:13
quoteIn this fetus with spina bifida, you can see an opening in the back with an exposed spinal cord.↗
▶Ep 16 · 1:44
clinicalPrenatal repair is most commonly done between 22 and 26 weeks gestation.↗
▶Ep 16 · 1:44
quotePrenatal repair is most commonly done between 22 and 26 weeks gestation.↗
▶Ep 16 · 1:44
clinicalPrenatal repair is most commonly done between 22 and 26 weeks gestation.↗
▶Ep 16 · 1:44
quotePrenatal repair is most commonly done between 22 and 26 weeks gestation.↗
▶Ep 16 · 1:54
clinicalFor maternal access, either a transverse incision or a midline incision may be used.↗
▶Ep 16 · 1:54
clinicalFor maternal access, either a transverse incision or a midline incision may be used.↗
▶Ep 16 · 2:22
clinicalThe amniotic cavity is expanded using humidified and heated carbon dioxide, which creates more space to do the repair.↗
▶Ep 16 · 2:22
clinicalThe amniotic cavity is expanded using humidified and heated carbon dioxide, which creates more space to do the repair.↗
▶Ep 16 · 2:34
clinicalA camera is inserted into the amniotic cavity through the first port to enable visualization inside the womb.↗
▶Ep 16 · 2:34
clinicalA camera is inserted into the amniotic cavity through the first port to enable visualization inside the womb.↗
▶Ep 16 · 2:43
clinicalTwo additional ports are placed under direct vision to allow placement of instruments for the repair.↗
▶Ep 16 · 2:43
clinicalTwo additional ports are placed under direct vision to allow placement of instruments for the repair.↗
▶Ep 16 · 2:56
clinicalA stabilization stitch is placed in the baby's upper back above the spina bifida.↗
▶Ep 16 · 2:56
clinicalA stabilization stitch is placed in the baby's upper back above the spina bifida.↗
▶Ep 16 · 3:22
clinicalOnce the sac is completely open, the placode is freed.↗
▶Ep 16 · 3:22
clinicalOnce the sac is completely open, the placode is freed.↗
▶Ep 16 · 3:34
quoteThis procedure, which is called untethering, allows the placcode to fall back down nicely into the spinal canal.↗
▶Ep 16 · 3:34
clinicalUntethering allows the placode to fall back down nicely into the spinal canal.↗
▶Ep 16 · 3:34
quoteThis procedure, which is called untethering, allows the placcode to fall back down nicely into the spinal canal.↗
▶Ep 16 · 3:34
clinicalUntethering allows the placode to fall back down nicely into the spinal canal.↗
▶Ep 16 · 3:57
clinicalTo protect the placode, a patch is placed into the defect and anchored on one end to the baby's back using dissolvable sutures.↗
▶Ep 16 · 3:57
clinicalTo protect the placode, a patch is placed into the defect and anchored on one end to the baby's back using dissolvable sutures.↗
▶Ep 16 · 4:08
clinicalA second patch is placed to give additional protection and is secured with dissolvable sutures.↗
▶Ep 16 · 4:08
clinicalA second patch is placed to give additional protection and is secured with dissolvable sutures.↗
▶Ep 16 · 4:17
clinicalThe skin is closed over the spinal defect using dissolvable sutures when the baby has enough skin to do so.↗
▶Ep 16 · 4:17
clinicalThe skin is closed over the spinal defect using dissolvable sutures when the baby has enough skin to do so.↗
▶Ep 16 · 4:26
clinicalWhen the defect is too big and the two ends of skin cannot be pulled together, a skin patch is used to form a watertight closure.↗
▶Ep 16 · 4:26
clinicalWhen the defect is too big and the two ends of skin cannot be pulled together, a skin patch is used to form a watertight closure.↗
▶Ep 16 · 4:49
clinicalPort sites are closed with dissolvable sutures.↗
▶Ep 16 · 4:49
clinicalPort sites are closed with dissolvable sutures.↗
▶Ep 16 · 4:57
clinicalThe amniotic fluid that was removed is replaced with warm fluid and antibiotics are placed into the amniotic cavity.↗
▶Ep 16 · 4:57
clinicalThe amniotic fluid that was removed is replaced with warm fluid and antibiotics are placed into the amniotic cavity.↗
Fung's statements about Gastroschisis71 statements
Omphalocele and Gastroschisis With Dr. Foong-Yen Lim
▶Ep 14 · 0:55
quotegastroschisis is a full thickness abdominal wall defect just to the right of the umbilicus, in which peritoneal contents, most often intestines, protrude through the abdomen without any membranous cover↗
▶Ep 14 · 0:55
quoteumbilical is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development↗
▶Ep 14 · 0:55
clinicalGastroschisis is a full thickness abdominal wall defect just to the right of the umbilicus, in which peritoneal contents, most often intestines, protrude through the abdomen without any membranous cover.↗
▶Ep 14 · 0:55
clinicalOmphalocele is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development.↗
▶Ep 14 · 0:55
clinicalOmphalocele is right through the middle of the umbilicus and has a membranous cover.↗
▶Ep 14 · 1:54
clinicalAlpha fetal protein (AFP) is a screening test, but ultrasound imaging is needed to definitively diagnose abdominal wall defects.↗
▶Ep 14 · 1:54
clinicalFor omphalocele, besides ultrasound, MRI and echocardiogram are routinely obtained because these patients may have other associated anomalies.↗
▶Ep 14 · 1:54
clinicalVery high level of alpha fetal protein is associated with gastroschisis or omphalocele.↗
▶Ep 14 · 1:54
clinicalFor gastroschisis, only ultrasound confirmed diagnosis is obtained without additional imaging.↗
▶Ep 14 · 1:54
quoteIf you see a very high level of alpha fetal protein, think about um, gastroschisis or emphalaceal↗
▶Ep 14 · 1:54
clinicalFetal growth is tracked monthly in gastroschisis and omphalocele cases because there is concern for significant growth restriction.↗
▶Ep 14 · 2:56
clinicalIf surveillance imaging becomes worrisome enough regarding intrauterine fetal demise, the mother and fetus need to be admitted for continuous monitoring or emergent delivery.↗
▶Ep 14 · 2:56
quoteInutero growth restriction, as well as IUFD in utero fetal demise, uh, can occur in this patient↗
▶Ep 14 · 2:56
clinicalBiophysical profile and non-stress testing are needed because intrauterine growth restriction and intrauterine fetal demise (IUFD) can occur in these patients.↗
▶Ep 14 · 3:27
quoteIt's, uh, most common among babies born to young mother of low gravity and usually first pregnancy. And 75% of that is the first born↗
▶Ep 14 · 3:27
epidemiologicalGastroschisis is most common among babies born to young mothers of low gravidity, usually first pregnancy, with 75% being first born and 25% in second or subsequent pregnancies.↗
▶Ep 14 · 3:27
quotemore than 90% of these infants born less than 2,500 grams in weight↗
▶Ep 14 · 3:27
epidemiologicalPseudoephedrine has an odds ratio of 4.2 times for gastroschisis compared to aspirin alone at 2.7.↗
▶Ep 14 · 3:27
epidemiologicalNearly 60% of gastroschisis cases are premature.↗
▶Ep 14 · 3:27
epidemiologicalMore than 90% of gastroschisis infants are born less than 2,500 grams in weight due to intrauterine growth restriction.↗
▶Ep 14 · 3:27
epidemiologicalOther risk factors for gastroschisis include acetaminophen, vitamin B deficiencies, drug use, and some genetic predispositions.↗
▶Ep 14 · 4:19
epidemiologicalMothers with omphalocele are usually advanced in age compared to the gastroschisis group, with advanced maternal age having an odds ratio of 3.3.↗
▶Ep 14 · 4:19
epidemiologicalMajor risk factors for omphalocele are trisomy 13, 18, and 21, which occur in anywhere between 35 and 90% of patients with omphalocele.↗
▶Ep 14 · 5:02
clinicalThese babies can have significant acidosis and pulmonary hypertension.↗
▶Ep 14 · 5:02
quoteMinimizing heat loss and fluid loss in these babies. Otherwise they can show up, uh, extremely dehydrated as well as, um, being cold↗
▶Ep 14 · 5:02
clinicalCrucial immediate postnatal procedures include minimizing heat loss and fluid loss, otherwise babies can show up extremely dehydrated and cold.↗
▶Ep 14 · 5:34
quoteIf you have a bowel that look pretty pristine, non-thickened, non-inflammatory, only small amount of them being on the outside and that's enough abdominal domain, you can actually push them all back very quickly and perform primary closure↗
▶Ep 14 · 5:34
clinicalPrimary closure is considered if the bowel looks pristine, non-thickened, non-inflammatory, with only small amount outside and enough abdominal domain to push them all back very quickly.↗
▶Ep 14 · 6:07
clinicalStaged closure is favored if the defect is large or there are issues with the bowel, including atresia, compromised bowel, or perforation.↗
▶Ep 14 · 6:07
quoteWe favor stage closure if the defect is large or, um, there's issue with the bowel↗
▶Ep 14 · 6:07
clinicalSome patients develop intestinal perforation after only two to four days of enteral feeding.↗
▶Ep 14 · 6:58
clinicalIn sutureless closure, after pushing the bowel back in, babies are not taken to the operating room for suture closure; instead, the umbilical cord is placed over with dressing, and skin will grow over, although a small umbilical defect may remain that can close spontaneously over time.↗
▶Ep 14 · 6:58
quoteAfter you push the bowel back in, uh, you don't take these babies to the operating room to close that with suture, but rather put the umbilical cord over and then the dressing over. And a lot of times skin will grow over↗
▶Ep 14 · 7:29
clinicalFor small bowel atresia encountered during closure, management options include tapering the dilated portion of bowel or resecting the bowel before tapering.↗
▶Ep 14 · 7:57
clinicalFor omphalocele with no significant respiratory issues, sequential reduction using meshes is the best option, sewing meshes to the edges of the fascia without interrupting the membrane.↗
▶Ep 14 · 8:43
clinicalAfter sequential reduction with plastic clips, the patient is taken to the operating room for delayed primary closure of the fascia and skin.↗
Omphalocele & Gastroschisis
▶Ep 16 · 0:55
clinicalGastroschisis is a full thickness abdominal wall defect just to the right of the umbilicus, in which peritoneal contents, most often intestines, protrude through the abdomen without any membranous cover.↗
▶Ep 16 · 0:55
clinicalOmphalocele is right through the middle of the umbilicus and has a membranous cover.↗
▶Ep 16 · 0:55
clinicalOmphalocele is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development.↗
▶Ep 16 · 0:55
quoteGastroschisis is a full thickness abdominal wall defect just to the right of the umbilicus, in which peritoneal contents, most often intestines, protrude through the abdomen without any membranous cover.↗
▶Ep 16 · 0:55
quoteThe main difference between gastroschisis and umphalocele is that umphalocele is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development.↗
▶Ep 16 · 1:54
clinicalAlpha fetal protein (AFP) is a great screening test, but ultrasound imaging is needed to definitively diagnose abdominal wall defects.↗
▶Ep 16 · 1:54
quoteIf you see a very high level of alpha fetal protein, think about um, gastroschisis or umphalocele.↗
▶Ep 16 · 1:54
clinicalA very high level of alpha fetal protein should prompt consideration of gastroschisis or omphalocele.↗
▶Ep 16 · 2:51
quoteIn utero growth restriction as well as IUFD in utero fetal demise, uh, can occur in this patient.↗
▶Ep 16 · 2:51
clinicalIf surveillance imaging becomes worrisome enough regarding intrauterine fetal demise, the mother and fetus need to be admitted for continuous monitoring or the fetus delivered emergently.↗
▶Ep 16 · 2:51
clinicalBiophysical profile and non-stress testing are needed because in utero growth restriction as well as intrauterine fetal demise (IUFD) can occur in these patients.↗
▶Ep 16 · 3:27
epidemiologicalOther risk factors for gastroschisis include vitamin B deficiencies, drug use, and some genetic predispositions.↗
▶Ep 16 · 3:27
quoteIt's, uh, most common among babies born to young mother of low gravity and usually first pregnancy. And 75% of that is the first born.↗
epidemiologicalNearly 60% of gastroschisis infants are premature.↗
▶Ep 16 · 3:27
epidemiologicalGastroschisis is most common among babies born to young mothers of low gravidity and usually first pregnancy, with 75% being first born.↗
▶Ep 16 · 3:27
epidemiologicalMore than 90% of gastroschisis infants are born with intrauterine growth restriction, weighing less than 2500 grams.↗
▶Ep 16 · 3:27
epidemiologicalPseudoephedrine-containing pseudofed has an odds ratio of 4.2 times for gastroschisis compared to aspirin alone at 2.7.↗
▶Ep 16 · 3:27
epidemiologicalAcetaminophen is identified as a risk factor for gastroschisis.↗
▶Ep 16 · 4:21
epidemiologicalThe major risk factors for omphalocele are trisomy 13, 18, and 21, which occur in anywhere between 35 and 90% of patients with omphalocele.↗
▶Ep 16 · 4:21
epidemiologicalMothers of omphalocele babies are usually advanced in age compared to the gastroschisis group, with advanced maternal age having an odds ratio of 3.3.↗
▶Ep 16 · 5:02
quoteMinimizing heat loss and fluid loss in these babies. Otherwise they can show up, uh, extremely dehydrated as well as, um, being cold.↗
▶Ep 16 · 5:02
clinicalThese babies can have significant acidosis and pulmonary hypertension.↗
▶Ep 16 · 5:02
clinicalMinimizing heat loss and fluid loss in these babies is crucial immediately after birth, otherwise they can show up extremely dehydrated as well as being cold.↗
▶Ep 16 · 5:02
quoteThese babies can have a significant acidosis and pulmonary hypertension.↗
▶Ep 16 · 5:32
clinicalPrimary closure is considered if the bowel looks pristine, non-thickened, non-inflammatory, with only a small amount on the outside and enough abdominal domain to push them all back very quickly.↗
▶Ep 16 · 5:32
quoteIf you have a bowel that look pretty pristine, non-thickened, non-inflammatory, and only small amount of them being on the outside, and that's enough abdominal domain, you can actually push them all back very quickly and perform primary closure.↗
▶Ep 16 · 6:03
clinicalSome patients develop intestinal perforation after only two to four days of enteral feeding.↗
▶Ep 16 · 6:03
clinicalStaged closure is favored if the defect is large or there's an issue with the bowel, including atresia, compromised bowel, or perforation.↗
▶Ep 16 · 6:03
quoteWe favor stage closure if the defect is large or there's issue with the bowel.↗
▶Ep 16 · 6:46
clinicalThe majority of gastroschisis babies at Cincinnati Children's Hospital in the last four and a half years are managed using a sutureless closure.↗
▶Ep 16 · 6:46
clinicalIn the sutureless closure technique, after pushing the bowel back in, the umbilical cord is placed over the defect with dressing, and skin will grow over, with small umbilical defects closing spontaneously over time.↗
▶Ep 16 · 7:25
clinicalFor small bowel atresia encountered in gastroschisis, management options include tapering the dilated portion of bowel or resecting the bowel before tapering.↗
▶Ep 16 · 7:54
clinicalFor omphalocele babies without significant respiratory issues, sequential reduction using meshes is the best option, sewing meshes to the edges of the fascia without interrupting the membrane.↗
▶Ep 16 · 7:54
clinicalAt Cincinnati Children's, a Duoderm silo is formed on top of the skin of the patient with omphalocele, using plastic clips to sequentially clip it down until it's flush to the abdominal skin.↗
Fung's statements about Gastroschisis71 statements
Omphalocele and Gastroschisis With Dr. Foong-Yen Lim
▶Ep 15 · 0:55
clinicalOmphalocele is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development.↗
▶Ep 15 · 0:55
quotegastroschisis is a full thickness abdominal wall defect just to the right of the umbilicus, in which peritoneal contents, most often intestines, protrude through the abdomen without any membranous cover↗
▶Ep 15 · 0:55
clinicalOmphalocele is right through the middle of the umbilicus and has a membranous cover.↗
▶Ep 15 · 0:55
quoteumbilical is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development↗
▶Ep 15 · 0:55
clinicalGastroschisis is a full thickness abdominal wall defect just to the right of the umbilicus, in which peritoneal contents, most often intestines, protrude through the abdomen without any membranous cover.↗
▶Ep 15 · 1:54
clinicalFetal growth is tracked monthly in gastroschisis and omphalocele cases because there is concern for significant growth restriction.↗
▶Ep 15 · 1:54
quoteIf you see a very high level of alpha fetal protein, think about um, gastroschisis or emphalaceal↗
▶Ep 15 · 1:54
clinicalFor omphalocele, besides ultrasound, MRI and echocardiogram are routinely obtained because these patients may have other associated anomalies.↗
▶Ep 15 · 1:54
clinicalFor gastroschisis, only ultrasound confirmed diagnosis is obtained without additional imaging.↗
▶Ep 15 · 1:54
clinicalAlpha fetal protein (AFP) is a screening test, but ultrasound imaging is needed to definitively diagnose abdominal wall defects.↗
▶Ep 15 · 1:54
clinicalVery high level of alpha fetal protein is associated with gastroschisis or omphalocele.↗
▶Ep 15 · 2:56
clinicalIf surveillance imaging becomes worrisome enough regarding intrauterine fetal demise, the mother and fetus need to be admitted for continuous monitoring or emergent delivery.↗
▶Ep 15 · 2:56
clinicalBiophysical profile and non-stress testing are needed because intrauterine growth restriction and intrauterine fetal demise (IUFD) can occur in these patients.↗
▶Ep 15 · 2:56
quoteInutero growth restriction, as well as IUFD in utero fetal demise, uh, can occur in this patient↗
▶Ep 15 · 3:27
quoteIt's, uh, most common among babies born to young mother of low gravity and usually first pregnancy. And 75% of that is the first born↗
▶Ep 15 · 3:27
epidemiologicalNearly 60% of gastroschisis cases are premature.↗
▶Ep 15 · 3:27
quotemore than 90% of these infants born less than 2,500 grams in weight↗
▶Ep 15 · 3:27
epidemiologicalGastroschisis is most common among babies born to young mothers of low gravidity, usually first pregnancy, with 75% being first born and 25% in second or subsequent pregnancies.↗
▶Ep 15 · 3:27
epidemiologicalMore than 90% of gastroschisis infants are born less than 2,500 grams in weight due to intrauterine growth restriction.↗
▶Ep 15 · 3:27
epidemiologicalPseudoephedrine has an odds ratio of 4.2 times for gastroschisis compared to aspirin alone at 2.7.↗
▶Ep 15 · 3:27
epidemiologicalOther risk factors for gastroschisis include acetaminophen, vitamin B deficiencies, drug use, and some genetic predispositions.↗
▶Ep 15 · 4:19
epidemiologicalMothers with omphalocele are usually advanced in age compared to the gastroschisis group, with advanced maternal age having an odds ratio of 3.3.↗
▶Ep 15 · 4:19
epidemiologicalMajor risk factors for omphalocele are trisomy 13, 18, and 21, which occur in anywhere between 35 and 90% of patients with omphalocele.↗
▶Ep 15 · 5:02
clinicalCrucial immediate postnatal procedures include minimizing heat loss and fluid loss, otherwise babies can show up extremely dehydrated and cold.↗
▶Ep 15 · 5:02
clinicalThese babies can have significant acidosis and pulmonary hypertension.↗
▶Ep 15 · 5:02
quoteMinimizing heat loss and fluid loss in these babies. Otherwise they can show up, uh, extremely dehydrated as well as, um, being cold↗
▶Ep 15 · 5:34
quoteIf you have a bowel that look pretty pristine, non-thickened, non-inflammatory, only small amount of them being on the outside and that's enough abdominal domain, you can actually push them all back very quickly and perform primary closure↗
▶Ep 15 · 5:34
clinicalPrimary closure is considered if the bowel looks pristine, non-thickened, non-inflammatory, with only small amount outside and enough abdominal domain to push them all back very quickly.↗
▶Ep 15 · 6:07
quoteWe favor stage closure if the defect is large or, um, there's issue with the bowel↗
▶Ep 15 · 6:07
clinicalStaged closure is favored if the defect is large or there are issues with the bowel, including atresia, compromised bowel, or perforation.↗
▶Ep 15 · 6:07
clinicalSome patients develop intestinal perforation after only two to four days of enteral feeding.↗
▶Ep 15 · 6:58
clinicalIn sutureless closure, after pushing the bowel back in, babies are not taken to the operating room for suture closure; instead, the umbilical cord is placed over with dressing, and skin will grow over, although a small umbilical defect may remain that can close spontaneously over time.↗
▶Ep 15 · 6:58
quoteAfter you push the bowel back in, uh, you don't take these babies to the operating room to close that with suture, but rather put the umbilical cord over and then the dressing over. And a lot of times skin will grow over↗
▶Ep 15 · 7:29
clinicalFor small bowel atresia encountered during closure, management options include tapering the dilated portion of bowel or resecting the bowel before tapering.↗
▶Ep 15 · 7:57
clinicalFor omphalocele with no significant respiratory issues, sequential reduction using meshes is the best option, sewing meshes to the edges of the fascia without interrupting the membrane.↗
▶Ep 15 · 8:43
clinicalAfter sequential reduction with plastic clips, the patient is taken to the operating room for delayed primary closure of the fascia and skin.↗
Omphalocele & Gastroschisis
▶Ep 17 · 0:55
quoteGastroschisis is a full thickness abdominal wall defect just to the right of the umbilicus, in which peritoneal contents, most often intestines, protrude through the abdomen without any membranous cover.↗
▶Ep 17 · 0:55
quoteThe main difference between gastroschisis and umphalocele is that umphalocele is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development.↗
▶Ep 17 · 0:55
clinicalOmphalocele is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development.↗
▶Ep 17 · 0:55
clinicalOmphalocele is right through the middle of the umbilicus and has a membranous cover.↗
▶Ep 17 · 0:55
clinicalGastroschisis is a full thickness abdominal wall defect just to the right of the umbilicus, in which peritoneal contents, most often intestines, protrude through the abdomen without any membranous cover.↗
▶Ep 17 · 1:54
clinicalA very high level of alpha fetal protein should prompt consideration of gastroschisis or omphalocele.↗
▶Ep 17 · 1:54
clinicalAlpha fetal protein (AFP) is a great screening test, but ultrasound imaging is needed to definitively diagnose abdominal wall defects.↗
▶Ep 17 · 1:54
quoteIf you see a very high level of alpha fetal protein, think about um, gastroschisis or umphalocele.↗
▶Ep 17 · 2:51
quoteIn utero growth restriction as well as IUFD in utero fetal demise, uh, can occur in this patient.↗
▶Ep 17 · 2:51
clinicalBiophysical profile and non-stress testing are needed because in utero growth restriction as well as intrauterine fetal demise (IUFD) can occur in these patients.↗
▶Ep 17 · 2:51
clinicalIf surveillance imaging becomes worrisome enough regarding intrauterine fetal demise, the mother and fetus need to be admitted for continuous monitoring or the fetus delivered emergently.↗
▶Ep 17 · 3:27
epidemiologicalOther risk factors for gastroschisis include vitamin B deficiencies, drug use, and some genetic predispositions.↗
▶Ep 17 · 3:27
epidemiologicalMore than 90% of gastroschisis infants are born with intrauterine growth restriction, weighing less than 2500 grams.↗
▶Ep 17 · 3:27
epidemiologicalAcetaminophen is identified as a risk factor for gastroschisis.↗
▶Ep 17 · 3:27
epidemiologicalNearly 60% of gastroschisis infants are premature.↗
▶Ep 17 · 3:27
epidemiologicalPseudoephedrine-containing pseudofed has an odds ratio of 4.2 times for gastroschisis compared to aspirin alone at 2.7.↗
▶Ep 17 · 3:27
epidemiologicalGastroschisis is most common among babies born to young mothers of low gravidity and usually first pregnancy, with 75% being first born.↗
▶Ep 17 · 3:27
quoteIt's, uh, most common among babies born to young mother of low gravity and usually first pregnancy. And 75% of that is the first born.↗
epidemiologicalMothers of omphalocele babies are usually advanced in age compared to the gastroschisis group, with advanced maternal age having an odds ratio of 3.3.↗
▶Ep 17 · 4:21
epidemiologicalThe major risk factors for omphalocele are trisomy 13, 18, and 21, which occur in anywhere between 35 and 90% of patients with omphalocele.↗
▶Ep 17 · 5:02
quoteMinimizing heat loss and fluid loss in these babies. Otherwise they can show up, uh, extremely dehydrated as well as, um, being cold.↗
▶Ep 17 · 5:02
quoteThese babies can have a significant acidosis and pulmonary hypertension.↗
▶Ep 17 · 5:02
clinicalMinimizing heat loss and fluid loss in these babies is crucial immediately after birth, otherwise they can show up extremely dehydrated as well as being cold.↗
▶Ep 17 · 5:02
clinicalThese babies can have significant acidosis and pulmonary hypertension.↗
▶Ep 17 · 5:32
quoteIf you have a bowel that look pretty pristine, non-thickened, non-inflammatory, and only small amount of them being on the outside, and that's enough abdominal domain, you can actually push them all back very quickly and perform primary closure.↗
▶Ep 17 · 5:32
clinicalPrimary closure is considered if the bowel looks pristine, non-thickened, non-inflammatory, with only a small amount on the outside and enough abdominal domain to push them all back very quickly.↗
▶Ep 17 · 6:03
clinicalStaged closure is favored if the defect is large or there's an issue with the bowel, including atresia, compromised bowel, or perforation.↗
▶Ep 17 · 6:03
clinicalSome patients develop intestinal perforation after only two to four days of enteral feeding.↗
▶Ep 17 · 6:03
quoteWe favor stage closure if the defect is large or there's issue with the bowel.↗
▶Ep 17 · 6:46
clinicalThe majority of gastroschisis babies at Cincinnati Children's Hospital in the last four and a half years are managed using a sutureless closure.↗
▶Ep 17 · 6:46
clinicalIn the sutureless closure technique, after pushing the bowel back in, the umbilical cord is placed over the defect with dressing, and skin will grow over, with small umbilical defects closing spontaneously over time.↗
▶Ep 17 · 7:25
clinicalFor small bowel atresia encountered in gastroschisis, management options include tapering the dilated portion of bowel or resecting the bowel before tapering.↗
▶Ep 17 · 7:54
clinicalAt Cincinnati Children's, a Duoderm silo is formed on top of the skin of the patient with omphalocele, using plastic clips to sequentially clip it down until it's flush to the abdominal skin.↗
▶Ep 17 · 7:54
clinicalFor omphalocele babies without significant respiratory issues, sequential reduction using meshes is the best option, sewing meshes to the edges of the fascia without interrupting the membrane.↗
Fung's statements about Intestinal Rehab71 statements
Omphalocele and Gastroschisis With Dr. Foong-Yen Lim
▶Ep 50 · 0:55
quoteumbilical is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development↗
▶Ep 50 · 0:55
quotegastroschisis is a full thickness abdominal wall defect just to the right of the umbilicus, in which peritoneal contents, most often intestines, protrude through the abdomen without any membranous cover↗
▶Ep 50 · 0:55
clinicalOmphalocele is right through the middle of the umbilicus and has a membranous cover.↗
▶Ep 50 · 0:55
clinicalOmphalocele is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development.↗
▶Ep 50 · 0:55
clinicalGastroschisis is a full thickness abdominal wall defect just to the right of the umbilicus, in which peritoneal contents, most often intestines, protrude through the abdomen without any membranous cover.↗
▶Ep 50 · 1:54
clinicalVery high level of alpha fetal protein is associated with gastroschisis or omphalocele.↗
▶Ep 50 · 1:54
clinicalFor gastroschisis, only ultrasound confirmed diagnosis is obtained without additional imaging.↗
▶Ep 50 · 1:54
clinicalAlpha fetal protein (AFP) is a screening test, but ultrasound imaging is needed to definitively diagnose abdominal wall defects.↗
▶Ep 50 · 1:54
quoteIf you see a very high level of alpha fetal protein, think about um, gastroschisis or emphalaceal↗
▶Ep 50 · 1:54
clinicalFetal growth is tracked monthly in gastroschisis and omphalocele cases because there is concern for significant growth restriction.↗
▶Ep 50 · 1:54
clinicalFor omphalocele, besides ultrasound, MRI and echocardiogram are routinely obtained because these patients may have other associated anomalies.↗
▶Ep 50 · 2:56
clinicalBiophysical profile and non-stress testing are needed because intrauterine growth restriction and intrauterine fetal demise (IUFD) can occur in these patients.↗
▶Ep 50 · 2:56
quoteInutero growth restriction, as well as IUFD in utero fetal demise, uh, can occur in this patient↗
▶Ep 50 · 2:56
clinicalIf surveillance imaging becomes worrisome enough regarding intrauterine fetal demise, the mother and fetus need to be admitted for continuous monitoring or emergent delivery.↗
▶Ep 50 · 3:27
epidemiologicalNearly 60% of gastroschisis cases are premature.↗
▶Ep 50 · 3:27
epidemiologicalGastroschisis is most common among babies born to young mothers of low gravidity, usually first pregnancy, with 75% being first born and 25% in second or subsequent pregnancies.↗
▶Ep 50 · 3:27
quotemore than 90% of these infants born less than 2,500 grams in weight↗
▶Ep 50 · 3:27
epidemiologicalOther risk factors for gastroschisis include acetaminophen, vitamin B deficiencies, drug use, and some genetic predispositions.↗
▶Ep 50 · 3:27
quoteIt's, uh, most common among babies born to young mother of low gravity and usually first pregnancy. And 75% of that is the first born↗
▶Ep 50 · 3:27
epidemiologicalMore than 90% of gastroschisis infants are born less than 2,500 grams in weight due to intrauterine growth restriction.↗
▶Ep 50 · 3:27
epidemiologicalPseudoephedrine has an odds ratio of 4.2 times for gastroschisis compared to aspirin alone at 2.7.↗
▶Ep 50 · 4:19
epidemiologicalMajor risk factors for omphalocele are trisomy 13, 18, and 21, which occur in anywhere between 35 and 90% of patients with omphalocele.↗
▶Ep 50 · 4:19
epidemiologicalMothers with omphalocele are usually advanced in age compared to the gastroschisis group, with advanced maternal age having an odds ratio of 3.3.↗
▶Ep 50 · 5:02
clinicalThese babies can have significant acidosis and pulmonary hypertension.↗
▶Ep 50 · 5:02
clinicalCrucial immediate postnatal procedures include minimizing heat loss and fluid loss, otherwise babies can show up extremely dehydrated and cold.↗
▶Ep 50 · 5:02
quoteMinimizing heat loss and fluid loss in these babies. Otherwise they can show up, uh, extremely dehydrated as well as, um, being cold↗
▶Ep 50 · 5:34
quoteIf you have a bowel that look pretty pristine, non-thickened, non-inflammatory, only small amount of them being on the outside and that's enough abdominal domain, you can actually push them all back very quickly and perform primary closure↗
▶Ep 50 · 5:34
clinicalPrimary closure is considered if the bowel looks pristine, non-thickened, non-inflammatory, with only small amount outside and enough abdominal domain to push them all back very quickly.↗
▶Ep 50 · 6:07
clinicalSome patients develop intestinal perforation after only two to four days of enteral feeding.↗
▶Ep 50 · 6:07
clinicalStaged closure is favored if the defect is large or there are issues with the bowel, including atresia, compromised bowel, or perforation.↗
▶Ep 50 · 6:07
quoteWe favor stage closure if the defect is large or, um, there's issue with the bowel↗
▶Ep 50 · 6:58
quoteAfter you push the bowel back in, uh, you don't take these babies to the operating room to close that with suture, but rather put the umbilical cord over and then the dressing over. And a lot of times skin will grow over↗
▶Ep 50 · 6:58
clinicalIn sutureless closure, after pushing the bowel back in, babies are not taken to the operating room for suture closure; instead, the umbilical cord is placed over with dressing, and skin will grow over, although a small umbilical defect may remain that can close spontaneously over time.↗
▶Ep 50 · 7:29
clinicalFor small bowel atresia encountered during closure, management options include tapering the dilated portion of bowel or resecting the bowel before tapering.↗
▶Ep 50 · 7:57
clinicalFor omphalocele with no significant respiratory issues, sequential reduction using meshes is the best option, sewing meshes to the edges of the fascia without interrupting the membrane.↗
▶Ep 50 · 8:43
clinicalAfter sequential reduction with plastic clips, the patient is taken to the operating room for delayed primary closure of the fascia and skin.↗
Omphalocele & Gastroschisis
▶Ep 54 · 0:55
clinicalGastroschisis is a full thickness abdominal wall defect just to the right of the umbilicus, in which peritoneal contents, most often intestines, protrude through the abdomen without any membranous cover.↗
▶Ep 54 · 0:55
clinicalOmphalocele is right through the middle of the umbilicus and has a membranous cover.↗
▶Ep 54 · 0:55
clinicalOmphalocele is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development.↗
▶Ep 54 · 0:55
quoteGastroschisis is a full thickness abdominal wall defect just to the right of the umbilicus, in which peritoneal contents, most often intestines, protrude through the abdomen without any membranous cover.↗
▶Ep 54 · 0:55
quoteThe main difference between gastroschisis and umphalocele is that umphalocele is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development.↗
▶Ep 54 · 1:54
quoteIf you see a very high level of alpha fetal protein, think about um, gastroschisis or umphalocele.↗
▶Ep 54 · 1:54
clinicalA very high level of alpha fetal protein should prompt consideration of gastroschisis or omphalocele.↗
▶Ep 54 · 1:54
clinicalAlpha fetal protein (AFP) is a great screening test, but ultrasound imaging is needed to definitively diagnose abdominal wall defects.↗
▶Ep 54 · 2:51
clinicalIf surveillance imaging becomes worrisome enough regarding intrauterine fetal demise, the mother and fetus need to be admitted for continuous monitoring or the fetus delivered emergently.↗
▶Ep 54 · 2:51
clinicalBiophysical profile and non-stress testing are needed because in utero growth restriction as well as intrauterine fetal demise (IUFD) can occur in these patients.↗
▶Ep 54 · 2:51
quoteIn utero growth restriction as well as IUFD in utero fetal demise, uh, can occur in this patient.↗
▶Ep 54 · 3:27
epidemiologicalMore than 90% of gastroschisis infants are born with intrauterine growth restriction, weighing less than 2500 grams.↗
▶Ep 54 · 3:27
epidemiologicalAcetaminophen is identified as a risk factor for gastroschisis.↗
▶Ep 54 · 3:27
epidemiologicalNearly 60% of gastroschisis infants are premature.↗
▶Ep 54 · 3:27
quoteIt's, uh, most common among babies born to young mother of low gravity and usually first pregnancy. And 75% of that is the first born.↗
epidemiologicalOther risk factors for gastroschisis include vitamin B deficiencies, drug use, and some genetic predispositions.↗
▶Ep 54 · 3:27
epidemiologicalPseudoephedrine-containing pseudofed has an odds ratio of 4.2 times for gastroschisis compared to aspirin alone at 2.7.↗
▶Ep 54 · 3:27
epidemiologicalGastroschisis is most common among babies born to young mothers of low gravidity and usually first pregnancy, with 75% being first born.↗
▶Ep 54 · 4:21
epidemiologicalThe major risk factors for omphalocele are trisomy 13, 18, and 21, which occur in anywhere between 35 and 90% of patients with omphalocele.↗
▶Ep 54 · 4:21
epidemiologicalMothers of omphalocele babies are usually advanced in age compared to the gastroschisis group, with advanced maternal age having an odds ratio of 3.3.↗
▶Ep 54 · 5:02
quoteThese babies can have a significant acidosis and pulmonary hypertension.↗
▶Ep 54 · 5:02
clinicalMinimizing heat loss and fluid loss in these babies is crucial immediately after birth, otherwise they can show up extremely dehydrated as well as being cold.↗
▶Ep 54 · 5:02
clinicalThese babies can have significant acidosis and pulmonary hypertension.↗
▶Ep 54 · 5:02
quoteMinimizing heat loss and fluid loss in these babies. Otherwise they can show up, uh, extremely dehydrated as well as, um, being cold.↗
▶Ep 54 · 5:32
quoteIf you have a bowel that look pretty pristine, non-thickened, non-inflammatory, and only small amount of them being on the outside, and that's enough abdominal domain, you can actually push them all back very quickly and perform primary closure.↗
▶Ep 54 · 5:32
clinicalPrimary closure is considered if the bowel looks pristine, non-thickened, non-inflammatory, with only a small amount on the outside and enough abdominal domain to push them all back very quickly.↗
▶Ep 54 · 6:03
quoteWe favor stage closure if the defect is large or there's issue with the bowel.↗
▶Ep 54 · 6:03
clinicalStaged closure is favored if the defect is large or there's an issue with the bowel, including atresia, compromised bowel, or perforation.↗
▶Ep 54 · 6:03
clinicalSome patients develop intestinal perforation after only two to four days of enteral feeding.↗
▶Ep 54 · 6:46
clinicalThe majority of gastroschisis babies at Cincinnati Children's Hospital in the last four and a half years are managed using a sutureless closure.↗
▶Ep 54 · 6:46
clinicalIn the sutureless closure technique, after pushing the bowel back in, the umbilical cord is placed over the defect with dressing, and skin will grow over, with small umbilical defects closing spontaneously over time.↗
▶Ep 54 · 7:25
clinicalFor small bowel atresia encountered in gastroschisis, management options include tapering the dilated portion of bowel or resecting the bowel before tapering.↗
▶Ep 54 · 7:54
clinicalAt Cincinnati Children's, a Duoderm silo is formed on top of the skin of the patient with omphalocele, using plastic clips to sequentially clip it down until it's flush to the abdominal skin.↗
▶Ep 54 · 7:54
clinicalFor omphalocele babies without significant respiratory issues, sequential reduction using meshes is the best option, sewing meshes to the edges of the fascia without interrupting the membrane.↗
Fung's statements about Myelomeningocele17 statements
Omphalocele and Gastroschisis With Dr. Foong-Yen Lim
▶Ep 9 · 0:55
clinicalOmphalocele is right through the middle of the umbilicus and has a membranous cover.↗
▶Ep 9 · 0:55
clinicalOmphalocele is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development.↗
▶Ep 9 · 0:55
clinicalGastroschisis is a full thickness abdominal wall defect just to the right of the umbilicus, in which peritoneal contents, most often intestines, protrude through the abdomen without any membranous cover.↗
▶Ep 9 · 0:55
quoteumbilical is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development↗
▶Ep 9 · 0:55
quotegastroschisis is a full thickness abdominal wall defect just to the right of the umbilicus, in which peritoneal contents, most often intestines, protrude through the abdomen without any membranous cover↗
▶Ep 9 · 1:54
quoteIf you see a very high level of alpha fetal protein, think about um, gastroschisis or emphalaceal↗
▶Ep 9 · 1:54
clinicalVery high level of alpha fetal protein is associated with gastroschisis or omphalocele.↗
▶Ep 9 · 1:54
clinicalAlpha fetal protein (AFP) is a screening test, but ultrasound imaging is needed to definitively diagnose abdominal wall defects.↗
▶Ep 9 · 1:54
clinicalFor gastroschisis, only ultrasound confirmed diagnosis is obtained without additional imaging.↗
▶Ep 9 · 1:54
clinicalFor omphalocele, besides ultrasound, MRI and echocardiogram are routinely obtained because these patients may have other associated anomalies.↗
▶Ep 9 · 1:54
clinicalFetal growth is tracked monthly in gastroschisis and omphalocele cases because there is concern for significant growth restriction.↗
▶Ep 9 · 2:56
clinicalBiophysical profile and non-stress testing are needed because intrauterine growth restriction and intrauterine fetal demise (IUFD) can occur in these patients.↗
▶Ep 9 · 2:56
clinicalIf surveillance imaging becomes worrisome enough regarding intrauterine fetal demise, the mother and fetus need to be admitted for continuous monitoring or emergent delivery.↗
▶Ep 9 · 2:56
quoteInutero growth restriction, as well as IUFD in utero fetal demise, uh, can occur in this patient↗
▶Ep 9 · 3:27
epidemiologicalMore than 90% of gastroschisis infants are born less than 2,500 grams in weight due to intrauterine growth restriction.↗
▶Ep 9 · 3:27
quotemore than 90% of these infants born less than 2,500 grams in weight↗
▶Ep 9 · 3:27
quoteIt's, uh, most common among babies born to young mother of low gravity and usually first pregnancy. And 75% of that is the first born↗
▶Ep 9 · 3:27
epidemiologicalOther risk factors for gastroschisis include acetaminophen, vitamin B deficiencies, drug use, and some genetic predispositions.↗
▶Ep 9 · 3:27
epidemiologicalGastroschisis is most common among babies born to young mothers of low gravidity, usually first pregnancy, with 75% being first born and 25% in second or subsequent pregnancies.↗
▶Ep 9 · 3:27
epidemiologicalNearly 60% of gastroschisis cases are premature.↗
▶Ep 9 · 3:27
epidemiologicalPseudoephedrine has an odds ratio of 4.2 times for gastroschisis compared to aspirin alone at 2.7.↗
▶Ep 9 · 4:19
epidemiologicalMajor risk factors for omphalocele are trisomy 13, 18, and 21, which occur in anywhere between 35 and 90% of patients with omphalocele.↗
▶Ep 9 · 4:19
epidemiologicalMothers with omphalocele are usually advanced in age compared to the gastroschisis group, with advanced maternal age having an odds ratio of 3.3.↗
▶Ep 9 · 5:02
quoteMinimizing heat loss and fluid loss in these babies. Otherwise they can show up, uh, extremely dehydrated as well as, um, being cold↗
▶Ep 9 · 5:02
clinicalCrucial immediate postnatal procedures include minimizing heat loss and fluid loss, otherwise babies can show up extremely dehydrated and cold.↗
▶Ep 9 · 5:02
clinicalThese babies can have significant acidosis and pulmonary hypertension.↗
▶Ep 9 · 5:34
quoteIf you have a bowel that look pretty pristine, non-thickened, non-inflammatory, only small amount of them being on the outside and that's enough abdominal domain, you can actually push them all back very quickly and perform primary closure↗
▶Ep 9 · 5:34
clinicalPrimary closure is considered if the bowel looks pristine, non-thickened, non-inflammatory, with only small amount outside and enough abdominal domain to push them all back very quickly.↗
▶Ep 9 · 6:07
quoteWe favor stage closure if the defect is large or, um, there's issue with the bowel↗
▶Ep 9 · 6:07
clinicalStaged closure is favored if the defect is large or there are issues with the bowel, including atresia, compromised bowel, or perforation.↗
▶Ep 9 · 6:07
clinicalSome patients develop intestinal perforation after only two to four days of enteral feeding.↗
▶Ep 9 · 6:58
clinicalIn sutureless closure, after pushing the bowel back in, babies are not taken to the operating room for suture closure; instead, the umbilical cord is placed over with dressing, and skin will grow over, although a small umbilical defect may remain that can close spontaneously over time.↗
▶Ep 9 · 6:58
quoteAfter you push the bowel back in, uh, you don't take these babies to the operating room to close that with suture, but rather put the umbilical cord over and then the dressing over. And a lot of times skin will grow over↗
▶Ep 9 · 7:29
clinicalFor small bowel atresia encountered during closure, management options include tapering the dilated portion of bowel or resecting the bowel before tapering.↗
▶Ep 9 · 7:57
clinicalFor omphalocele with no significant respiratory issues, sequential reduction using meshes is the best option, sewing meshes to the edges of the fascia without interrupting the membrane.↗
▶Ep 9 · 8:43
clinicalAfter sequential reduction with plastic clips, the patient is taken to the operating room for delayed primary closure of the fascia and skin.↗
Omphalocele & Gastroschisis
▶Ep 10 · 0:55
clinicalGastroschisis is a full thickness abdominal wall defect just to the right of the umbilicus, in which peritoneal contents, most often intestines, protrude through the abdomen without any membranous cover.↗
▶Ep 10 · 0:55
clinicalOmphalocele is right through the middle of the umbilicus and has a membranous cover.↗
▶Ep 10 · 0:55
clinicalOmphalocele is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development.↗
▶Ep 10 · 0:55
quoteGastroschisis is a full thickness abdominal wall defect just to the right of the umbilicus, in which peritoneal contents, most often intestines, protrude through the abdomen without any membranous cover.↗
▶Ep 10 · 0:55
quoteThe main difference between gastroschisis and umphalocele is that umphalocele is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development.↗
▶Ep 10 · 1:54
clinicalA very high level of alpha fetal protein should prompt consideration of gastroschisis or omphalocele.↗
▶Ep 10 · 1:54
quoteIf you see a very high level of alpha fetal protein, think about um, gastroschisis or umphalocele.↗
▶Ep 10 · 1:54
clinicalAlpha fetal protein (AFP) is a great screening test, but ultrasound imaging is needed to definitively diagnose abdominal wall defects.↗
▶Ep 10 · 2:51
clinicalBiophysical profile and non-stress testing are needed because in utero growth restriction as well as intrauterine fetal demise (IUFD) can occur in these patients.↗
▶Ep 10 · 2:51
clinicalIf surveillance imaging becomes worrisome enough regarding intrauterine fetal demise, the mother and fetus need to be admitted for continuous monitoring or the fetus delivered emergently.↗
▶Ep 10 · 2:51
quoteIn utero growth restriction as well as IUFD in utero fetal demise, uh, can occur in this patient.↗
▶Ep 10 · 3:27
quoteIt's, uh, most common among babies born to young mother of low gravity and usually first pregnancy. And 75% of that is the first born.↗
epidemiologicalGastroschisis is most common among babies born to young mothers of low gravidity and usually first pregnancy, with 75% being first born.↗
▶Ep 10 · 3:27
epidemiologicalMore than 90% of gastroschisis infants are born with intrauterine growth restriction, weighing less than 2500 grams.↗
▶Ep 10 · 3:27
epidemiologicalPseudoephedrine-containing pseudofed has an odds ratio of 4.2 times for gastroschisis compared to aspirin alone at 2.7.↗
▶Ep 10 · 3:27
epidemiologicalAcetaminophen is identified as a risk factor for gastroschisis.↗
▶Ep 10 · 3:27
epidemiologicalOther risk factors for gastroschisis include vitamin B deficiencies, drug use, and some genetic predispositions.↗
▶Ep 10 · 3:27
epidemiologicalNearly 60% of gastroschisis infants are premature.↗
▶Ep 10 · 4:21
epidemiologicalMothers of omphalocele babies are usually advanced in age compared to the gastroschisis group, with advanced maternal age having an odds ratio of 3.3.↗
▶Ep 10 · 4:21
epidemiologicalThe major risk factors for omphalocele are trisomy 13, 18, and 21, which occur in anywhere between 35 and 90% of patients with omphalocele.↗
▶Ep 10 · 5:02
clinicalMinimizing heat loss and fluid loss in these babies is crucial immediately after birth, otherwise they can show up extremely dehydrated as well as being cold.↗
▶Ep 10 · 5:02
clinicalThese babies can have significant acidosis and pulmonary hypertension.↗
▶Ep 10 · 5:02
quoteMinimizing heat loss and fluid loss in these babies. Otherwise they can show up, uh, extremely dehydrated as well as, um, being cold.↗
▶Ep 10 · 5:02
quoteThese babies can have a significant acidosis and pulmonary hypertension.↗
▶Ep 10 · 5:32
quoteIf you have a bowel that look pretty pristine, non-thickened, non-inflammatory, and only small amount of them being on the outside, and that's enough abdominal domain, you can actually push them all back very quickly and perform primary closure.↗
▶Ep 10 · 5:32
clinicalPrimary closure is considered if the bowel looks pristine, non-thickened, non-inflammatory, with only a small amount on the outside and enough abdominal domain to push them all back very quickly.↗
▶Ep 10 · 6:03
clinicalStaged closure is favored if the defect is large or there's an issue with the bowel, including atresia, compromised bowel, or perforation.↗
▶Ep 10 · 6:03
clinicalSome patients develop intestinal perforation after only two to four days of enteral feeding.↗
▶Ep 10 · 6:03
quoteWe favor stage closure if the defect is large or there's issue with the bowel.↗
▶Ep 10 · 6:46
clinicalIn the sutureless closure technique, after pushing the bowel back in, the umbilical cord is placed over the defect with dressing, and skin will grow over, with small umbilical defects closing spontaneously over time.↗
▶Ep 10 · 6:46
clinicalThe majority of gastroschisis babies at Cincinnati Children's Hospital in the last four and a half years are managed using a sutureless closure.↗
▶Ep 10 · 7:25
clinicalFor small bowel atresia encountered in gastroschisis, management options include tapering the dilated portion of bowel or resecting the bowel before tapering.↗
▶Ep 10 · 7:54
clinicalAt Cincinnati Children's, a Duoderm silo is formed on top of the skin of the patient with omphalocele, using plastic clips to sequentially clip it down until it's flush to the abdominal skin.↗
▶Ep 10 · 7:54
clinicalFor omphalocele babies without significant respiratory issues, sequential reduction using meshes is the best option, sewing meshes to the edges of the fascia without interrupting the membrane.↗
Omphalocele and Gastroschisis With Dr. Foong-Yen Lim
▶Ep 10 · 0:55
clinicalOmphalocele is right through the middle of the umbilicus and has a membranous cover.↗
▶Ep 10 · 0:55
clinicalGastroschisis is a full thickness abdominal wall defect just to the right of the umbilicus, in which peritoneal contents, most often intestines, protrude through the abdomen without any membranous cover.↗
▶Ep 10 · 0:55
quotegastroschisis is a full thickness abdominal wall defect just to the right of the umbilicus, in which peritoneal contents, most often intestines, protrude through the abdomen without any membranous cover↗
▶Ep 10 · 0:55
clinicalOmphalocele is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development.↗
▶Ep 10 · 0:55
quoteumbilical is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development↗
▶Ep 10 · 1:54
quoteIf you see a very high level of alpha fetal protein, think about um, gastroschisis or emphalaceal↗
▶Ep 10 · 1:54
clinicalFor gastroschisis, only ultrasound confirmed diagnosis is obtained without additional imaging.↗
▶Ep 10 · 1:54
clinicalAlpha fetal protein (AFP) is a screening test, but ultrasound imaging is needed to definitively diagnose abdominal wall defects.↗
▶Ep 10 · 1:54
clinicalVery high level of alpha fetal protein is associated with gastroschisis or omphalocele.↗
▶Ep 10 · 1:54
clinicalFetal growth is tracked monthly in gastroschisis and omphalocele cases because there is concern for significant growth restriction.↗
▶Ep 10 · 1:54
clinicalFor omphalocele, besides ultrasound, MRI and echocardiogram are routinely obtained because these patients may have other associated anomalies.↗
▶Ep 10 · 2:56
quoteInutero growth restriction, as well as IUFD in utero fetal demise, uh, can occur in this patient↗
▶Ep 10 · 2:56
clinicalIf surveillance imaging becomes worrisome enough regarding intrauterine fetal demise, the mother and fetus need to be admitted for continuous monitoring or emergent delivery.↗
▶Ep 10 · 2:56
clinicalBiophysical profile and non-stress testing are needed because intrauterine growth restriction and intrauterine fetal demise (IUFD) can occur in these patients.↗
▶Ep 10 · 3:27
quotemore than 90% of these infants born less than 2,500 grams in weight↗
▶Ep 10 · 3:27
quoteIt's, uh, most common among babies born to young mother of low gravity and usually first pregnancy. And 75% of that is the first born↗
▶Ep 10 · 3:27
epidemiologicalOther risk factors for gastroschisis include acetaminophen, vitamin B deficiencies, drug use, and some genetic predispositions.↗
▶Ep 10 · 3:27
epidemiologicalPseudoephedrine has an odds ratio of 4.2 times for gastroschisis compared to aspirin alone at 2.7.↗
▶Ep 10 · 3:27
epidemiologicalMore than 90% of gastroschisis infants are born less than 2,500 grams in weight due to intrauterine growth restriction.↗
▶Ep 10 · 3:27
epidemiologicalNearly 60% of gastroschisis cases are premature.↗
▶Ep 10 · 3:27
epidemiologicalGastroschisis is most common among babies born to young mothers of low gravidity, usually first pregnancy, with 75% being first born and 25% in second or subsequent pregnancies.↗
▶Ep 10 · 4:19
epidemiologicalMajor risk factors for omphalocele are trisomy 13, 18, and 21, which occur in anywhere between 35 and 90% of patients with omphalocele.↗
▶Ep 10 · 4:19
epidemiologicalMothers with omphalocele are usually advanced in age compared to the gastroschisis group, with advanced maternal age having an odds ratio of 3.3.↗
▶Ep 10 · 5:02
quoteMinimizing heat loss and fluid loss in these babies. Otherwise they can show up, uh, extremely dehydrated as well as, um, being cold↗
▶Ep 10 · 5:02
clinicalCrucial immediate postnatal procedures include minimizing heat loss and fluid loss, otherwise babies can show up extremely dehydrated and cold.↗
▶Ep 10 · 5:02
clinicalThese babies can have significant acidosis and pulmonary hypertension.↗
▶Ep 10 · 5:34
clinicalPrimary closure is considered if the bowel looks pristine, non-thickened, non-inflammatory, with only small amount outside and enough abdominal domain to push them all back very quickly.↗
▶Ep 10 · 5:34
quoteIf you have a bowel that look pretty pristine, non-thickened, non-inflammatory, only small amount of them being on the outside and that's enough abdominal domain, you can actually push them all back very quickly and perform primary closure↗
▶Ep 10 · 6:07
quoteWe favor stage closure if the defect is large or, um, there's issue with the bowel↗
▶Ep 10 · 6:07
clinicalSome patients develop intestinal perforation after only two to four days of enteral feeding.↗
▶Ep 10 · 6:07
clinicalStaged closure is favored if the defect is large or there are issues with the bowel, including atresia, compromised bowel, or perforation.↗
▶Ep 10 · 6:58
quoteAfter you push the bowel back in, uh, you don't take these babies to the operating room to close that with suture, but rather put the umbilical cord over and then the dressing over. And a lot of times skin will grow over↗
▶Ep 10 · 6:58
clinicalIn sutureless closure, after pushing the bowel back in, babies are not taken to the operating room for suture closure; instead, the umbilical cord is placed over with dressing, and skin will grow over, although a small umbilical defect may remain that can close spontaneously over time.↗
▶Ep 10 · 7:29
clinicalFor small bowel atresia encountered during closure, management options include tapering the dilated portion of bowel or resecting the bowel before tapering.↗
▶Ep 10 · 7:57
clinicalFor omphalocele with no significant respiratory issues, sequential reduction using meshes is the best option, sewing meshes to the edges of the fascia without interrupting the membrane.↗
▶Ep 10 · 8:43
clinicalAfter sequential reduction with plastic clips, the patient is taken to the operating room for delayed primary closure of the fascia and skin.↗
Omphalocele & Gastroschisis
▶Ep 11 · 0:55
quoteThe main difference between gastroschisis and umphalocele is that umphalocele is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development.↗
▶Ep 11 · 0:55
clinicalOmphalocele is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development.↗
▶Ep 11 · 0:55
clinicalOmphalocele is right through the middle of the umbilicus and has a membranous cover.↗
▶Ep 11 · 0:55
clinicalGastroschisis is a full thickness abdominal wall defect just to the right of the umbilicus, in which peritoneal contents, most often intestines, protrude through the abdomen without any membranous cover.↗
▶Ep 11 · 0:55
quoteGastroschisis is a full thickness abdominal wall defect just to the right of the umbilicus, in which peritoneal contents, most often intestines, protrude through the abdomen without any membranous cover.↗
▶Ep 11 · 1:54
quoteIf you see a very high level of alpha fetal protein, think about um, gastroschisis or umphalocele.↗
▶Ep 11 · 1:54
clinicalA very high level of alpha fetal protein should prompt consideration of gastroschisis or omphalocele.↗
▶Ep 11 · 1:54
clinicalAlpha fetal protein (AFP) is a great screening test, but ultrasound imaging is needed to definitively diagnose abdominal wall defects.↗
▶Ep 11 · 2:51
clinicalBiophysical profile and non-stress testing are needed because in utero growth restriction as well as intrauterine fetal demise (IUFD) can occur in these patients.↗
▶Ep 11 · 2:51
quoteIn utero growth restriction as well as IUFD in utero fetal demise, uh, can occur in this patient.↗
▶Ep 11 · 2:51
clinicalIf surveillance imaging becomes worrisome enough regarding intrauterine fetal demise, the mother and fetus need to be admitted for continuous monitoring or the fetus delivered emergently.↗
▶Ep 11 · 3:27
epidemiologicalOther risk factors for gastroschisis include vitamin B deficiencies, drug use, and some genetic predispositions.↗
▶Ep 11 · 3:27
quoteIt's, uh, most common among babies born to young mother of low gravity and usually first pregnancy. And 75% of that is the first born.↗
epidemiologicalAcetaminophen is identified as a risk factor for gastroschisis.↗
▶Ep 11 · 3:27
epidemiologicalPseudoephedrine-containing pseudofed has an odds ratio of 4.2 times for gastroschisis compared to aspirin alone at 2.7.↗
▶Ep 11 · 3:27
epidemiologicalMore than 90% of gastroschisis infants are born with intrauterine growth restriction, weighing less than 2500 grams.↗
▶Ep 11 · 3:27
epidemiologicalNearly 60% of gastroschisis infants are premature.↗
▶Ep 11 · 3:27
epidemiologicalGastroschisis is most common among babies born to young mothers of low gravidity and usually first pregnancy, with 75% being first born.↗
▶Ep 11 · 4:21
epidemiologicalMothers of omphalocele babies are usually advanced in age compared to the gastroschisis group, with advanced maternal age having an odds ratio of 3.3.↗
▶Ep 11 · 4:21
epidemiologicalThe major risk factors for omphalocele are trisomy 13, 18, and 21, which occur in anywhere between 35 and 90% of patients with omphalocele.↗
▶Ep 11 · 5:02
quoteThese babies can have a significant acidosis and pulmonary hypertension.↗
▶Ep 11 · 5:02
clinicalMinimizing heat loss and fluid loss in these babies is crucial immediately after birth, otherwise they can show up extremely dehydrated as well as being cold.↗
▶Ep 11 · 5:02
quoteMinimizing heat loss and fluid loss in these babies. Otherwise they can show up, uh, extremely dehydrated as well as, um, being cold.↗
▶Ep 11 · 5:02
clinicalThese babies can have significant acidosis and pulmonary hypertension.↗
▶Ep 11 · 5:32
quoteIf you have a bowel that look pretty pristine, non-thickened, non-inflammatory, and only small amount of them being on the outside, and that's enough abdominal domain, you can actually push them all back very quickly and perform primary closure.↗
▶Ep 11 · 5:32
clinicalPrimary closure is considered if the bowel looks pristine, non-thickened, non-inflammatory, with only a small amount on the outside and enough abdominal domain to push them all back very quickly.↗
▶Ep 11 · 6:03
clinicalStaged closure is favored if the defect is large or there's an issue with the bowel, including atresia, compromised bowel, or perforation.↗
▶Ep 11 · 6:03
quoteWe favor stage closure if the defect is large or there's issue with the bowel.↗
▶Ep 11 · 6:03
clinicalSome patients develop intestinal perforation after only two to four days of enteral feeding.↗
▶Ep 11 · 6:46
clinicalThe majority of gastroschisis babies at Cincinnati Children's Hospital in the last four and a half years are managed using a sutureless closure.↗
▶Ep 11 · 6:46
clinicalIn the sutureless closure technique, after pushing the bowel back in, the umbilical cord is placed over the defect with dressing, and skin will grow over, with small umbilical defects closing spontaneously over time.↗
▶Ep 11 · 7:25
clinicalFor small bowel atresia encountered in gastroschisis, management options include tapering the dilated portion of bowel or resecting the bowel before tapering.↗
▶Ep 11 · 7:54
clinicalAt Cincinnati Children's, a Duoderm silo is formed on top of the skin of the patient with omphalocele, using plastic clips to sequentially clip it down until it's flush to the abdominal skin.↗
▶Ep 11 · 7:54
clinicalFor omphalocele babies without significant respiratory issues, sequential reduction using meshes is the best option, sewing meshes to the edges of the fascia without interrupting the membrane.↗
