Fung Lim
469 statements · 9 topics
Abdominal Wall Defects
· guest expert
Etiologies (Gastroschisis/NEC/Atresia/Volvulus)
· guest expert
Fetal Surgery
· guest expert
Intestinal Rehab
· guest expert
Featured statements
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.
quote ·
Abdominal Wall Defects
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.
quote ·
Abdominal Wall Defects
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.
quote ·
Gastroschisis
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
quote ·
Gastroschisis
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Fung's statements about Abdominal Wall Defects 71 statements
Open the Abdominal Wall Defects collection →
Omphalocele and Gastroschisis With Dr. Foong-Yen Lim
Statement
Omphalocele is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development.
Open
Statement
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.
Open
Quotation
umbilical is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development
Open
Quotation
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
Open
Statement
Fetal growth is tracked monthly in gastroschisis and omphalocele cases because there is concern for significant growth restriction.
Open
Quotation
If you see a very high level of alpha fetal protein, think about um, gastroschisis or emphalaceal
Open
Statement
Very high level of alpha fetal protein is associated with gastroschisis or omphalocele.
Open
Statement
Alpha fetal protein (AFP) is a screening test, but ultrasound imaging is needed to definitively diagnose abdominal wall defects.
Open
Statement
For gastroschisis, only ultrasound confirmed diagnosis is obtained without additional imaging.
Open
Statement
For omphalocele, besides ultrasound, MRI and echocardiogram are routinely obtained because these patients may have other associated anomalies.
Open
Statement
If surveillance imaging becomes worrisome enough regarding intrauterine fetal demise, the mother and fetus need to be admitted for continuous monitoring or emergent delivery.
Open
Statement
Biophysical profile and non-stress testing are needed because intrauterine growth restriction and intrauterine fetal demise (IUFD) can occur in these patients.
Open
Quotation
Inutero growth restriction, as well as IUFD in utero fetal demise, uh, can occur in this patient
Open
Quotation
It'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
Open
Statement
Other risk factors for gastroschisis include acetaminophen, vitamin B deficiencies, drug use, and some genetic predispositions.
Open
Statement
Pseudoephedrine has an odds ratio of 4.2 times for gastroschisis compared to aspirin alone at 2.7.
Open
Statement
More than 90% of gastroschisis infants are born less than 2,500 grams in weight due to intrauterine growth restriction.
Open
Statement
Gastroschisis 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.
Open
Statement
Mothers with omphalocele are usually advanced in age compared to the gastroschisis group, with advanced maternal age having an odds ratio of 3.3.
Open
Statement
Major risk factors for omphalocele are trisomy 13, 18, and 21, which occur in anywhere between 35 and 90% of patients with omphalocele.
Open
Quotation
Minimizing heat loss and fluid loss in these babies. Otherwise they can show up, uh, extremely dehydrated as well as, um, being cold
Open
Statement
Crucial immediate postnatal procedures include minimizing heat loss and fluid loss, otherwise babies can show up extremely dehydrated and cold.
Open
Quotation
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
Open
Statement
Primary 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.
Open
Statement
Staged closure is favored if the defect is large or there are issues with the bowel, including atresia, compromised bowel, or perforation.
Open
Statement
Some patients develop intestinal perforation after only two to four days of enteral feeding.
Open
Statement
In 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.
Open
Quotation
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
Open
Statement
For small bowel atresia encountered during closure, management options include tapering the dilated portion of bowel or resecting the bowel before tapering.
Open
Statement
For 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.
Open
Statement
After sequential reduction with plastic clips, the patient is taken to the operating room for delayed primary closure of the fascia and skin.
Open
Omphalocele & Gastroschisis
Quotation
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.
Open
Quotation
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.
Open
Statement
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.
Open
Statement
Omphalocele is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development.
Open
Statement
A very high level of alpha fetal protein should prompt consideration of gastroschisis or omphalocele.
Open
Quotation
If you see a very high level of alpha fetal protein, think about um, gastroschisis or umphalocele.
Open
Statement
Alpha fetal protein (AFP) is a great screening test, but ultrasound imaging is needed to definitively diagnose abdominal wall defects.
Open
Statement
If 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.
Open
Statement
Biophysical profile and non-stress testing are needed because in utero growth restriction as well as intrauterine fetal demise (IUFD) can occur in these patients.
Open
Quotation
In utero growth restriction as well as IUFD in utero fetal demise, uh, can occur in this patient.
Open
Statement
More than 90% of gastroschisis infants are born with intrauterine growth restriction, weighing less than 2500 grams.
Open
Statement
Gastroschisis is most common among babies born to young mothers of low gravidity and usually first pregnancy, with 75% being first born.
Open
Statement
Pseudoephedrine-containing pseudofed has an odds ratio of 4.2 times for gastroschisis compared to aspirin alone at 2.7.
Open
Statement
Other risk factors for gastroschisis include vitamin B deficiencies, drug use, and some genetic predispositions.
Open
Quotation
It'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.
Open
Statement
The major risk factors for omphalocele are trisomy 13, 18, and 21, which occur in anywhere between 35 and 90% of patients with omphalocele.
Open
Statement
Mothers of omphalocele babies are usually advanced in age compared to the gastroschisis group, with advanced maternal age having an odds ratio of 3.3.
Open
Statement
Minimizing 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.
Open
Quotation
Minimizing heat loss and fluid loss in these babies. Otherwise they can show up, uh, extremely dehydrated as well as, um, being cold.
Open
Statement
Primary 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.
Open
Quotation
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.
Open
Statement
Some patients develop intestinal perforation after only two to four days of enteral feeding.
Open
Statement
Staged closure is favored if the defect is large or there's an issue with the bowel, including atresia, compromised bowel, or perforation.
Open
Statement
The majority of gastroschisis babies at Cincinnati Children's Hospital in the last four and a half years are managed using a sutureless closure.
Open
Statement
In 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.
Open
Statement
For small bowel atresia encountered in gastroschisis, management options include tapering the dilated portion of bowel or resecting the bowel before tapering.
Open
Statement
At 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.
Open
Statement
For 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.
Open
Fung's statements about Congenital Diaphragmatic Hernia 23 statements
Open the Congenital Diaphragmatic Hernia collection →
Fetoscopic Endoluminal Tracheal Occlusion (FETO)
Quotation
This animation shows a prenatal intervention of a congenital diaphragmatic hernia or CDH using phytoscopic endoluminal tracheal occlusion or fetal.
Open
Quotation
One thing to note is that it's difficult to determine with imaging exactly how large the hole in the diaphragm is.
Open
Statement
It is difficult to determine with imaging exactly how large the hole in the diaphragm is in CDH.
Open
Statement
In moderate diaphragmatic hernia, the left lung gets smaller as the intestines and part of the liver push upwards.
Open
Statement
In 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.
Open
Statement
The tracheal occlusion procedure is commonly performed at gestational age between 27 weeks and 29 weeks 6 days.
Open
Statement
Anesthesia for FETO is induced by ultrasound guidance with local anesthetic and numbing medication injected into the mother.
Open
Statement
An introducer is inserted into the amniotic space to allow placement of a fetoscope (small camera) through the introducer into the amniotic space.
Open
Statement
The fetoscope is advanced carefully into the fetal trachea once the baby's mouth is located.
Open
Statement
The 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.
Open
Quotation
The ideal position is in the main trachea below the vocal cords, but above the carina before the trachea splits into the two main bronchi.
Open
Statement
A balloon is inserted into the fetal airway, inflated to completely occlude the trachea, then detached and left in place.
Open
Quotation
The balloon is inflated to completely occlude the trachea before it is detached and left in place.
Open
Statement
If the baby is in proper position, the balloon can be punctured under ultrasound guidance.
Open
Quotation
The deflated balloon is pushed out of the baby's trachea by the lung fluids and poses no risk to the baby's health.
Open
Statement
The deflated balloon is pushed out of the baby's trachea by lung fluids and poses no risk to the baby's health.
Open
Statement
If 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.
Open
Statement
After balloon removal, the mother and fetus are monitored carefully for the remainder of the pregnancy.
Open
Statement
Ideally, the baby is delivered vaginally at term, with cesarean section reserved for the usual obstetrical reasons.
Open
Quotation
Ideally, the baby is delivered vaginally a term with a C-section reserved for the usual obstetrical reasons.
Open
Fung's statements about Etiologies (Gastroschisis/NEC/Atresia/Volvulus) 71 statements
Open the Etiologies (Gastroschisis/NEC/Atresia/Volvulus) collection →
Omphalocele and Gastroschisis With Dr. Foong-Yen Lim
Quotation
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
Open
Quotation
umbilical is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development
Open
Statement
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.
Open
Statement
Omphalocele is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development.
Open
Quotation
If you see a very high level of alpha fetal protein, think about um, gastroschisis or emphalaceal
Open
Statement
Alpha fetal protein (AFP) is a screening test, but ultrasound imaging is needed to definitively diagnose abdominal wall defects.
Open
Statement
For gastroschisis, only ultrasound confirmed diagnosis is obtained without additional imaging.
Open
Statement
For omphalocele, besides ultrasound, MRI and echocardiogram are routinely obtained because these patients may have other associated anomalies.
Open
Statement
Fetal growth is tracked monthly in gastroschisis and omphalocele cases because there is concern for significant growth restriction.
Open
Statement
Very high level of alpha fetal protein is associated with gastroschisis or omphalocele.
Open
Statement
Biophysical profile and non-stress testing are needed because intrauterine growth restriction and intrauterine fetal demise (IUFD) can occur in these patients.
Open
Statement
If surveillance imaging becomes worrisome enough regarding intrauterine fetal demise, the mother and fetus need to be admitted for continuous monitoring or emergent delivery.
Open
Quotation
Inutero growth restriction, as well as IUFD in utero fetal demise, uh, can occur in this patient
Open
Statement
Gastroschisis 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.
Open
Quotation
It'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
Open
Statement
More than 90% of gastroschisis infants are born less than 2,500 grams in weight due to intrauterine growth restriction.
Open
Statement
Other risk factors for gastroschisis include acetaminophen, vitamin B deficiencies, drug use, and some genetic predispositions.
Open
Statement
Pseudoephedrine has an odds ratio of 4.2 times for gastroschisis compared to aspirin alone at 2.7.
Open
Statement
Major risk factors for omphalocele are trisomy 13, 18, and 21, which occur in anywhere between 35 and 90% of patients with omphalocele.
Open
Statement
Mothers with omphalocele are usually advanced in age compared to the gastroschisis group, with advanced maternal age having an odds ratio of 3.3.
Open
Quotation
Minimizing heat loss and fluid loss in these babies. Otherwise they can show up, uh, extremely dehydrated as well as, um, being cold
Open
Statement
Crucial immediate postnatal procedures include minimizing heat loss and fluid loss, otherwise babies can show up extremely dehydrated and cold.
Open
Quotation
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
Open
Statement
Primary 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.
Open
Statement
Some patients develop intestinal perforation after only two to four days of enteral feeding.
Open
Statement
Staged closure is favored if the defect is large or there are issues with the bowel, including atresia, compromised bowel, or perforation.
Open
Statement
In 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.
Open
Quotation
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
Open
Statement
For small bowel atresia encountered during closure, management options include tapering the dilated portion of bowel or resecting the bowel before tapering.
Open
Statement
For 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.
Open
Statement
After sequential reduction with plastic clips, the patient is taken to the operating room for delayed primary closure of the fascia and skin.
Open
Omphalocele & Gastroschisis
Statement
Omphalocele is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development.
Open
Quotation
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.
Open
Quotation
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.
Open
Statement
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.
Open
Quotation
If you see a very high level of alpha fetal protein, think about um, gastroschisis or umphalocele.
Open
Statement
A very high level of alpha fetal protein should prompt consideration of gastroschisis or omphalocele.
Open
Statement
Alpha fetal protein (AFP) is a great screening test, but ultrasound imaging is needed to definitively diagnose abdominal wall defects.
Open
Quotation
In utero growth restriction as well as IUFD in utero fetal demise, uh, can occur in this patient.
Open
Statement
Biophysical profile and non-stress testing are needed because in utero growth restriction as well as intrauterine fetal demise (IUFD) can occur in these patients.
Open
Statement
If 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.
Open
Statement
Gastroschisis is most common among babies born to young mothers of low gravidity and usually first pregnancy, with 75% being first born.
Open
Statement
More than 90% of gastroschisis infants are born with intrauterine growth restriction, weighing less than 2500 grams.
Open
Statement
Pseudoephedrine-containing pseudofed has an odds ratio of 4.2 times for gastroschisis compared to aspirin alone at 2.7.
Open
Statement
Other risk factors for gastroschisis include vitamin B deficiencies, drug use, and some genetic predispositions.
Open
Quotation
It'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.
Open
Statement
The major risk factors for omphalocele are trisomy 13, 18, and 21, which occur in anywhere between 35 and 90% of patients with omphalocele.
Open
Statement
Mothers of omphalocele babies are usually advanced in age compared to the gastroschisis group, with advanced maternal age having an odds ratio of 3.3.
Open
Quotation
Minimizing heat loss and fluid loss in these babies. Otherwise they can show up, uh, extremely dehydrated as well as, um, being cold.
Open
Statement
Minimizing 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.
Open
Statement
Primary 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.
Open
Quotation
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.
Open
Statement
Staged closure is favored if the defect is large or there's an issue with the bowel, including atresia, compromised bowel, or perforation.
Open
Statement
Some patients develop intestinal perforation after only two to four days of enteral feeding.
Open
Statement
The majority of gastroschisis babies at Cincinnati Children's Hospital in the last four and a half years are managed using a sutureless closure.
Open
Statement
In 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.
Open
Statement
For small bowel atresia encountered in gastroschisis, management options include tapering the dilated portion of bowel or resecting the bowel before tapering.
Open
Statement
For 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.
Open
Statement
At 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.
Open
Fung's statements about Fetal Surgery 57 statements
Open the Fetal Surgery collection →
Fetoscopic Endoluminal Tracheal Occlusion (FETO)
Quotation
This animation shows a prenatal intervention of a congenital diaphragmatic hernia or CDH using phytoscopic endoluminal tracheal occlusion or fetal.
Open
Statement
It is difficult to determine with imaging exactly how large the hole in the diaphragm is in CDH.
Open
Quotation
One thing to note is that it's difficult to determine with imaging exactly how large the hole in the diaphragm is.
Open
Statement
In moderate diaphragmatic hernia, the left lung gets smaller as the intestines and part of the liver push upwards.
Open
Statement
In 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.
Open
Statement
The tracheal occlusion procedure is commonly performed at gestational age between 27 weeks and 29 weeks 6 days.
Open
Statement
Anesthesia for FETO is induced by ultrasound guidance with local anesthetic and numbing medication injected into the mother.
Open
Statement
An introducer is inserted into the amniotic space to allow placement of a fetoscope (small camera) through the introducer into the amniotic space.
Open
Statement
The fetoscope is advanced carefully into the fetal trachea once the baby's mouth is located.
Open
Statement
The 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.
Open
Quotation
The ideal position is in the main trachea below the vocal cords, but above the carina before the trachea splits into the two main bronchi.
Open
Statement
A balloon is inserted into the fetal airway, inflated to completely occlude the trachea, then detached and left in place.
Open
Quotation
The balloon is inflated to completely occlude the trachea before it is detached and left in place.
Open
Statement
If the baby is in proper position, the balloon can be punctured under ultrasound guidance.
Open
Quotation
The deflated balloon is pushed out of the baby's trachea by the lung fluids and poses no risk to the baby's health.
Open
Statement
The deflated balloon is pushed out of the baby's trachea by lung fluids and poses no risk to the baby's health.
Open
Statement
If 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.
Open
Statement
After balloon removal, the mother and fetus are monitored carefully for the remainder of the pregnancy.
Open
Quotation
Ideally, the baby is delivered vaginally a term with a C-section reserved for the usual obstetrical reasons.
Open
Statement
Ideally, the baby is delivered vaginally at term, with cesarean section reserved for the usual obstetrical reasons.
Open
Fetoscopic Repair of Myelomeningocele (MMC)
Quotation
In this fetus with spina bifida, you can see an opening in the back with an exposed spinal cord.
Open
Quotation
In this fetus with spina bifida, you can see an opening in the back with an exposed spinal cord.
Open
Statement
The amniotic cavity is expanded using humidified and heated carbon dioxide, which creates more space to do the repair.
Open
Statement
The amniotic cavity is expanded using humidified and heated carbon dioxide, which creates more space to do the repair.
Open
Statement
A camera is inserted into the amniotic cavity through the first port to enable visualization inside the womb.
Open
Statement
A camera is inserted into the amniotic cavity through the first port to enable visualization inside the womb.
Open
Statement
Two additional ports are placed under direct vision to allow placement of instruments for the repair.
Open
Statement
Two additional ports are placed under direct vision to allow placement of instruments for the repair.
Open
Quotation
This procedure, which is called untethering, allows the placcode to fall back down nicely into the spinal canal.
Open
Quotation
This procedure, which is called untethering, allows the placcode to fall back down nicely into the spinal canal.
Open
Statement
To protect the placode, a patch is placed into the defect and anchored on one end to the baby's back using dissolvable sutures.
Open
Statement
To protect the placode, a patch is placed into the defect and anchored on one end to the baby's back using dissolvable sutures.
Open
Statement
A second patch is placed to give additional protection and is secured with dissolvable sutures.
Open
Statement
A second patch is placed to give additional protection and is secured with dissolvable sutures.
Open
Statement
The skin is closed over the spinal defect using dissolvable sutures when the baby has enough skin to do so.
Open
Statement
The skin is closed over the spinal defect using dissolvable sutures when the baby has enough skin to do so.
Open
Statement
When 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.
Open
Statement
When 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.
Open
Statement
The amniotic fluid that was removed is replaced with warm fluid and antibiotics are placed into the amniotic cavity.
Open
Statement
The amniotic fluid that was removed is replaced with warm fluid and antibiotics are placed into the amniotic cavity.
Open
Fung's statements about Gastroschisis 71 statements
Open the Gastroschisis collection →
Omphalocele and Gastroschisis With Dr. Foong-Yen Lim
Statement
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.
Open
Statement
Omphalocele is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development.
Open
Quotation
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
Open
Quotation
umbilical is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development
Open
Statement
For omphalocele, besides ultrasound, MRI and echocardiogram are routinely obtained because these patients may have other associated anomalies.
Open
Statement
Alpha fetal protein (AFP) is a screening test, but ultrasound imaging is needed to definitively diagnose abdominal wall defects.
Open
Statement
Very high level of alpha fetal protein is associated with gastroschisis or omphalocele.
Open
Quotation
If you see a very high level of alpha fetal protein, think about um, gastroschisis or emphalaceal
Open
Statement
Fetal growth is tracked monthly in gastroschisis and omphalocele cases because there is concern for significant growth restriction.
Open
Statement
For gastroschisis, only ultrasound confirmed diagnosis is obtained without additional imaging.
Open
Quotation
Inutero growth restriction, as well as IUFD in utero fetal demise, uh, can occur in this patient
Open
Statement
Biophysical profile and non-stress testing are needed because intrauterine growth restriction and intrauterine fetal demise (IUFD) can occur in these patients.
Open
Statement
If surveillance imaging becomes worrisome enough regarding intrauterine fetal demise, the mother and fetus need to be admitted for continuous monitoring or emergent delivery.
Open
Statement
Other risk factors for gastroschisis include acetaminophen, vitamin B deficiencies, drug use, and some genetic predispositions.
Open
Statement
Pseudoephedrine has an odds ratio of 4.2 times for gastroschisis compared to aspirin alone at 2.7.
Open
Statement
More than 90% of gastroschisis infants are born less than 2,500 grams in weight due to intrauterine growth restriction.
Open
Statement
Gastroschisis 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.
Open
Quotation
It'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
Open
Statement
Major risk factors for omphalocele are trisomy 13, 18, and 21, which occur in anywhere between 35 and 90% of patients with omphalocele.
Open
Statement
Mothers with omphalocele are usually advanced in age compared to the gastroschisis group, with advanced maternal age having an odds ratio of 3.3.
Open
Quotation
Minimizing heat loss and fluid loss in these babies. Otherwise they can show up, uh, extremely dehydrated as well as, um, being cold
Open
Statement
Crucial immediate postnatal procedures include minimizing heat loss and fluid loss, otherwise babies can show up extremely dehydrated and cold.
Open
Quotation
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
Open
Statement
Primary 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.
Open
Statement
Some patients develop intestinal perforation after only two to four days of enteral feeding.
Open
Statement
Staged closure is favored if the defect is large or there are issues with the bowel, including atresia, compromised bowel, or perforation.
Open
Quotation
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
Open
Statement
In 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.
Open
Statement
For small bowel atresia encountered during closure, management options include tapering the dilated portion of bowel or resecting the bowel before tapering.
Open
Statement
For 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.
Open
Statement
After sequential reduction with plastic clips, the patient is taken to the operating room for delayed primary closure of the fascia and skin.
Open
Omphalocele & Gastroschisis
Statement
Omphalocele is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development.
Open
Quotation
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.
Open
Quotation
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.
Open
Statement
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.
Open
Statement
Alpha fetal protein (AFP) is a great screening test, but ultrasound imaging is needed to definitively diagnose abdominal wall defects.
Open
Quotation
If you see a very high level of alpha fetal protein, think about um, gastroschisis or umphalocele.
Open
Statement
A very high level of alpha fetal protein should prompt consideration of gastroschisis or omphalocele.
Open
Quotation
In utero growth restriction as well as IUFD in utero fetal demise, uh, can occur in this patient.
Open
Statement
If 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.
Open
Statement
Biophysical profile and non-stress testing are needed because in utero growth restriction as well as intrauterine fetal demise (IUFD) can occur in these patients.
Open
Quotation
It'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.
Open
Statement
Other risk factors for gastroschisis include vitamin B deficiencies, drug use, and some genetic predispositions.
Open
Statement
Pseudoephedrine-containing pseudofed has an odds ratio of 4.2 times for gastroschisis compared to aspirin alone at 2.7.
Open
Statement
More than 90% of gastroschisis infants are born with intrauterine growth restriction, weighing less than 2500 grams.
Open
Statement
Gastroschisis is most common among babies born to young mothers of low gravidity and usually first pregnancy, with 75% being first born.
Open
Statement
Mothers of omphalocele babies are usually advanced in age compared to the gastroschisis group, with advanced maternal age having an odds ratio of 3.3.
Open
Statement
The major risk factors for omphalocele are trisomy 13, 18, and 21, which occur in anywhere between 35 and 90% of patients with omphalocele.
Open
Quotation
Minimizing heat loss and fluid loss in these babies. Otherwise they can show up, uh, extremely dehydrated as well as, um, being cold.
Open
Statement
Minimizing 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.
Open
Quotation
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.
Open
Statement
Primary 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.
Open
Statement
Some patients develop intestinal perforation after only two to four days of enteral feeding.
Open
Statement
Staged closure is favored if the defect is large or there's an issue with the bowel, including atresia, compromised bowel, or perforation.
Open
Statement
The majority of gastroschisis babies at Cincinnati Children's Hospital in the last four and a half years are managed using a sutureless closure.
Open
Statement
In 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.
Open
Statement
For small bowel atresia encountered in gastroschisis, management options include tapering the dilated portion of bowel or resecting the bowel before tapering.
Open
Statement
At 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.
Open
Statement
For 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.
Open
Fung's statements about Intestinal Rehab 71 statements
Open the Intestinal Rehab collection →
Omphalocele and Gastroschisis With Dr. Foong-Yen Lim
Statement
Omphalocele is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development.
Open
Quotation
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
Open
Statement
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.
Open
Quotation
umbilical is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development
Open
Statement
Fetal growth is tracked monthly in gastroschisis and omphalocele cases because there is concern for significant growth restriction.
Open
Quotation
If you see a very high level of alpha fetal protein, think about um, gastroschisis or emphalaceal
Open
Statement
For omphalocele, besides ultrasound, MRI and echocardiogram are routinely obtained because these patients may have other associated anomalies.
Open
Statement
For gastroschisis, only ultrasound confirmed diagnosis is obtained without additional imaging.
Open
Statement
Alpha fetal protein (AFP) is a screening test, but ultrasound imaging is needed to definitively diagnose abdominal wall defects.
Open
Statement
Very high level of alpha fetal protein is associated with gastroschisis or omphalocele.
Open
Quotation
Inutero growth restriction, as well as IUFD in utero fetal demise, uh, can occur in this patient
Open
Statement
Biophysical profile and non-stress testing are needed because intrauterine growth restriction and intrauterine fetal demise (IUFD) can occur in these patients.
Open
Statement
If surveillance imaging becomes worrisome enough regarding intrauterine fetal demise, the mother and fetus need to be admitted for continuous monitoring or emergent delivery.
Open
Statement
Gastroschisis 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.
Open
Statement
Other risk factors for gastroschisis include acetaminophen, vitamin B deficiencies, drug use, and some genetic predispositions.
Open
Quotation
It'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
Open
Statement
Pseudoephedrine has an odds ratio of 4.2 times for gastroschisis compared to aspirin alone at 2.7.
Open
Statement
More than 90% of gastroschisis infants are born less than 2,500 grams in weight due to intrauterine growth restriction.
Open
Statement
Mothers with omphalocele are usually advanced in age compared to the gastroschisis group, with advanced maternal age having an odds ratio of 3.3.
Open
Statement
Major risk factors for omphalocele are trisomy 13, 18, and 21, which occur in anywhere between 35 and 90% of patients with omphalocele.
Open
Quotation
Minimizing heat loss and fluid loss in these babies. Otherwise they can show up, uh, extremely dehydrated as well as, um, being cold
Open
Statement
Crucial immediate postnatal procedures include minimizing heat loss and fluid loss, otherwise babies can show up extremely dehydrated and cold.
Open
Quotation
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
Open
Statement
Primary 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.
Open
Statement
Some patients develop intestinal perforation after only two to four days of enteral feeding.
Open
Statement
Staged closure is favored if the defect is large or there are issues with the bowel, including atresia, compromised bowel, or perforation.
Open
Quotation
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
Open
Statement
In 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.
Open
Statement
For small bowel atresia encountered during closure, management options include tapering the dilated portion of bowel or resecting the bowel before tapering.
Open
Statement
For 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.
Open
Statement
After sequential reduction with plastic clips, the patient is taken to the operating room for delayed primary closure of the fascia and skin.
Open
Omphalocele & Gastroschisis
Quotation
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.
Open
Statement
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.
Open
Quotation
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.
Open
Statement
Omphalocele is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development.
Open
Statement
A very high level of alpha fetal protein should prompt consideration of gastroschisis or omphalocele.
Open
Quotation
If you see a very high level of alpha fetal protein, think about um, gastroschisis or umphalocele.
Open
Statement
Alpha fetal protein (AFP) is a great screening test, but ultrasound imaging is needed to definitively diagnose abdominal wall defects.
Open
Statement
Biophysical profile and non-stress testing are needed because in utero growth restriction as well as intrauterine fetal demise (IUFD) can occur in these patients.
Open
Quotation
In utero growth restriction as well as IUFD in utero fetal demise, uh, can occur in this patient.
Open
Statement
If 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.
Open
Quotation
It'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.
Open
Statement
Other risk factors for gastroschisis include vitamin B deficiencies, drug use, and some genetic predispositions.
Open
Statement
Pseudoephedrine-containing pseudofed has an odds ratio of 4.2 times for gastroschisis compared to aspirin alone at 2.7.
Open
Statement
More than 90% of gastroschisis infants are born with intrauterine growth restriction, weighing less than 2500 grams.
Open
Statement
Gastroschisis is most common among babies born to young mothers of low gravidity and usually first pregnancy, with 75% being first born.
Open
Statement
Mothers of omphalocele babies are usually advanced in age compared to the gastroschisis group, with advanced maternal age having an odds ratio of 3.3.
Open
Statement
The major risk factors for omphalocele are trisomy 13, 18, and 21, which occur in anywhere between 35 and 90% of patients with omphalocele.
Open
Quotation
Minimizing heat loss and fluid loss in these babies. Otherwise they can show up, uh, extremely dehydrated as well as, um, being cold.
Open
Statement
Minimizing 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.
Open
Quotation
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.
Open
Statement
Primary 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.
Open
Statement
Staged closure is favored if the defect is large or there's an issue with the bowel, including atresia, compromised bowel, or perforation.
Open
Statement
Some patients develop intestinal perforation after only two to four days of enteral feeding.
Open
Statement
The majority of gastroschisis babies at Cincinnati Children's Hospital in the last four and a half years are managed using a sutureless closure.
Open
Statement
In 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.
Open
Statement
For small bowel atresia encountered in gastroschisis, management options include tapering the dilated portion of bowel or resecting the bowel before tapering.
Open
Statement
For 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.
Open
Statement
At 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.
Open
Fung's statements about Myelomeningocele 17 statements
Open the Myelomeningocele collection →
Fetoscopic Repair of Myelomeningocele (MMC)
Quotation
In this fetus with spina bifida, you can see an opening in the back with an exposed spinal cord.
Open
Statement
The amniotic cavity is expanded using humidified and heated carbon dioxide, which creates more space to do the repair.
Open
Statement
A camera is inserted into the amniotic cavity through the first port to enable visualization inside the womb.
Open
Statement
Two additional ports are placed under direct vision to allow placement of instruments for the repair.
Open
Quotation
This procedure, which is called untethering, allows the placcode to fall back down nicely into the spinal canal.
Open
Statement
To protect the placode, a patch is placed into the defect and anchored on one end to the baby's back using dissolvable sutures.
Open
Statement
A second patch is placed to give additional protection and is secured with dissolvable sutures.
Open
Statement
The skin is closed over the spinal defect using dissolvable sutures when the baby has enough skin to do so.
Open
Statement
When 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.
Open
Statement
The amniotic fluid that was removed is replaced with warm fluid and antibiotics are placed into the amniotic cavity.
Open
Fung's statements about Omphalocele 71 statements
Open the Omphalocele collection →
Omphalocele and Gastroschisis With Dr. Foong-Yen Lim
Statement
Omphalocele is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development.
Open
Quotation
umbilical is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development
Open
Quotation
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
Open
Statement
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.
Open
Statement
Alpha fetal protein (AFP) is a screening test, but ultrasound imaging is needed to definitively diagnose abdominal wall defects.
Open
Statement
Very high level of alpha fetal protein is associated with gastroschisis or omphalocele.
Open
Quotation
If you see a very high level of alpha fetal protein, think about um, gastroschisis or emphalaceal
Open
Statement
For omphalocele, besides ultrasound, MRI and echocardiogram are routinely obtained because these patients may have other associated anomalies.
Open
Statement
Fetal growth is tracked monthly in gastroschisis and omphalocele cases because there is concern for significant growth restriction.
Open
Statement
For gastroschisis, only ultrasound confirmed diagnosis is obtained without additional imaging.
Open
Quotation
Inutero growth restriction, as well as IUFD in utero fetal demise, uh, can occur in this patient
Open
Statement
Biophysical profile and non-stress testing are needed because intrauterine growth restriction and intrauterine fetal demise (IUFD) can occur in these patients.
Open
Statement
If surveillance imaging becomes worrisome enough regarding intrauterine fetal demise, the mother and fetus need to be admitted for continuous monitoring or emergent delivery.
Open
Statement
Pseudoephedrine has an odds ratio of 4.2 times for gastroschisis compared to aspirin alone at 2.7.
Open
Quotation
It'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
Open
Statement
Gastroschisis 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.
Open
Statement
More than 90% of gastroschisis infants are born less than 2,500 grams in weight due to intrauterine growth restriction.
Open
Statement
Other risk factors for gastroschisis include acetaminophen, vitamin B deficiencies, drug use, and some genetic predispositions.
Open
Statement
Mothers with omphalocele are usually advanced in age compared to the gastroschisis group, with advanced maternal age having an odds ratio of 3.3.
Open
Statement
Major risk factors for omphalocele are trisomy 13, 18, and 21, which occur in anywhere between 35 and 90% of patients with omphalocele.
Open
Quotation
Minimizing heat loss and fluid loss in these babies. Otherwise they can show up, uh, extremely dehydrated as well as, um, being cold
Open
Statement
Crucial immediate postnatal procedures include minimizing heat loss and fluid loss, otherwise babies can show up extremely dehydrated and cold.
Open
Statement
Primary 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.
Open
Quotation
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
Open
Statement
Some patients develop intestinal perforation after only two to four days of enteral feeding.
Open
Statement
Staged closure is favored if the defect is large or there are issues with the bowel, including atresia, compromised bowel, or perforation.
Open
Quotation
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
Open
Statement
In 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.
Open
Statement
For small bowel atresia encountered during closure, management options include tapering the dilated portion of bowel or resecting the bowel before tapering.
Open
Statement
For 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.
Open
Statement
After sequential reduction with plastic clips, the patient is taken to the operating room for delayed primary closure of the fascia and skin.
Open
Omphalocele & Gastroschisis
Statement
Omphalocele is a congenital disorder and can have associated anomalies, but gastroschisis occurs in otherwise normal babies that have an intrauterine event during development.
Open
Statement
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.
Open
Quotation
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.
Open
Quotation
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.
Open
Quotation
If you see a very high level of alpha fetal protein, think about um, gastroschisis or umphalocele.
Open
Statement
A very high level of alpha fetal protein should prompt consideration of gastroschisis or omphalocele.
Open
Statement
Alpha fetal protein (AFP) is a great screening test, but ultrasound imaging is needed to definitively diagnose abdominal wall defects.
Open
Quotation
In utero growth restriction as well as IUFD in utero fetal demise, uh, can occur in this patient.
Open
Statement
If 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.
Open
Statement
Biophysical profile and non-stress testing are needed because in utero growth restriction as well as intrauterine fetal demise (IUFD) can occur in these patients.
Open
Statement
Gastroschisis is most common among babies born to young mothers of low gravidity and usually first pregnancy, with 75% being first born.
Open
Statement
More than 90% of gastroschisis infants are born with intrauterine growth restriction, weighing less than 2500 grams.
Open
Statement
Other risk factors for gastroschisis include vitamin B deficiencies, drug use, and some genetic predispositions.
Open
Statement
Pseudoephedrine-containing pseudofed has an odds ratio of 4.2 times for gastroschisis compared to aspirin alone at 2.7.
Open
Quotation
It'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.
Open
Statement
Mothers of omphalocele babies are usually advanced in age compared to the gastroschisis group, with advanced maternal age having an odds ratio of 3.3.
Open
Statement
The major risk factors for omphalocele are trisomy 13, 18, and 21, which occur in anywhere between 35 and 90% of patients with omphalocele.
Open
Statement
Minimizing 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.
Open
Quotation
Minimizing heat loss and fluid loss in these babies. Otherwise they can show up, uh, extremely dehydrated as well as, um, being cold.
Open
Quotation
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.
Open
Statement
Primary 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.
Open
Statement
Some patients develop intestinal perforation after only two to four days of enteral feeding.
Open
Statement
Staged closure is favored if the defect is large or there's an issue with the bowel, including atresia, compromised bowel, or perforation.
Open
Statement
The majority of gastroschisis babies at Cincinnati Children's Hospital in the last four and a half years are managed using a sutureless closure.
Open
Statement
In 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.
Open
Statement
For small bowel atresia encountered in gastroschisis, management options include tapering the dilated portion of bowel or resecting the bowel before tapering.
Open
Statement
At 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.
Open
Statement
For 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.
Open
Fung's statements about Spina Bifida 17 statements
Open the Spina Bifida collection →
Fetoscopic Repair of Myelomeningocele (MMC)
Quotation
In this fetus with spina bifida, you can see an opening in the back with an exposed spinal cord.
Open
Statement
The amniotic cavity is expanded using humidified and heated carbon dioxide, which creates more space to do the repair.
Open
Statement
A camera is inserted into the amniotic cavity through the first port to enable visualization inside the womb.
Open
Statement
Two additional ports are placed under direct vision to allow placement of instruments for the repair.
Open
Quotation
This procedure, which is called untethering, allows the placcode to fall back down nicely into the spinal canal.
Open
Statement
To protect the placode, a patch is placed into the defect and anchored on one end to the baby's back using dissolvable sutures.
Open
Statement
A second patch is placed to give additional protection and is secured with dissolvable sutures.
Open
Statement
The skin is closed over the spinal defect using dissolvable sutures when the baby has enough skin to do so.
Open
Statement
When 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.
Open
Statement
The amniotic fluid that was removed is replaced with warm fluid and antibiotics are placed into the amniotic cavity.
Open