Amnioexchange for fetuses with gastroschisis: is it effective?

Paola Midrio, Giorgio Stefanutti, Michele Mussap, Donato D'Antona, Elisa Zolpi, Piergiorgio Gamba

Research output: Contribution to journalArticlepeer-review

Abstract

Background/Purpose: Amniotic fluid of fetuses with gastroschisis (GS) contains inflammatory mediators, gastrointestinal, and urinary waste products. Dilution and removal of such harmful substances have been advocated to prevent damage to the herniated intestine. We evaluated the effectiveness of serial amnioexchange procedures in 8 consecutive fetuses with GS. Methods: Amnioexchange was performed bimonthly during the third trimester. Amniotic fluid collected before each procedure was tested for pH, osmolarity, urea, creatinine, cystatin-C, proteins, albumin, bilirubin, biliary salts, pancreatic amylase, serum amyloid A, C-reactive protein, alanine transaminase (ALT), alcaline phosphatase (ALP), gamma-glutamyl transpetidase (γGT), tumor necrosis factor α, interleukin 2, interleukin 6, epidermal growth factor, transforming growth factor β, and myeloperoxidase. Results: A total of 25 samples (median, 3 per fetus) were examined. Biochemical or inflammatory markers did not correlate with gestational age, nor was any trend observed in values from individual patients during the course of amnioexchange treatment. There was no correlation between biochemical or inflammatory markers and clinical outcome, including time to full enteral feeding. Conclusions: Serial amnioexchanges did not modify the biochemical or inflammatory status of amniotic fluid nor appeared to prevent injury to the herniated gut. Because repeated amnioexchanges may carry some risks, their use in fetuses with GS is not recommended outside the setting of a prospective randomized trial.

Original languageEnglish
Pages (from-to)777-782
Number of pages6
JournalJournal of Pediatric Surgery
Volume42
Issue number5
DOIs
Publication statusPublished - Jul 2007

Keywords

  • Amnioexchange
  • Amnioinfusion
  • Gastroschisis
  • Inflammatory mediators

ASJC Scopus subject areas

  • Surgery

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