In this retrospective study, the use of tissue glue, dural grafts, and external ventricular drainage was not associated with a reduced rate of clinically or radiologically diagnosed pseudomeningocele formation or postoperative CSF leak. The results of this study provide a basis for planning a randomized controlled trial to determine the effectiveness of tissue glue and/or dural grafting in preventing these complications.
Objective: To identify perinatal risk variables predictive of outcome in gastroschisis.Study Design: Gastroschisis cases were collected over a 3-year period from a national database. Risk variables evaluated included gestational age (GA), birth weight, time of birth, admission illness severity (score for neonatal acute physiology-II, SNAP-II) score, and abdominal closure type. Mortality and survival outcomes were analyzed. Multivariate analyses were performed.Result: In all, 239 infants were survived (96%). SNAP-II score predicted mortality (relative risk (RR) ¼ 1.07, 95% confidence interval (CI) ¼ 1.0 to 1.1). Length of hospital stay (LOS) and ventilation days were predicted by GA and by SNAP-II score. SNAP-II score predicted total parenteral nutrition (TPN) days (P ¼ 0.006). Severe cholestasis (conjugated bilirubin of >10 mg per 100 ml) was inversely related to GA (RR ¼ 0.77, 95% CI ¼ 0.61 to 0.97) and directly to categorical SNAP-II score (RR ¼ 3.4, 95% CI ¼ 1.2 to 10.1). Urgent closure predicted fewer TPN days (P ¼ 0.003) and shorter LOS (P ¼ 0.0002).Conclusion: SNAP-II scores significantly predict mortality and survival outcomes. Urgent closure favors fewer TPN days and shorter LOS. Our data refute routine preterm delivery in gastroschisis.
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