Gastroschisis: preterm or term delivery?

Abstract

AIMThe main objective of this study was to evaluate the association between prematurity and the time to achieve full enteral feeding in newborns with gastroschisis. The second objective was to analyze the associations between length of hospital stay and time to achieve full enteral feeding with mode of delivery, birth weight and surgical procedure.METHODSThe medical records of newborns with gastroschisis treated between 1997 and 2007 were reviewed. Two groups were considered: those delivered before 37 weeks (group A) and those delivered after 37 weeks (group B). The variables of gestational age, mode of delivery, birth weight, time to achieve full enteral feeding, length of hospital stay and surgical approach were analyzed and compared between groups.RESULTSForty-one patients were studied. In Group A, there were 14 patients with a mean birth weight (BW) of 2300 g (range=1680–3000) and a mean gestational age (GA) of 36 weeks (range=34–36). In group B, there were 24 patients with a mean BW of 2700 g (range=1500–3550) and a mean GA of 38 weeks (range=37–39). The mean time to achieve full enteral feeding was 30.1±6.7 days in group A and 17.0±2.5 days in group B (p=0.09) with an OR of 0.82 and a 95% CI of 0.20–3.23 after adjustment for sepsis and BW. No statistical difference was found between low BW (<2500 g), mode of delivery and number of days to achieve full enteral feeding (p=0.34 and p=0.13, respectively). Patients with BW over 2500 g had fewer days in the hospital (22.9±3.1 vs. 35.7±5.7 days; p=0.06).CONCLUSIONThe results of this study do not support the idea of anticipating the delivery of fetuses with gastroschisis in order to achieve full enteral feeding earlier.

Gastroschisis. Case report and management in primary care services

“…(13,14) The risk factors associated with the disease are prematurity; small for gestational age newborns; maternal age <20 years; being born to a primigravida mother; Caucasian race; Hispanic mothers; maternal malnutrition; exposure to nitrosamines; teratogens and agrochemicals; consumption of nonsteroidal anti-inflammatory drugs and acetaminophen in the first trimester; cigarette, alcohol and illicit drugs consumption; low socioeconomic class; absence of prenatal checkups, and short cohabitation with the father of the child.…”

Ferritin and bile acid levels during the intrauterine pre-treatment of gastroschisis by serial amnioexchange

“…The amnioexchange procedure reduced the hospital stay time almost by half in the present study. Additionally, in term deliveries of fetuses with gastroschisis, the mean time to achieve enteral feeding was 17 days (9). In our study, the amnioexchange procedure seemed to reduce this value.…”

Outcomes in infants with prenatally diagnosed gastroschisis and planned preterm delivery

“…Most of these studies divided the patients more crudely into those born before or after 37 GA, without stratifying the degree of prematurity. Lastly, several studies have failed to demonstrate any difference in outcome between preterm and term delivery [32,42]. These include a small randomized controlled trial [23] and a recently published Cochrane review [14].…”

“…Contradictory results have also been reported regarding the gestational age at induced delivery, preterm vs term. Preterm delivery has been associated with more complications, longer hospital stay and longer time to full enteral feeds, [31,32]. At the same time, others advocate for early deliver to ameliorate damage to the bowel due to the prolonged exposure to toxic substances in the amniotic fluid as well as mechanical obstruction secondary to the inflammatory ongoing process [26,29,33].…”