Gastroschisis: determinants of neonatal outcome

Singh, Sonali; Fraser, Alyssa; Leditschke, J. F.; Spence, Kenneth W.; Kimble, Roy M.; Dalby‐Payne, Jacqueline R; Baskaranathan, S.; Barr, Peter; Halliday, Robert; Badawi, Nadia; Peat, Jennifer K.; Glasson, M. J.; Cass, Danny

doi:10.1007/s00383-002-0886-0

Cited by 71 publications

(55 citation statements)

References 31 publications

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“…This has been confirmed in other published reports, in which either no benefit to routine caesarean section or an adverse outcome with vaginal delivery was shown [11][12][13][14]. As there is no clear benefit of elective caesarean section over vaginal delivery, in our opinion the decision should only be guided by obstetrical indications.…”

Section: Discussionsupporting

confidence: 79%

“…To determine whether presence of intestinal pathology influences outcome, we defined compromised bowel as the presence of intestinal atresia, severe ischemia, necrosis, volvulus, perforation or a combination. In the literature several other factors have also been found to be associated with adverse outcome, including marked prematurity, mode of delivery and method of closure [3,4,[9][10][11].…”

Section: Discussionmentioning

confidence: 99%

“…In several outcome analyses the presence of marked prematurity or intestinal pathology with malrotation, volvulus, infarction, atresia, perforation or stenosis have been recognized as factors associated with adverse outcome [3,4,[9][10][11].…”

Section: Introductionmentioning

confidence: 99%

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Factors determining outcome in gastroschisis: clinical experience over 18 years

Jager

Heij

2007

Pediatr Surg Int

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Although the survival in gastroschisis has improved to more than 85%, serious morbidity with consequent long hospital stay is still very common. Alternative strategies such as planned early delivery and amniotic fluid exchange are being explored. In order to evaluate these approaches, adequate risk stratification of patients with gastroschisis is required. The aim of this study was to identify the risk factors associated with increased morbidity and mortality. A retrospective analysis of all patients with gastroschisis treated at our institution between 1988 and 2005 was conducted. Patients' data were collected from the files and compared for statistical significance with three outcome measures: (1) complicated post-operative course; (2) time to full enteral feeding (TFE); (3) length of hospital stay (LOS). SPSS was used for statistical analysis. Fifty-nine newborns with gastroschisis were admitted during the study period. Antenatal diagnosis was made in 40 cases (68%). Associated malformations (other than intestinal anomalies) were present in eight patients. One patient with trisomy 13 was excluded from the analysis. Ten patients (17%) had compromised bowel (atresia, severe ischaemia or a combination). Primary repair was successful in 47 (81%) and in 11 patients a silo was applied. Overall survival was 54/58 children (93%), four patients died. Complications associated with closure occurred in eight patients. Postoperative course was uncomplicated in 45 patients and complicated in 13. The RR for patients with compromised bowel to have a complicated post-operative course is 9 (95% CI 2-39) and the RR to die is 20 (95% CI 2-222) for these patients. Risk stratification of patients with gastroschisis appears possible based on the presence of compromised bowel before closure.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

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Factors determining outcome in gastroschisis: clinical experience over 18 years

Jager

Heij

2007

Pediatr Surg Int

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“…The ideal method of abdominal wall closure has been previously evaluated in terms of mortality, length of hospitalization, time on parenteral nutrition and time to initiate or achieve full enteral feeds. [12][13][14][15] Yet, one could argue that aside from mortality, none of those outcomes are relevant if they come at the expense of continued, prolonged morbidity after discharge. In our sample, infants undergoing primary closure were more likely to be readmitted for bowel obstruction, however, this did not reach statistical significance.…”

Section: Discussionmentioning

confidence: 99%

Hospital readmission among infants with gastroschisis

et al. 2011

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Objective: Infants with gastroschisis have significant perinatal morbidity including long hospitalizations and feeding intolerance. Two thirds are premature and 20% are growth restricted. Despite these known risk factors for post-natal complications, little is known about readmission for infants with gastroschisis. Our objective was to determine the frequency and indication for hospital readmission after initial discharge among infants with gastroschisis.Study Design: Retrospective cohort study. All surviving infants treated for gastroschisis at Cincinnati Children's Hospital Medical Center, born between January 2006 and December 2008 were included. Main outcome measures included the frequency and indication for readmission. Associated neonatal risk factors also were assessed.Result: Fifty-eight patients were analyzed. Twenty-three (40%) subjects were readmitted (five with multiple readmissions); 65% of readmissions occurred in the first year and 70% involved complications directly related to gastroschisis. The most common reasons for readmission were bowel obstruction and abdominal distention/pain. Median time to readmission directly related to gastroschisis was 23 weeks (range 5 to 92). All three infants with home parenteral nutrition were readmitted. Readmission was not associated with gestational age, birth weight or length of initial hospitalization.Conclusion: Readmission after initial hospitalization is common in gastroschisis patients. Parental counseling should include education regarding the possibility of complications requiring readmission. Determinants of readmission require further study.

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“…1 Survival is greater than 90%. 2,3 The most common neonatal morbidities associated with gastroschisis include gastroesophageal reflux disease (GERD), feeding intolerance due to prolonged intestinal dysmotility and sepsis. 4 Infants with gastroschisis frequently have risk factors for impaired growth and delayed neurodevelopment, including premature birth, small for gestational age (SGA) or nutritional compromise early in life.…”

Section: Introductionmentioning

confidence: 99%

Growth and neurodevelopment at 16 to 24 months of age for infants born with gastroschisis

et al. 2008

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Objective: To examine growth, neurodevelopment and morbidity in infants with gastroschisis. Study Design:We enrolled all infants with gastroschisis treated at the North Carolina Children's Hospital from March 2003 through June 2005. Neonatal data were collected. Medical history, growth and neurodevelopment were assessed at 16 to 24 months.Result: Of 24 infants, 17 completed follow-up. Weight and length were below the 10th percentile for five and six infants, respectively. Three infants scored less than 85 on the Bayley Scales of Infant Development, second edition. Small for gestational age (SGA) infants were smaller and had lower neurodevelopmental scores. Fourteen experienced continued bowel dysfunction; nine were rehospitalized. Conclusion:One-third of infants with gastroschisis experience growth delay. Infants who are SGA are at higher risk, suggesting that postnatal growth may be influenced by fetal phenomena, and may not be modifiable. Neurodevelopment is not delayed. Continued bowel dysfunction is common.

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Gastroschisis: determinants of neonatal outcome

Cited by 71 publications

References 31 publications

Factors determining outcome in gastroschisis: clinical experience over 18 years

Factors determining outcome in gastroschisis: clinical experience over 18 years

Hospital readmission among infants with gastroschisis

Growth and neurodevelopment at 16 to 24 months of age for infants born with gastroschisis

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