Hospital readmission among infants with gastroschisis

Abstract

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.

Opioid Use Disorder in Pregnancy

“…50 Further, more work is needed to explore the potential positive impact of NAS care delivery models that minimize separation of the mother-infant dyad and that minimize adverse post-discharge outcomes such as readmission. 51 …”

The Eccentricities of Nourishing the Infant With Abdominal Anomalies

“…After surgical repair, all infants are at increased risk of ileus and small bowel obstructions, frequent complications experienced throughout childhood. 17 In a study by Phillips, approximately 43% of gastroschisis/intestinal atresia patients were found to have significant dysmotility without having a severely shortened length of bowel typically seen in short bowel syndrome (SBS) or without having a true obstruction. Remaining bowel lengths ranged from 66 to 233 cm.…”

“…1 Associated abnormalities, such as intestinal stenosis, atresia(s), volvulus, and so forth, occur in 10% to 20% of all gastroschisis cases, and all patients have intestinal malrotation. [16][17] The cause of gastroschisis is unknown but is thought to arise either from an ischemic insult to the developing abdominal wall or from an early rupture of a hernia in the umbilical cord. 13 Currently 3 to 4.5 infants are born with gastroschisis per 10 000 births 13 but, for unknown reasons, the rate is increasing dramatically, [16][17] commonly occurring in young mothers.…”

“…[16][17] The cause of gastroschisis is unknown but is thought to arise either from an ischemic insult to the developing abdominal wall or from an early rupture of a hernia in the umbilical cord. 13 Currently 3 to 4.5 infants are born with gastroschisis per 10 000 births 13 but, for unknown reasons, the rate is increasing dramatically, [16][17] commonly occurring in young mothers. [18][19] In multiple studies, the average gestational age of patients born with gastroschisis is 35 to 36 weeks, just meeting the criteria for premature birth.…”

“…[18][19] In multiple studies, the average gestational age of patients born with gastroschisis is 35 to 36 weeks, just meeting the criteria for premature birth. 17,20 Surgical objectives include protecting the intestine, returning it to the abdominal cavity, closing the defect, and repairing-associated atresias when present. In many cases, the intestine may be gently reduced back into the abdominal cavity at the bedside within hours after birth, and the defect closed with a stitch or even a simple pressure dressing.…”