Perinatal predictors of outcome in gastroschisis

Abstract

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.

Score for Neonatal Acute Physiology–II and Neonatal Pain Predict Corticospinal Tract Development in Premature Newborns

“…SNAP-II was initially developed to predict mortality of infants admitted to neonatal intensive care units [14]. Several studies have reported that SNAP-II is predictive of infant mortality for various conditions, including prematurity [15,35,36], congenital diaphragmatic hernia [37][38][39], gastroschisis [40], respiratory distress [41], and persistent pulmonary hypertension [42]. However, SNAP-II has also been shown to be predictive of brain abnormalities in the preterm population, specifically suppressed amplitude-integrated electroencephalographic activity [43], intraventricular hemorrhage [15,44], moderate to severe ventriculomegaly, and echodense lesions in white matter [15].…”

The gastroschisis prognostic score: reliable outcome prediction in gastroschisis

“…This finding may reflect the failure of these individual variables to enhance the predictive ability already encompassed by the GPS, a potentially stronger predictor of outcome. An examination of the individual risk attributes of SNAP-II suggests that its predictive ability is focused on the uncommon clinical scenario of the physiologically unstable infant with gastroschisis [15]. Indeed, the risk of mortality was increased only for those infants with SNAP-II scores greater than 28, a value far exceeding the average SNAP-II score of 8 observed in the patient population with gastroschisis used in this study [15].…”

“…Recently, the CAPSNet database used SNAP-II scoring to predict mortality in patients with gastroschisis [15]. This assessment, however, still required 12 hours of intensive hemodynamic, respiratory, and laboratory surveillance to calculate.…”

“…The individual components of the gastroschisis bowel injury scoring tool (matting, perforation, atresia, necrosis), as well as other putative outcome predictors identified in the literature, including gestational age, birth weight, and SNAP-II [7,8,15], were subject to univariate analysis to identify those variables that were predictive of mortality. Variables displaying continued outcome prediction by logistic regression analyses were subsequently reweighted to derive a new prognostic score, denoted the gastroschisis prognostic score (GPS).…”

Institutional practice and outcome variation in the management of congenital diaphragmatic hernia and gastroschisis in Canada: a report from the Canadian Pediatric Surgery Network

“…Treatment was considered to include a prenatal phase (prenatal diagnostic workup); an intrapartum phase, including obstetrical planning and actual intrapartum management; and a condition-specific phase of postnatal treatment. Reported risk factors included maternal (age, smoking, and drug use for GS) and neonatal criteria such as gestational age, birth weight, and Score for Neonatal Acute Physiology (SNAP-II) [6], a validated outcome predictor for both CDH and GS [7,8] …”