Predicting the outcome of newborns with gastroschisis

Abstract

Objective-Determine factors predicting outcome in newborns with gastroschisisMethods-Retrospective analysis of 155 consecutive cases admitted from 1 January 1990 to 31 December 2007. Prenatal ultrasound findings were available for 89/155 (57%) patients and were compared to final outcome. Both univariate and multiple regression analyses were used.Results-All patients survived to discharge home. The primary outcome measure was length of stay (LOS). Multiple regression identified four factors associated with LOS: 1) gestational age (p=0.004), 2) non-elective silo (p<0.001), 3) gastrointestinal (GI) complication (intestinal atresia, perforation, or resection) (p<0.001), and 4) non-GI anomaly (p=0.029). Non-GI anomalies occurred in 17/155 (11%) patients and tended to increase the risk of a non-elective silo or GI complication (59% vs. 39%, p=0.190). Dilated bowel (>10 mm) on prenatal ultrasound was associated with GI complications (22% vs. 3%, p=0.010). However, 78% of patients with dilated bowel on prenatal ultrasound did not have a GI complication. The absence of dilated bowel on prenatal ultrasound accurately predicted the absence of GI complications in 97% of cases.Conclusion-Prematurity, non-elective silo, GI complications, and non-GI anomalies predict the short-term outcome of newborns with gastroschisis. Prenatal ultrasound serves primarily to predict the absence of GI complications.

Prenatal Risk Factors and Outcomes in Gastroschisis: A Meta-Analysis

“…Two studies 10,30 explored the relationship between polyhydramnios and LOS but failed to find a significant association (Table 5). There was no study analyzing the association between polyhydramnios and TFEF.…”

“…Recently, several ultrasound signs, such as bowel dilatation, polyhydramnios, and bowel wall thickness (BWT), have been reported to be associated with the occurrence of unfavorable outcomes and, in particular, with BA. 5,[8][9][10][11] However, these studies were often based on small sample sizes, and the results did not reach good evidence examining single data sets in isolation.…”

Recent Advances in Neonatal Gastroenterology and Neonatal Nutrition

“…Development of polyhydromnios (Japaraj et al 2003) or of progressive bowel dilatation is considered by some to indicate a poor prognosis (David et al 2008, Payne et al 2009) and may warrant early delivery.…”

Surgically Correctable Fetal Anomalies: Ultrasound Diagnosis and Management

“…In both malformations, the abdominal content is placed outside the abdomen through abdominal wall defect with membrane in omphalocele and without membrane in gastroschisis. [63][64][65][66][67][68][69][70][71] Both are frequently detected prenatally due to routine maternal serum screening and fetal ultrasound. Prenatal diagnosis may influence timing, mode and location of delivery.…”

“…The surgical management of both conditions consists of closure of the abdominal wall defect, while minimizing the risk of injury to the abdominal viscera either through direct trauma or due to increased intra-abdominal pressure. [63][64][65][66][67][68][69][70][71] Options include primary closure or a variety of staged approaches. Long-term outcome is favorable in most cases; however, significant associated anomalies (in the case of omphalocele) or intestinal dysfunction (in the case of gastroschisis) may result in severe morbidity and mortality.…”