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

Abstract

BACKGROUND AND OBJECTIVE: Gastroschisis is a congenital anomaly with increasing incidence, easy prenatal diagnosis and extremely variable postnatal outcomes. Our objective was to systematically review the evidence regarding the association between prenatal ultrasound signs (intraabdominal bowel dilatation [IABD], extraabdominal bowel dilatation, gastric dilatation [GD], bowel wall thickness, polyhydramnios, and small for gestational age) and perinatal outcomes in gastroschisis (bowel atresia, intra uterine death, neonatal death, time to full enteral feeding, length of total parenteral nutrition and length of in hospital stay).

Sonographic Markers in the Prediction of Fetal Complex Gastroschisis

“…Polyhydramnios was predictive of CG, which is in agreement with data from a recent meta-analysis [14] . This marker may be present as a consequence of bowel damage, which impairs fetal swallowing.…”

“…However, few studies have investigated the associations between US markers and CG [8,12] . Of these studies, intra-abdominal bowel dilatation (IABD) was theAccording to a recent meta-analysis of publications on US markers used to predict fetal gastroschisis prognosis [14] , limitations remain because the majority of the studies included small sample sizes, utilized different thresholds to define the US markers as abnormal, assessed limited outcome measures, and investigated the US markers at limited gestational ages (GAs). Therefore, considering the relevance of CG in association with fetal gastroschisis outcomes, we aimed to obtain additional, good-quality, robust data, including several US markers, from a single center to provide additional information regarding the usefulness of US markers in the prediction of CG.…”

Prenatal markers and longitudinal follow-up in simple and complex gastroschisis

“…Surprisingly, IABD at 30 weeks’ gestation only occurred in simple gastroschisis, which suggests that IABD is not a clear sign of complex gastroschisis. A recent meta-analysis in contrast showed a significant association between IABD and bowel atresia, although the positive predictive value was low (22%, derived from table 4 of that paper) and thresholds of bowel dilatation differed between studies 7. Furthermore, EABD –with thresholds ranging from 6 to 30 mm—did not predict bowel atresia 7.…”

“…A recent meta-analysis in contrast showed a significant association between IABD and bowel atresia, although the positive predictive value was low (22%, derived from table 4 of that paper) and thresholds of bowel dilatation differed between studies 7. Furthermore, EABD –with thresholds ranging from 6 to 30 mm—did not predict bowel atresia 7. One recent study showed an association between GA-corrected EABD and complex gastroschisis 24.…”

“…A recent meta-analysis evaluated several prenatal ultrasound markers and showed significant positive associations between intra-abdominal bowel dilatation (IABD) and intestinal atresia, between polyhydramnios and intestinal atresia, and between gastric dilatation and neonatal death 7. These findings should be interpreted with caution, however, given that definitions of bowel and gastric dilatation differed between studies and data were not always corrected for gestational age (GA).…”