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Outcome analysis for gastroschisis
1Department of Surgery, The Children's Mercy Hospital, Kansas City, MO 64108, USA.
Insights
Gastroschisis survival is not linked to delivery mode, closure type, or birth weight. Major anomalies, necrotizing enterocolitis (NEC), and repair era significantly impact mortality in gastroschisis patients.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Congenital Anomalies
Background:
- Gastroschisis is a congenital defect with potential for adverse outcomes.
- Several factors have been anecdotally linked to poor outcomes, including delivery mode, in utero diagnosis, closure type, concurrent anomalies, intestinal atresia, and necrotizing enterocolitis (NEC).
Purpose of the Study:
- To analyze a 30-year institutional database of gastroschisis patients.
- To identify specific variables associated with increased morbidity and mortality in gastroschisis.
Main Methods:
- Retrospective analysis of 185 gastroschisis cases treated between 1969 and 1999.
- Logistic regression analysis comparing survivors and nonsurvivors based on various clinical parameters.
- Further analysis to identify predictors of specific morbidities like sepsis, bowel obstruction, and closure complications.
Main Results:
- Overall survival rate was 91%, improving to 94% in the last two decades.
- Mortality correlated significantly with the era of repair, presence of necrotizing enterocolitis (NEC), and other major anomalies.
- Low gestational age and NEC predicted sepsis; low birth weight predicted closure complications. Intestinal atresia, birth weight, and gestational age did not correlate with survival.
Conclusions:
- Major anomalies, NEC, and the era of repair are key predictors of mortality in gastroschisis.
- Prematurity and NEC increase sepsis risk; low birth weight is linked to closure complications.
- Delivery mode and closure method do not significantly influence gastroschisis outcomes.
Background/Purpose:
Several factors are reportedly associated with an adverse outcome in gastroschisis, including mode of delivery, in utero diagnosis, type of closure, concurrent anomalies, intestinal atresia, and necrotizing enterocolitis (NEC). Since 1969, the authors have treated 185 patients who had gastroschisis. The authors analyzed their database to identify variables associated with increased morbidity and mortality.
Methods:
A retrospective study of all patients with gastroschisis treated at our institution in the last 30 years was performed. The characteristics of survivors and nonsurvivors were compared. A logistic regression analysis was performed, with survival as the dependent variable, and the following parameters as independent variables: in utero diagnosis, mode of delivery, gestational age and birth weight, era of repair, type of closure, presence of other associated anomalies, intestinal atresia, and development of necrotizing enterocolitis. Further logistic regression analysis was performed, with various indicators of morbidity as dependent variables. These included development of sepsis, bowel obstruction, and complications related to the closure or to the silo. No attempt at long-term follow-up was made.
Results:
A total of 185 infants with gastroschisis were treated at our institution from 1969 to 1999. Mean gestational age was 36.6 weeks, and the mean birth weight was 2,501 g. A total of 21 infants had intestinal atresia. NEC developed in 8 infants. Six infants had other serious anomalies. The overall survival rate was 91%. Survival improved in last 2 decades (94%). There were no differences in gestational age, birth weight and mode of delivery, method of closure, or presence of intestinal atresia between survivors and nonsurvivors. Only the era of repair (P = .002), presence of necrotizing enterocolitis (P = .044), and presence of other major anomalies (P < .001) correlated with mortality in the logistic regression analysis. Sepsis, bowel obstruction, and closure complications accounted for most of the morbidity. Analysis of these three morbidity factors identified low gestational age (P = .038) and development of necrotizing enterocolitis (P = .020) as independent predictors of sepsis. Closure complications were only associated with lower birth weight (P = .006). No predictors of bowel obstruction were identified.
Conclusions:
Mode of delivery, method of closure, birth weight and gestational age, and the presence of intestinal atresia do not appear to correlate with survival in infants with gastroschisis. Only the presence of another major anomaly, the era of repair, and the development of necrotizing enterocolitis were associated with increased mortality. Degree of prematurity and development of enterocolitis were associated with an increased incidence of septic complications. Low birth weight was a marker for closure complications. Type of delivery (vaginal or cesarean section) had no influence on either morbidity or mortality.