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Outcome analysis for gastroschisis.

C L Snyder1

  • 1Department of Surgery, The Children's Mercy Hospital, Kansas City, MO 64108, USA.

Journal of Pediatric Surgery
|August 31, 1999
PubMed
Summary
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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.

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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.