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Morbidity in infants with antenatally-diagnosed anterior abdominal wall defects
G Dimitriou1, A Greenough, J S Mantagos
1Children Nationwide Regional Neonatal Intensive Care Centre, King's College Hospital, London, UK.
Insights
Infants with gastroschisis (GS) experience greater morbidity than those with exomphalos (EX). Structural bowel abnormalities in GS infants independently predict adverse outcomes, including prolonged hospital stays and need for parenteral nutrition.
Area of Science:
- Pediatric Surgery
- Neonatalogy
- Congenital Anomalies
Background:
- Gastroschisis (GS) and exomphalos (EX) are congenital anterior wall defects with varying clinical outcomes.
- Comparing morbidity between GS and EX infants is crucial for understanding disease severity and predicting patient trajectories.
Purpose of the Study:
- To compare the morbidity of infants with gastroschisis (GS) versus exomphalos (EX) without lethal abnormalities.
- To identify predictive factors for adverse outcomes, specifically prolonged parenteral nutrition (PN) and extended hospital admission.
Main Methods:
- Retrospective review of medical records for 45 infants with anterior wall defects diagnosed antenatally.
- Analysis included gestational age, birth weight, time to initiate feeds, liver dysfunction, mortality, PN duration, and hospital admission length.
Main Results:
- Gastroschisis infants had lower birth weight and required significantly longer PN (median 20 vs 10 days) and hospital admission (median 40 vs 25 days) compared to exomphalos infants.
- Structural bowel abnormalities (SBA) in GS infants were independently associated with prolonged hospital stay and adverse outcomes, with 100% predictive value.
- Five GS infants (16%) died, and 10 (31%) developed liver dysfunction.
Conclusions:
- Infants with gastroschisis exhibit significantly higher morbidity than those with exomphalos.
- Structural bowel abnormalities are a critical predictor of poor outcomes in gastroschisis, necessitating close monitoring and tailored management.
Abstract:
The aims of this study were to compare the morbidity of infants with gastroschisis (GS) with that of infants with exomphalos (EX) without lethal abnormalities and to identify factors predictive of adverse outcome: a requirement for parenteral nutrition (PN) for over 1 month and hospital admission for over 2 months. The medical records of 45 infants with anterior wall defects (32 with GS) diagnosed antenatally who consecutively received intensive care in one institution from 1993 were reviewed. Both the GS and EX infants had a median gestational age of 37 weeks, but the former were lighter at birth (P < 0.01). Fourteen infants (all with GS) were able to start feeds only after 2 weeks; 10 (8 with GS) developed liver dysfunction; and 5 (all with GS) died. The GS compared to the EX infants required a longer period of PN (median 20 vs 10 days, P < 0.01) and longer hospital admission (median 40 vs 25 days, P < 0.01). In the GS group the time to start feeding related independently to prolonged hospital stay, and the existence of structural bowel abnormalities (SBA) related independently to both measures of adverse outcome, with a positive predictive value of 100%. We conclude that infants with GS, particularly those with SBA, suffer greater morbidity than infants with EX without lethal abnormalities.