Bowel-defect disproportion in gastroschisis: does the need to extend the fascial defect predict outcome?
Arash Safavi1, Erik Skarsgard, Sonia Butterworth
1BC Children's Hospital, Vancouver, BC, Canada.
Insights
Need for gastroschisis (GS) defect extension indicates more complicated cases and higher risk for adverse outcomes. However, it is not an independent predictor of prolonged parenteral nutrition (PN).
Area of Science:
- Neonatal surgery
- Pediatric surgery
- Congenital anomalies
Background:
- Gastroschisis (GS) is a congenital defect requiring surgical intervention.
- Accurate prediction of outcomes for GS is crucial for risk stratification and management.
- The need for surgical intervention, such as fascial extension, may indicate disease severity.
Purpose of the Study:
- To determine if the need for gastroschisis (GS) defect extension correlates with bowel injury severity at birth.
- To assess whether the need for GS defect extension predicts patient outcomes, specifically days of parenteral nutrition (PN).
Main Methods:
- Analysis of a national dataset of gastroschisis (GS) cases born between 2005 and 2010.
- Categorization of patients based on the extent of fascial extension required for closure (none, <2 cm, >2 cm).
- Primary outcome measured was days of parenteral nutrition (PN); univariate and multivariate analyses were performed.
Main Results:
- Patients requiring >2 cm fascial extension had higher rates of atresia, perforation, and severe matting (P=0.001).
- These patients also required significantly more days of parenteral nutrition (PN) compared to those without extension (63.0 vs. 39.7 days, P=0.03).
- Multivariate analysis identified atresia and infections as independent predictors of prolonged PN, not fascial extension.
Conclusions:
- Newborns with gastroschisis (GS) requiring fascial extension are more likely to have complicated disease.
- While associated with adverse outcomes, fascial extension is not an independent predictor of prolonged parenteral nutrition (PN).
- Further research may explore other indicators for predicting gastroschisis outcomes.
Background/Purpose:
Validated outcome prediction for gastroschisis (GS) permits early risk stratification. The aim of our study was to determine whether the need for GS defect extension: (a) correlates with bowel injury severity at birth, and (b) predicts outcome.
Methods:
A national dataset was used to study GS babies born between 2005 and 2010. The primary outcome was days of parenteral nutrition (PN). Outcomes were analyzed according to the need for fascial extension to facilitate closure or silo placement as follows: Group 1, no extension; Group 2A, extension <2 cm; Group 2B, extension >2 cm. Univariate and where appropriate, multivariate analyses were used.
Results:
Of 507 cases, 402 had complete defect extension data: Group 1, 297 (73%); Group 2A, 67 (17%); Group 2B, 42 (10%). Group 2B patients had higher rates of atresia, perforation and severe matting (P = 0.001) and required more days on PN compared to Group 1 (63.0 ± 100.4 vs. 39.7 ± 44.5 days: CI 1.2-45.1; P = 0.03). Multivariate analysis revealed that the presence of atresia (P = 0.01) and surgical site (P = 0.001) or bloodstream (P = 0.001) infections were predictive of prolonged PN; however, the need for fascial extension was not.
Conclusions:
GS newborns who require fascial extension are more likely to have complicated GS and are at greater risk for adverse outcome, although it is not an independent predictor of the latter.
