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Is early delivery beneficial in gastroschisis?
Helen Carnaghan1, Susana Pereira2, Catherine P James3
1UCL Institute of Child Health and Great Ormond Street Hospital for Children, London, UK.
Insights
Elective delivery before 37 weeks gestation does not improve outcomes for gastroschisis neonates. Increased bowel dilatation before 30 weeks may indicate complex gastroschisis, requiring closer monitoring.
Area of Science:
- Neonatal surgery
- Pediatric gastroenterology
- Fetal development
Background:
- Gastroschisis neonates often experience delayed time to full enteral feeds (ENT).
- Bowel exposure to amniotic fluid may contribute to delayed feeding in gastroschisis.
- Intra-abdominal and extra-abdominal bowel dilatation (IABD/EABD) are observed in gastroschisis.
Purpose of the Study:
- To investigate if delivery before 37 weeks gestation improves neonatal outcomes in gastroschisis.
- To assess the impact of intra/extra-abdominal bowel dilatation (IABD/EABD) on gastroschisis outcomes.
Main Methods:
- Retrospective review of 246 gastroschisis cases (1992-2012) from two tertiary centers.
- Primary outcomes analyzed: time to full enteral feeds (ENT) and length of hospital stay (LOS).
- Statistical analysis included parametric/non-parametric tests, predictive values, and regression analysis.
Main Results:
- Increasing gestational age correlated with reduced ENT and LOS (p<0.0001).
- IABD persisted in 92 patients; 26% were complex cases.
- Combined IABD/EABD or IABD with collapsed extra-abdominal bowel before 30 weeks had a 75% positive predictive value for complex gastroschisis.
Conclusions:
- Early delivery (<37 weeks) is associated with prolonged ENT and LOS, indicating it is not beneficial for gastroschisis.
- Combined IABD/EABD or IABD with collapsed extra-abdominal bowel suggests complex gastroschisis.
- Gestational age at delivery significantly impacts neonatal outcomes in gastroschisis.
Purpose:
Gastroschisis neonates have delayed time to full enteral feeds (ENT), possibly due to bowel exposure to amniotic fluid. We investigated whether delivery at <37weeks improves neonatal outcomes of gastroschisis and impact of intra/extra-abdominal bowel dilatation (IABD/EABD).
Methods:
A retrospective review of gastroschisis (1992-2012) linked fetal/neonatal data at 2 tertiary referral centers was performed. Primary outcomes were ENT and length of hospital stay (LOS). Data (median [range]) were analyzed using parametric/non-parametric tests, positive/negative predictive values, and regression analysis.
Results:
Two hundred forty-six patients were included. Thirty-two were complex (atresia/necrosis/perforation/stenosis). ENT (p<0.0001) and LOS (p<0.0001) were reduced with increasing gestational age. IABD persisted to last scan in 92 patients, 68 (74%) simple (intact/uncompromised bowel), 24 (26%) complex. IABD or EABD diameter in complex patients was not significantly greater than simple gastroschisis. Combined IABD/EABD was present in 22 patients (14 simple, 8 complex). When present at <30weeks, the positive predictive value for complex gastroschisis was 75%. Two patients with necrosis and one atresia had IABD and collapsed extra-abdominal bowel from <30weeks.
Conclusion:
Early delivery is associated with prolonged ENT/LOS, suggesting elective delivery at <37weeks is not beneficial. Combined IABD/EABD or IABD/collapsed extra-abdominal bowel is suggestive of complex gastroschisis.
