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Improving gastroschisis outcomes: does birth place matter?

Kate B Savoie1, Eunice Y Huang1, Shahroz K Aziz2

  • 1University of Tennessee Health Science Center, Memphis, Tennessee.

Journal of Pediatric Surgery
|December 10, 2014
PubMed
Summary

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Infants born with gastroschisis at the hospital for surgery (inborn) experienced faster recovery, including earlier full enteral nutrition (FEN) and shorter hospital stays. However, birthplace was not a predictor in multivariable analysis for time to FEN.

Area of Science:

  • Pediatric Surgery
  • Neonatal Outcomes
  • Congenital Malformations

Background:

  • Gastroschisis, a congenital defect, requires surgical intervention.
  • The impact of birthplace (inborn vs. outborn) on gastroschisis outcomes is debated.
  • Optimizing care pathways for neonates with gastroschisis is crucial.

Purpose of the Study:

  • To compare outcomes for inborn versus outborn infants with gastroschisis.
  • To evaluate the effect of birthplace on time to surgical intervention and recovery.
  • To identify factors influencing outcomes in gastroschisis management.

Main Methods:

  • Retrospective study of 528 infants with gastroschisis across six institutions (2008-2013).
  • Data collected on birthplace, perinatal factors, and postoperative course.
Keywords:
Birth locationBirthplaceGastroschisisOutcomesRegionalization

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  • Primary outcome: days to full enteral nutrition (FEN).

    • Main Results:

    • Inborn infants showed significantly shorter time to FEN, bowel coverage, and abdominal wall closure, with shorter hospital stays.
    • Multivariable analysis indicated birthplace was not a significant predictor for time to FEN.
    • Gestational age, atresia/necrosis, primary closure rate, and time to abdominal wall closure were significant predictors.

    Conclusions:

    • Inborn infants with gastroschisis achieve key recovery milestones faster.
    • Birthplace is a relevant factor to consider in improving gastroschisis patient outcomes.
    • Further investigation into optimizing care based on birthplace is warranted.