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Prenatal Risk Factors and Outcomes in Gastroschisis: A Meta-Analysis
Francesco D'Antonio1, Calogero Virgone2, Giuseppe Rizzo3
1Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, United Kingdom;
Insights
Prenatal ultrasound signs like intraabdominal bowel dilatation (IABD), polyhydramnios, and gastric dilatation (GD) help identify gastroschisis neonates at higher risk for complications. Further research is needed to improve prenatal counseling and neonatal care.
Area of Science:
- Perinatal Medicine
- Fetal Surgery
- Neonatalogy
Background:
- Gastroschisis, a congenital anomaly, has an increasing incidence and variable postnatal outcomes.
- Prenatal diagnosis is readily achievable through ultrasound.
- Identifying predictive markers for neonatal outcomes is crucial.
Purpose of the Study:
- To systematically review evidence associating prenatal ultrasound signs with perinatal outcomes in gastroschisis.
- To identify specific ultrasound markers that predict complications in neonates with gastroschisis.
Main Methods:
- Electronic searches of Medline, Embase, and Cochrane databases.
- Inclusion of studies correlating antenatal ultrasound signs with gastroschisis outcomes.
- Meta-analysis using individual data random-effect logistic regression.
Main Results:
- Twenty-six studies involving 2023 fetuses were analyzed.
- Intraabdominal bowel dilatation (IABD) showed a significant association with bowel atresia (OR: 5.48).
- Polyhydramnios was linked to bowel atresia (OR: 3.76), and gastric dilatation (GD) to neonatal death (OR: 5.58).
Conclusions:
- IABD, polyhydramnios, and GD can identify high-risk gastroschisis neonates.
- Combined predictive ability of multiple signs requires further investigation.
- Large prospective studies are needed to enhance prenatal counseling and neonatal care.
Background And Objective:
Gastroschisis is a congenital anomaly with increasing incidence, easy prenatal diagnosis and extremely variable postnatal outcomes. Our objective was to systematically review the evidence regarding the association between prenatal ultrasound signs (intraabdominal bowel dilatation [IABD], extraabdominal bowel dilatation, gastric dilatation [GD], bowel wall thickness, polyhydramnios, and small for gestational age) and perinatal outcomes in gastroschisis (bowel atresia, intra uterine death, neonatal death, time to full enteral feeding, length of total parenteral nutrition and length of in hospital stay).
Methods:
Medline, Embase, and Cochrane databases were searched electronically. Studies exploring the association between antenatal ultrasound signs and outcomes in gastroschisis were considered suitable for inclusion. Two reviewers independently extracted relevant data regarding study characteristics and pregnancy outcome. All meta-analyses were computed using individual data random-effect logistic regression, with single study as the cluster unit.
Results:
Twenty-six studies, including 2023 fetuses, were included. We found significant positive associations between IABD and bowel atresia (odds ratio [OR]: 5.48, 95% confidence interval [CI] 3.1-9.8), polyhydramnios and bowel atresia (OR: 3.76, 95% CI 1.7-8.3), and GD and neonatal death (OR: 5.58, 95% CI 1.3-24.1). No other ultrasound sign was significantly related to any other outcome.
Conclusions:
IABD, polyhydramnios, and GD can be used to an extent to identify a subgroup of neonates with a prenatal diagnosis of gastroschisis at higher risk to develop postnatal complications. Data are still inconclusive on the predictive ability of several signs combined, and large prospective studies are needed to improve the quality of prenatal counseling and the neonatal care for this condition.
