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Outcome of isolated gastroschisis; an international study, systematic review and meta-analysis
Chiara C M M Lap1, Maria L Brizot2, Lourens R Pistorius3
1University Medical Center Utrecht, Division Woman and Baby, Department of Obstetrics, Utrecht, The Netherlands..
Insights
Outcomes for isolated gastroschisis vary, with complex cases experiencing longer feeding times, hospital stays, and higher mortality. Differentiating between simple and complex gastroschisis is crucial for predicting patient outcomes.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Congenital Abnormalities
Background:
- Gastroschisis is a congenital defect where abdominal organs develop outside the body.
- Isolated gastroschisis lacks other major congenital abnormalities, but outcomes can still vary significantly.
- Predicting outcomes is essential for clinical management and parental counseling.
Purpose of the Study:
- To determine the outcomes of children born with isolated gastroschisis.
- To compare outcomes between simple and complex gastroschisis.
- To provide a comprehensive analysis through a cohort study and meta-analysis.
Main Methods:
- International cohort study and meta-analysis of children with isolated gastroschisis.
- Primary outcome: time to full enteral feeding (TFEF).
- Secondary outcomes: mechanical ventilation duration, length of stay (LOS), and mortality, comparing simple vs. complex gastroschisis.
Main Results:
- The cohort study (204 cases) showed a median TFEF of 26 days and LOS of 33 days, with 10.8% mortality.
- Complex gastroschisis (with bowel atresia, volvulus, perforation, or necrosis) had significantly longer TFEF and LOS, and fourfold higher mortality.
- Meta-analysis of 1652 patients confirmed longer TFEF, ventilation, LOS, and higher mortality in complex cases (3.64 times higher).
Conclusions:
- This study provides key indicators for TFEF, ventilation, LOS, and mortality in isolated gastroschisis.
- Wide ranges in outcomes highlight the complexity of managing gastroschisis.
- Stratifying gastroschisis into simple and complex categories is vital for accurate outcome prediction.
Objective:
To determine outcome of children born with isolated gastroschisis (no extra-gastrointestinal congenital abnormalities).
Study Design:
International cohort study and meta-analysis.
Primary Outcome:
time to full enteral feeding (TFEF); secondary outcomes: Duration of mechanical ventilation, length of stay (LOS), mortality and differences in outcome between simple and complex gastroschisis (complex; born with bowel atresia, volvulus, perforation or necrosis). To compare the cohort study results with literature three databases were searched. Studies were eligible for inclusion if cases were born in developed countries with isolated gastroschisis after 1990, number of cases >20 and TFEF was reported.
Results:
The cohort study included 204 liveborn cases of isolated gastroschisis. The TFEF, median duration of ventilation and LOS was, 26days (range 6-515), 2days (range 0-90) and 33days (range 11-515), respectively. Overall mortality was 10.8%. TFEF and LOS were significantly longer (P<0.0001) and mortality was fourfold higher in the complex group. Seventeen studies, amongst the current study, were included for further meta-analysis comprising a total of 1652 patients. Mean TFEF was 35.3±4.4days, length of ventilation was 5.5±2.0days, LOS was 46.4±5.2days and mortality risk was 0.06 [0.04-0.07 95%CI]. Outcome of simple and complex gastroschisis was described in five studies. TFEF, ventilation time, LOS were significant longer and mortality rate was 3.64 [1.95-6.83 95%CI] times higher in complex cases.
Conclusions:
These results give a good indication of the expected TFEF, ventilation time and LOS and mortality risk in children born with isolated gastroschisis, although ranges remain wide. This study shows the importance of dividing gastroschisis into simple and complex for the prediction of outcome.
