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Outcome differences between simple and complex gastroschisis
Insights
Outcomes for simple gastroschisis were better than complex gastroschisis, with lower rates of mechanical ventilation, parenteral nutrition, reoperation, sepsis, and shorter hospital stays. Further research is needed to improve prenatal diagnosis and management of complex gastroschisis.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Congenital Abnormalities
Background:
- Gastroschisis is a congenital defect with variable outcomes.
- Distinguishing between simple and complex gastroschisis is crucial for prognosis.
- Outcomes for newborns with gastroschisis have been analyzed over a 15-year period.
Purpose of the Study:
- To compare the outcomes of simple and complex gastroschisis in newborns.
- To identify key differences in treatment and prognosis between gastroschisis types.
Main Methods:
- A retrospective cohort study of 70 infants with gastroschisis treated between 2001 and 2015.
- Exclusion of premature infants (<34 weeks) and those with low birth weight (<1500g).
- Analysis of outcomes including defect closure, complications, ventilation, nutrition, reoperation, sepsis, hospital stay, and mortality.
Main Results:
- Complex gastroschisis (15 patients) included atresia, ischemic complications, or vanishing gastroschisis.
- Simple gastroschisis showed significantly better outcomes: less mechanical ventilation, parenteral nutrition, reoperations, sepsis, and shorter hospital stays.
- Survival to discharge was 92% for simple gastroschisis, compared to 3 deaths in the complex group.
Conclusions:
- Complex gastroschisis is associated with significantly worse outcomes compared to simple gastroschisis.
- Improved prenatal diagnosis and postnatal management are needed for complex gastroschisis.
- Further research should focus on predicting and managing complex gastroschisis to reduce morbidity and mortality.
Background:
We reviewed differences of the outcome of newborn with simple and complex gastroschisis treated at our institution over the past fifteen years.
Methods:
A retrospective cohort study was performed on all infants with gastroschisis treated at the Institute for mother and child health care, Belgrade, between 2001 and 2015 (n=70). Premature infants (<34 weeks of gestation) and babies with birth weight less than 1500 g were excluded (n=5). We compared outcomes in infants with simple gastroschisis and those with complex gastroschisis. An outcome analysis was performed for birth weight, gestational age, gender, mode of defect closure, presence of intestinal necrosis or perforation, reoperation, duration of mechanical ventilation and total parenteral nutrition, presence of bowel pseudoopstraction, sepsis, total duration of hospital stay, mortality rates.
Results:
Of 65 patients, 15 (23,07%) had complex gastroschisis, including atresia 5 patients (33,3%), ischemic complication 9 patients (60%) and one patient with closing gastroschisis (6,66%). Sixty eight percent underwent primary closure.There was difference between the simple and the complex gastroschisis in duration of mechanical ventilation (P= ,000003), total parenteral nutrition (P= ,000019), bowel pseudoobstruction (P= ,00067), reoperation (P= ,00122), sepsis (P= ,0043), hospital stay (P= ,000198). In the simple gastroschisis group 92% of patients survived to discharge. In the complex gastroschisis group 3 patients died in hospital (P= ,338).
Conclusions:
More research should be focused to predict complex gastroschisis and to improve prenatal diagnosis and postnatal management, without a significant increase in morbidity and mortality.
Key Words:
Complex, Gastroschisis, Outcomes, Simple, Vanishing.
