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Functional outcome at school age of children born with gastroschisis
Chiara C M M Lap1, Sandra W Bolhuis2, Koenraad N J A Van Braeckel3
1University Medical Center Utrecht, Division Woman and Baby, Department of Obstetrics, Lundlaan 6, Post number KE.04.123.1, Postbox 85090, 3508 AB Utrecht, The Netherlands.
Insights
Children born with gastroschisis show poorer verbal intelligence and executive functioning. They also face increased risks for attention, response inhibition, and fine motor skill deficits in school-aged years.
Area of Science:
- Pediatric Surgery
- Developmental Pediatrics
- Neuroscience
Background:
- Gastroschisis is a congenital abdominal wall defect with potential long-term neurodevelopmental implications.
- Early identification of developmental outcomes is crucial for timely intervention in affected children.
Purpose of the Study:
- To compare motor, cognitive, and behavioral outcomes in school-aged children born with gastroschisis versus matched controls.
- To identify specific areas of neurodevelopmental risk associated with gastroschisis.
Main Methods:
- A cohort of 16 children born with gastroschisis was compared to 32 matched controls.
- Evaluated outcomes included intelligence, memory, attention, response inhibition, visual perception, motor skills, and executive functioning.
- Adjustments were made for small for gestational age (SGA) and socioeconomic status (SES).
Main Results:
- Children with gastroschisis exhibited significantly lower verbal intelligence and global executive functioning scores.
- Increased risks were observed for impaired response inhibition, selective visual attention, sustained auditory attention, and fine motor skills.
- Higher rates of grade retention were noted in the gastroschisis group, persisting after adjustments.
Conclusions:
- Gastroschisis is linked to poorer verbal intelligence and executive function in school-aged children.
- There is an elevated risk for deficits in attention, response inhibition, and fine motor skills.
- Long-term follow-up focusing on these neurodevelopmental domains is recommended to enhance functional outcomes for children with gastroschisis.
Objective:
We aimed to determine motor, cognitive and behavioural outcomes of school aged children born with gastroschisis compared to matched controls.
Study Design:
We compared outcomes of 16 children born with gastroschisis treated at the University Medical Center Groningen, the Netherlands, between 1999 and 2006 with 32 controls matched for gender, gestational age, birth weight, and corrected for small for gestational age (SGA) and parental socioeconomic status (SES). Intelligence, auditory-verbal memory, attention, response inhibition, visual perception, motor skills, visuomotor integration, problem behaviour and executive functioning were evaluated.
Results:
Median verbal intelligence quotient and global executive functioning scores of children born with gastroschisis were poorer than of controls (95 (inter quartile range (IQR) 88-100) vs. 104 (IQR 98-113), P=0.001, and 29 (IQR 6.8-63.8) vs. 5.0 (IQR 2.8-19.8), P=0.03, respectively). Children with gastroschisis were more often classified as borderline or abnormal than controls regarding response inhibition (odds ratio (OR) 20.4; 95%-confidence interval (95%-CI); 2.4-171.5), selective visual attention (OR 40.4; 95%-CI 5.9-275.4), sustained auditory attention (OR 88.1; 95%-CI 5.8-1342.8), and fine motor skills (50% vs. 0%). Grade retention was more prevalent in gastroschisis children (OR 6.07; 95%-CI 1.42-25.9). These associations persisted after adjustment for SGA and SES. The auditory-verbal memory, visuomotor integration and behavioural problems did not significantly differ from the controls.
Conclusions:
Gastroschisis is associated with poorer verbal intelligence, and with an increased risk for poor performance on several aspects of attention, response inhibition and fine motor skills at school age. The follow-up of children born with gastroschisis deserves attention regarding these specific domains, to improve their functional outcomes.
