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Prenatal markers and longitudinal follow-up in simple and complex gastroschisis
Annelieke Hijkoop1, Hanneke IJsselstijn1, René M H Wijnen1
1Intensive Care and Department of Paediatric Surgery, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.
Insights
Prenatal ultrasound markers could not reliably identify complex gastroschisis. Children with complex gastroschisis showed delayed psychomotor development and require closer monitoring and timely intervention.
Area of Science:
- Pediatric Surgery
- Fetal Medicine
- Developmental Pediatrics
Background:
- Gastroschisis is a congenital abdominal wall defect.
- Distinguishing between simple and complex gastroschisis prenatally is challenging.
- Early identification of complex gastroschisis can inform management and prognosis.
Purpose of the Study:
- To identify gestational-age corrected prenatal ultrasound markers for complex gastroschisis.
- To compare physical growth and neurodevelopment in children with simple versus complex gastroschisis.
Main Methods:
- Retrospective analysis of prenatally diagnosed gastroschisis cases (2000-2012).
- Logistic regression used to associate prenatal ultrasound markers with complex gastroschisis.
- Physical growth (SDS) and neurodevelopment (MDI, PDI) assessed at 12 and 24 months.
Main Results:
- Extra-abdominal bowel dilatation at 30 weeks' gestation was associated with complex gastroschisis (OR 5.00), but with low positive predictive value.
- Children exhibited significantly lower height and weight standard deviation scores at 12 and 24 months.
- Mental and psychomotor developmental indices were significantly below population norms at 24 months.
Conclusions:
- Prenatal ultrasound markers were insufficient to reliably differentiate simple from complex gastroschisis.
- Complex gastroschisis is linked to a higher risk of delayed psychomotor development.
- Close monitoring and early intervention are recommended for children with complex gastroschisis.
Objective:
We aimed to identify gestational-age corrected prenatal ultrasound markers of complex gastroschisis, and to compare physical growth and neurodevelopment between children with simple and complex gastroschisis.
Design:
We included prenatally diagnosed gastroschisis patients from 2000 to 2012 who joined our longitudinal follow-up programme. Associations between complex gastroschisis and prenatal ultrasound markers collected at 30 weeks' gestation and prior to delivery were tested using logistic regression. Physical growth (SD scores (SDS)), mental and psychomotor developmental index (MDI, PDI; Bayley Scales of Infant Development) were recorded at 12 and 24 months. Data were analysed using general linear models and compared with population norms.
Results:
Data of 61 children were analysed (82% of eligible cases). Extra-abdominal bowel dilatation at 30 weeks' gestation was significantly associated with complex gastroschisis (OR (95% CI): 5.00 (1.09 to 22.98)), with a high negative (88%) but low positive (40%) predictive value. The mean (95% CI) height SDS at 12 months (-0.46 (-0.82 to -0.11)), and weight SDS at 12 and 24 months (-0.45 (-0.85 to -0.05), and -0.44 (-0.87 to -0.01), respectively) fell significantly below 0 SDS. MDI and PDI were significantly below 100 at 24 months; 93 (88 to 99) and 83 (78 to 87), respectively). Children with complex gastroschisis had a significantly lower PDI (76 (68 to 84)) than those with simple gastroschisis (94 (90 to 97), p<0.001).
Conclusions:
Prenatal ultrasound markers could not reliably distinguish between simple and complex gastroschisis. Children with complex gastroschisis may be at increased risk for delayed psychomotor development; they should be monitored more closely, and offered timely intervention.
