Related Experiment Video
Updated: Feb 22, 2026
External Cephalic Version: Is it an Effective and Safe Procedure?
Published on: June 6, 2020
Outcomes of gastroschisis early delivery: A systematic review and meta-analysis
Rachel M Landisch1, Ziyan Yin2, Melissa Christensen1
1Division of Pediatric Surgery, Department of Surgery, The Children's Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, WI, USA.
Insights
Elective preterm delivery for gastroschisis may reduce sepsis and improve feeding outcomes. However, using gestational age alone as a proxy for delivery timing negates these benefits, necessitating further research.
Area of Science:
- Neonatal surgery
- Maternal-fetal medicine
- Pediatric gastroenterology
Background:
- Gastroschisis, a congenital abdominal wall defect, poses risks of fetal demise and intestinal injury.
- Optimal timing for delivery in gastroschisis remains debated.
- Elective preterm delivery (EPD) is hypothesized to improve outcomes.
Purpose of the Study:
- To evaluate the impact of EPD on neonatal outcomes in gastroschisis.
- To compare outcomes between elective preterm delivery and other delivery timing strategies.
- To synthesize existing evidence through a meta-analysis.
Main Methods:
- Meta-analysis of 18 studies (1990-2016) involving 1430 neonates with gastroschisis.
- Comparison of outcomes based on elective preterm delivery (G1) versus preterm gestational age (G2).
- Analyzed outcomes included: total parenteral nutrition (TPN), first enteral feeding (FF), length of stay, ventilator days, fetal demise, complex gastroschisis, sepsis, and death.
Main Results:
- EPD (G1) was associated with reduced sepsis (p<0.01) and faster first enteral feeding (p=0.03).
- G1 showed a trend towards reduced TPN duration (p=0.07).
- Preterm infants in G2 had significantly lower birth weight (BW) compared to controls (p=0.001), while G1 BWs were similar.
Conclusions:
- EPD appears beneficial for gastroschisis, particularly regarding feeding and sepsis.
- These benefits are diminished when gestational age is used as a surrogate for EPD.
- A multi-institutional randomized trial is required to confirm the advantages of EPD in gastroschisis.
Background/Purpose:
Elective preterm delivery (EPD) of a fetus with gastroschisis may prevent demise and ameliorate intestinal injury. While the literature on optimal timing of delivery varies, we hypothesize that a potential benefit may be found with EPD.
Methods:
A meta-analysis of publications describing timing of delivery in gastroschisis from 1/1990 to 8/2016 was performed, including studies where either elective preterm delivery (group 1, G1) or preterm gestational age (GA) (group 2, G2) were evaluated against respective comparators. The following outcomes were analyzed: total parenteral nutrition (TPN), first enteral feeding (FF), length of stay, ventilator days, fetal demise, complex gastroschisis, sepsis, and death.
Results:
Eighteen studies describing 1430 gastroschisis patients were identified. G1 studies found less sepsis (p<0.01), fewer days to FF (p=0.03), and 11days less of TPN (p=0.07) in the preterm cohort. Comparatively, G2 studies showed less days to FF in term GA (p=0.02).Whereas G1 BWs were similar, G2 preterm had a significantly lower BW compared to controls (p=0.001).
Conclusions:
Elective preterm delivery appears favorable with respect to feeding and sepsis. However, benefits are lost when age is used as a surrogate of EPD. A randomized, prospective, multi-institutional trial is necessary to delineate whether EPD is advantageous to neonates with gastroschisis.
Type Of Study:
Treatment study.
Level Of Evidence:
Level III.
