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Elective Delivery versus Expectant Management for Gastroschisis: A Systematic Review and Meta-Analysis.

Yong Chen1, Jiashen Zhao2, Mashriq Alganabi3

  • 1Department of Pediatric Surgery, KK Women's and Children's Hospital, Singapore, Singapore.

European Journal of Pediatric Surgery : Official Journal of Austrian Association of Pediatric Surgery ... [Et Al] = Zeitschrift Fur Kinderchirurgie
|July 11, 2022
PubMed
Summary

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Near-term elective delivery (36-37 weeks) for gastroschisis improves neonatal outcomes by reducing bowel morbidity and total parenteral nutrition days. Moderately preterm delivery did not show similar benefits.

Area of Science:

  • Perinatal Medicine
  • Neonatal Surgery
  • Maternal-Fetal Medicine

Background:

  • Optimal delivery timing for prenatally diagnosed gastroschisis is debated.
  • This study evaluates elective versus expectant delivery for improved neonatal outcomes.

Approach:

  • Systematic review and meta-analysis of RCTs and cohort studies up to 2021.
  • Compared moderately preterm (34-35 weeks) and near-term (36-37 weeks) elective delivery versus expectant management.
  • Assessed outcomes including bowel morbidity, TPN days, LOS, and mortality.

Key Points:

  • Near-term elective delivery (36-37 weeks) significantly reduced bowel morbidity (RR 0.37) and TPN days (MD -13.44 days).
  • Moderately preterm elective delivery (34-35 weeks) did not improve clinical outcomes.

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  • Mean length of stay (LOS) was shorter in the near-term elective delivery group (39.2 vs. 48.7 days).

    • Conclusions:

    • Near-term elective delivery (36-37 weeks) is associated with better neonatal outcomes in gastroschisis.
    • Further RCTs are needed to confirm these findings and establish optimal delivery protocols.