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Long-term gastrointestinal morbidity in patients born with gastroschisis: A national register-based cohort study
Cecilia Caldeman1, Anna Fogelström1, Tomas Wester1
1Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.
Insights
Children with complex gastroschisis face significantly higher risks of intestinal failure and bowel obstruction compared to simple cases. These complications predominantly manifest within the first two years of life.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Gastroenterology
Background:
- Gastroschisis involves intestinal exposure to amniotic fluid, potentially compromising blood supply and causing varying degrees of damage.
- Complex gastroschisis is characterized by severe complications like intestinal atresia, volvulus, necrosis, and perforation.
Purpose of the Study:
- To investigate long-term gastrointestinal morbidity in gastroschisis.
- To compare outcomes between simple and complex gastroschisis cases.
Main Methods:
- Nationwide retrospective cohort study utilizing Swedish national registers.
- Inclusion of all children born with gastroschisis between January 1, 1997, and December 31, 2016.
- Primary outcomes assessed were intestinal failure and bowel obstruction, with complex gastroschisis as the exposure.
Main Results:
- The study included 315 gastroschisis cases (260 simple, 55 complex) with a median follow-up of 8 years.
- Complex gastroschisis significantly increased the risk of intestinal failure (HR: 11.7) and bowel obstruction (HR: 4.3).
- Nine percent of complex cases required reconstructive surgery for intestinal failure, compared to none in simple cases; 18.2% of complex cases needed surgery for obstruction versus 6.9% of simple cases.
Conclusions:
- Complex gastroschisis presents a substantially higher risk of long-term gastrointestinal morbidity, including intestinal failure and bowel obstruction.
- The majority of these adverse gastrointestinal events occur within the first two years post-birth.
Objectives:
In gastroschisis, the intestines are exposed to amniotic fluid during pregnancy. The defect in the abdominal wall may also compress the mesentery and impair the intestinal blood supply. There is a varying degree of intestinal damage at birth. Complex gastroschisis is defined as gastroschisis with severe complications such as intestinal atresia, volvulus, necrosis and perforation. The aim of this study was to investigate long-term gastrointestinal morbidity and compare simple and complex cases.
Methods:
A nation-wide retrospective cohort study with data from national registers was conducted. All children born with gastroschisis in Sweden from 1 January 1997 to 31 December 2016 were included in the study. Exposure was complex gastroschisis and the primary outcomes were intestinal failure and bowel obstruction.
Results:
The study included 315 cases with gastroschisis, 260 classifieds as simple gastroschisis and 55 as complex. The median time to follow was 8 years. A significantly higher risk of developing intestinal failure (hazard ratio [HR]: 11.7) was found in complex cases. Nine percent of the complex cases underwent autologous gastrointestinal reconstructive surgery for intestinal failure, none of the simple cases did. The complex cases had a higher risk for bowel obstruction (HR: 4.3) with a higher proportion requiring surgery (18.2% vs. 6.9%) compared to simple cases.
Conclusions:
This nationwide study showed that the risk for intestinal failure and bowel obstruction is significantly higher for children with complex gastroschisis compared to simple gastroschisis. Most of the events occurred during the first 2 years of life.
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