Critical Organ Dysfunction in Newborns with Gastroschisis

Area of Science:

• Neonatalogy
• Pediatric Surgery
• Critical Care Medicine

Background:

• Gastroschisis, a common newborn abdominal wall defect, is classified as simple (SG) or complex (CG) based on bowel complications.
• The extent of critical organ dysfunction in gastroschisis, particularly beyond gastrointestinal issues, remains largely unquantified.

Purpose of the Study:

• To quantify critical organ dysfunction in neonates with gastroschisis using the neonatal sequential organ failure assessment (nSOFA) score.
• To compare organ dysfunction severity and heterogeneity between simple and complex gastroschisis.

Main Methods:

• A multicenter, retrospective cohort study of infants with gastroschisis (birth weight ≥ 1.8 kg, gestational age ≥ 35 weeks) was conducted.
• Organ dysfunction was assessed hourly using the neonatal sequential organ failure assessment (nSOFA) score.
• Complex gastroschisis (CG) was defined by the presence of specific bowel morbidities.

Main Results:

• Most infants with gastroschisis exhibited minimal organ dysfunction; 50% of SG and 33% of CG cases had no organ failure.
• Neonates with CG demonstrated significantly higher maximum nSOFA scores compared to those with SG (median 3 vs. 2, p=0.02).
• Significant heterogeneity in organ dysfunction was observed within both SG and CG groups.

Conclusions:

• This study provides the first high-granularity quantification of critical organ dysfunction in gastroschisis using the nSOFA score.
• While overall organ dysfunction is low, the nSOFA score may aid in identifying high-risk gastroschisis patients with critical organ dysfunction, potentially improving risk stratification and clinical trial design.