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The effect of gestational age at birth on morbidity in patients with gastroschisis
1University of Alabama School of Medicine, Children's Hospital of Alabama, Birmingham 35233, USA.
Insights
Early elective delivery for infants with gastroschisis does not improve outcomes. This approach did not reduce the need for surgical intervention or shorten hospital stays for newborns with this congenital condition.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Fetal Development
Background:
- Gastroschisis involves intestinal evisceration, leading to inflammation and motility issues.
- Damage is attributed to amniotic fluid exposure and umbilical ring constriction.
- Early elective delivery is proposed to mitigate these damaging effects.
Purpose of the Study:
- To evaluate the impact of early elective delivery on gastroschisis outcomes.
- To determine if antenatal intervention improves post-repair recovery.
Main Methods:
- Retrospective review of 55 patients undergoing gastroschisis repair.
- Patients grouped by gestational age at delivery, including those with early elective delivery.
- Assessment of pulmonary maturity using amniotic lecithin/sphingomyelin ratios.
Main Results:
- Early elective delivery did not decrease the need for silo closure.
- Time to enteral feeding tolerance was not improved by early delivery.
- Hospital stay duration was not shortened in the early delivery group.
Conclusions:
- Early elective delivery for gastroschisis does not offer significant clinical benefits.
- Full-term delivery is recommended for infants with sonographically identified antenatal gastroschisis.
Abstract:
Infants born with gastroschisis frequently present with an eviscerated intestinal segment that is inflamed and thickened. The damaged segment of intestine displays absorption and motility disturbances for a variable period of time after gastroschisis repair. Clinical and animal research suggests that the damage to the eviscerated intestine is caused by prolonged exposure to amniotic fluid and/or progressive constriction on the intestine and its blood supply by the umbilical ring. Some obstetricians and pediatric surgeons have advocated early elective delivery to decrease the exposure of the bowel to these potentially damaging influences. Fifty-five patients underwent gastroschisis repair at the authors' institution during the last 6 years. Many of these patients had early elective delivery after their pulmonary maturity was judged adequate based on their amniotic lecithin/sphingomyelin ratios. The patients were divided into three groups according to gestational age at the time of delivery. Elective early delivery did not lessen the need for silo closure or hasten the time until enteral feeding could be tolerated. The hospital stay was not shortened for the early delivery group. This retrospective review supports the concept that patients with sonographically identified antenatal gastroschisis are best managed by delivery at full term.