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Pediatric Surgery International

Published in:

01-04-2009 | Original Article

Risk stratification in gastroschisis: can prenatal evaluation or early postnatal factors predict outcome?

Authors: Ryan P. Davis, Marjorie C. Treadwell, Robert A. Drongowski, Daniel H. Teitelbaum, George B. Mychaliska

Published in: Pediatric Surgery International | Issue 4/2009

Abstract

Purpose

The prenatal or postnatal factors that predict complex gastroschisis in patients (atresia, volvulus, necrotic bowel and bowel perforation) remain controversial. We evaluated the prognostic value of prenatal ultrasonographic parameters and early postnatal factors in predicting clinical outcomes.

Methods

We analyzed maternal and neonatal records of 46 gastroschisis patients treated from 1998 to 2007. Information regarding demographics, prenatal ultrasound data when available, intrapartum and postnatal course was abstracted from medical records. Outcome variables included survival, ventilator days, TPN days, time to full enteral feeds, complications and length of stay. Univariate or multivariate analysis was used, with P < 0.05 considered as significant.

Result

A total of 75% of complex patients were categorized within 1 week of life. Interestingly, prenatal bowel dilation (>17 mm) and thickness (>3 mm) did not correlate with outcome or risk stratification into simple versus complex (P < 0.05). Complex patients had increased morbidity compared to simple patients (sepsis 58 versus 18%; P = 0.021, NEC 42 versus 9%; P = 0.020, short bowel syndrome 58 versus 3%; P = 0.0001, ventilator days 24 versus 10; P = 0.021; TPN days 178 versus 38; P = 0.0001 and days to full feeds 171 versus 31; P = 0.0001; and length of stay 90 versus 39 days, P = 0.0001).

Conclusions

Prenatal bowel wall dilation and/or thickness did not predict complex patients or adverse outcome. Complex gastroschisis patients can be identified postnatally and have substantial morbidity.

Wilson R, Johnson M (2004) Congenital abdominal wall defects: an update. Fetal Diagn Ther 19:385–398. doi:10.1159/000078990 PubMedCrossRef

Suita S, Okamatsu T, Yamamoto T et al (2000) Changing profile of abdominal wall defects in Japan: results of a national survey. J Pediatr Surg 35:66–71PubMed

Eggink B, Richardson C, Malloy M et al (2006) Outcome of gastroschisis: a 20-year case review of infants with gastroschisis born in Galveston, Texas. J Pediatr Surg 41:1103–1108. doi:10.1016/j.jpedsurg.2006.02.008 PubMedCrossRef

Ledbetter D (2006) Gastroschisis and omphalocele. Surg Clin North Am 86:249–260. doi:10.1016/j.suc.2005.12.003 PubMedCrossRef

Fleet M, de la Hunt M (2000) Intestinal atresia with gastroschisis: a selective approach to management. J Pediatr Surg 35:1323–1325. doi:10.1053/jpsu.2000.9324 PubMedCrossRef

Alsulyman O, Monteiro H, Ouzounian J et al (1996) Clinical significance of prenatal ultrasonographic intestinal dilation in fetuses with gastroschisis. Am J Obstet Gynecol 175:982–984. doi:10.1016/S0002-9378(96)80037-8 PubMedCrossRef

Langer J, Khanna J, Caco C et al (1993) Prenatal diagnosis of gastroschisis: development of objective sonographic criteria for predicting outcome. Obstet Gynecol 81:53–54PubMed

Adra A, Landy H, Nahmias J et al (1996) The fetus with gastroschisis: impact of route of delivery and prenatal ultrasonography. Am J Obstet Gynecol 174:540–546. doi:10.1016/S0002-9378(96)70424-6 PubMedCrossRef

Piper H, Jaksic T (2006) The impact of prenatal bowel dilation on clinical outcomes in neonates with gastroschisis. J Pediatr Surg 41:897–900. doi:10.1016/j.jpedsurg.2006.01.005 PubMedCrossRef

10.

Bond S, Harrison M, Filly R et al (1988) Severity of intestinal damage in gastroschisis: correlation with prenatal sonographic findings. J Pediatr Surg 23:520–525. doi:10.1016/S0022-3468(88)80360-9 PubMedCrossRef

11.

Babcook C, Hedrick M, Goldstein R et al (1994) Gastroschisis: can sonography of the fetal bowel accurately predict postnatal outcome? J Ultrasound Med 13:701–706PubMed

12.

Japaraj R, Hockey R, Chan F (2003) Gastroschisis: can prenatal sonography predict neonatal outcome? Ultrasound Obstet Gynecol 21:329–333. doi:10.1002/uog.85 PubMedCrossRef

13.

Lenke R, Persutte W, Nemes J (1990) Ultraonographic assessment of intestinal damage in fetuses with gastroschisis: is it of clinical value? Am J Obstet Gynecol 163:995–998PubMed

14.

Sipes S, Weiner C, Williamson R et al (1990) Fetal gastroschisis complicated by bowel dilation: an indication for imminent delivery? Fetal Diagn Ther 5:100–103PubMedCrossRef

15.

Pryde P, Bardicef M, Treadwell M et al (1994) Gastroschisis: can antenatal ultrasound predict infant outcomes? Obstet Gynecol 84:505–510PubMed

16.

Abdullah F, Arnold M, Nabaweesi R et al (2007) Gastroschisis in the United States 1988–2003: analysis and risk categorization of 4,344 patients. J Perinatol 27:50–55. doi:10.1038/sj.jp.7211616 PubMedCrossRef

17.

Arnold M, Chang D, Nabaweesis R et al (2007) Risk stratification of 4,344 patients with gastroschisis into simple and complex categories. J Pediatr Surg 42:1520–1525. doi:10.1016/j.jpedsurg.2007.04.032 PubMedCrossRef

18.

Caniano D, Brokaw B, Ginn-Pease M (1990) An individualized approach to the management of gastroschisis. J Pediatr Surg 25:297–300. doi:10.1016/0022-3468(90)90070-P PubMedCrossRef

19.

Molik K, Gingalewski C, West K et al (2001) Gastroschisis: a plea for risk categorization. J Pediatr Surg 36:51–55. doi:10.1053/jpsu.2001.20004 PubMedCrossRef

20.

Lenke R, Hatch E Jr (1986) Fetal gastroschisis: a preliminary report advocating the use of cesarean section. Obstet Gynecol 67:395–398PubMed

21.

Quirk J, Fortney J, Collins H et al (1996) Outcomes of newborns with gastroschisis: the effect of mode of delivery, site of delivery, and interval from birth to surgery. Am J Obstet Gynecol 174:1134–1138. doi:10.1016/S0002-9378(96)70655-5 PubMedCrossRef

22.

Tawil K, Gillam G (1995) Gastroschisis: 13 years’ experience at RCH Melbourne. J Paediatr Child Health 31:553–556. doi:10.1111/j.1440-1754.1995.tb00883.x PubMedCrossRef

23.

Driver C, Bowen J, Doig C et al (2001) The influence of delay in closure of the abdominal wall on outcomes in gastroschisis. Pediatr Surg Int 17:32–34. doi:10.1007/s003830000441 PubMedCrossRef

24.

Minkes R, Langer J, Mazziotti M et al (2000) Routine insertion of a silastic spring-loaded silo for infants with gastroschisis. J Pediatr Surg 35:843–846. doi:10.1053/jpsu.2000.6858 PubMedCrossRef

25.

Chiu B, Lopoo J, Hoover J et al (2006) Closing arguments for gastroschisis: management with silo reduction. J Perinat Med 34:243–245. doi:10.1515/JPM.2006.043 PubMedCrossRef

26.

Kidd J Jr, Jackson R, Smith S et al (2003) Evolution of staged versus primary closure of gastroschisis. Ann Surg 237:759–764. doi:10.1097/00000658-200306000-00003 PubMedCrossRef

27.

Schlatter M (2003) Preformed silos in the management of gastroschisis: new progress with an old idea. Curr Opin Pediatr 15:239–242. doi:10.1097/00008480-200306000-00002 PubMedCrossRef

28.

Wu Y, Vogel A, Sailhamer E et al (2003) Primary insertion of a silastic spring-loaded silo for gastroschisis. Am Surg 69:1083–1086PubMed

29.

Singh S, Fraser A, Leditschke J et al (2003) Gastroschisis: determinants of neonatal outcome. Pediatr Surg Int 19:260–265. doi:10.1007/s00383-002-0886-0 PubMedCrossRef

30.

Tibboel D, Raine P, McNee M et al (1986) Developmental aspects of gastroschisis. J Pediatr Surg 21:865–869. doi:10.1016/S0022-3468(86)80009-4 PubMedCrossRef

31.

Langer J, Longaker M, Crombleholme T et al (1989) Etiology of intestinal damage in gastroschisis: effects of amniotic fluid exposure and bowel constriction in fetal lamb model. J Pediatr Surg 24:992–997. doi:10.1016/S0022-3468(89)80200-3 PubMedCrossRef

32.

Albert A, Sancho M, Julia V et al (2001) Intestinal damage in gastroschisis is independent of the size of the abdominal defect. Pediatr Surg Int 17:116–119. doi:10.1007/s003830000482 PubMedCrossRef

Title: Risk stratification in gastroschisis: can prenatal evaluation or early postnatal factors predict outcome?
Authors: Ryan P. Davis
Marjorie C. Treadwell
Robert A. Drongowski
Daniel H. Teitelbaum
George B. Mychaliska
Publication date: 01-04-2009
Publisher: Springer-Verlag
Published in: Pediatric Surgery International / Issue 4/2009
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-009-2342-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Risk stratification in gastroschisis: can prenatal evaluation or early postnatal factors predict outcome?

Abstract

Purpose

Methods

Result

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Result

Conclusions

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