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Pediatric Surgery International
Published in: Pediatric Surgery International 4/2018

01-04-2018 | Original Article

The influence of gestational age, mode of delivery and abdominal wall closure method on the surgical outcome of neonates with uncomplicated gastroschisis

Authors: Maria V. Fraga, Pablo Laje, William H. Peranteau, Holly L. Hedrick, Nahla Khalek, Juliana S. Gebb, Julie S. Moldenhauer, Mark P. Johnson, Alan W. Flake, N. Scott Adzick

Published in: Pediatric Surgery International | Issue 4/2018

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Abstract

Aim of the study

To evaluate if gestational age (GA), mode of delivery and abdominal wall closure method influence outcomes in uncomplicated gastroschisis (GTC).

Methods

Retrospective review of NICU admissions for gastroschisis, August 2008–July 2016. Primary outcomes were: time to start enteral feeds (on-EF), time to discontinue parenteral nutrition (off-PN), and length of stay (LOS).

Main results

A total of 200 patients with GTC were admitted to our NICU. Patients initially operated elsewhere (n = 13) were excluded. Patients with medical/surgical complications (n = 62) were analyzed separately. The study included 125 cases of uncomplicated GTC. There were no statistically significant differences in the outcomes of patients born late preterm (34 0/7–36 6/7; n = 70) and term (n = 40): on-EF 19 (5–54) versus 17 (7–34) days (p = 0.29), off-PN 32 (12–101) versus 30 (16–52) days (p = 0.46) and LOS 40 (18–137) versus 37 (21–67) days (p = 0.29), respectively. Patients born before 34 weeks GA (n = 15) had significantly longer on-EF, off-PN and LOS times compared to late preterm patients: 26 (12–50) days (p = 0.01), 41 (20–105) days (p = 0.04) and 62 (34–150) days (p < 0.01), respectively. There were no significant differences in outcomes between patients delivered by C-section (n = 62) and patients delivered vaginally (n = 63): on-EF 20 (5–50) versus 19 (7–54) days (p = 0.72), off-PN 32 (12–78) versus 33 (15–105) days (p = 0.83), LOS 42 (18–150) versus 41 (18–139) days (p = 0.68), respectively. There were significant differences in outcomes between patients who underwent primary reduction (n = 37) and patients who had a silo (88): on-EF 15 (5–37) versus 22 (6–54) days (p < 0.01), off-PN 28 (12–52) versus 34 (15–105) days (p = 0.04), LOS 36 (18–72) versus 44 (21–150) days (p = 0.04), respectively.

Conclusion

In our experience, late preterm delivery did not affect outcomes compared to term delivery in uncomplicated GTC. Outcomes were also not influenced by the mode of delivery. Patients who underwent primary reduction had better outcomes than patients who underwent silo placement.
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Metadata
Title
The influence of gestational age, mode of delivery and abdominal wall closure method on the surgical outcome of neonates with uncomplicated gastroschisis
Authors
Maria V. Fraga
Pablo Laje
William H. Peranteau
Holly L. Hedrick
Nahla Khalek
Juliana S. Gebb
Julie S. Moldenhauer
Mark P. Johnson
Alan W. Flake
N. Scott Adzick
Publication date
01-04-2018
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Surgery International / Issue 4/2018
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI
https://doi.org/10.1007/s00383-018-4233-5

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