Is early delivery beneficial in gastroschisis?

Helen Carnaghan; Susana Pereira; Catherine P. James; Paul B. Charlesworth; Marco Ghionzoli; Elkhouli Mohamed; Kate M. K. Cross; Edward Kiely; Shailesh Patel; Ashish Desai; Kypros Nicolaides; Joseph I. Curry; Niyi Ade-Ajayi; Paolo De Coppi; Mark Davenport; Anna L. David; Agostino Pierro; Simon Eaton

doi:10.1016/j.jpedsurg.2014.01.027

Is early delivery beneficial in gastroschisis?

Helen Carnaghan, Susana Pereira, Catherine P. James, Paul B. Charlesworth, Marco Ghionzoli, Elkhouli Mohamed, Kate M. K. Cross, Edward Kiely, Shailesh Patel, Ashish Desai, Kypros Nicolaides, Joseph I. Curry, Niyi Ade-Ajayi, Paolo De Coppi, Mark Davenport, Anna L. David, Agostino Pierro, Simon Eaton^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

49 Citations (Scopus)

Abstract

Purpose: Gastroschisis neonates have delayed time to full enteral feeds (ENT), possibly due to bowel exposure to amniotic fluid. We investigated whether delivery at < 37 weeks improves neonatal outcomes of gastroschisis and impact of intra/extra-abdominal bowel dilatation (IABD/EABD). Methods: A retrospective review of gastroschisis (1992–2012) linked fetal/neonatal data at 2 tertiary referral centers was performed. Primary outcomes were ENT and length of hospital stay (LOS). Data (median [range]) were analyzed using parametric/non-parametric tests, positive/negative predictive values, and regression analysis. Results: Two hundred forty-six patients were included. Thirty-two were complex (atresia/necrosis/perforation/stenosis). ENT (p < 0.0001) and LOS (p < 0.0001) were reduced with increasing gestational age. IABD persisted to last scan in 92 patients, 68 (74%) simple (intact/uncompromised bowel), 24 (26%) complex. IABD or EABD diameter in complex patients was not significantly greater than simple gastroschisis. Combined IABD/EABD was present in 22 patients (14 simple, 8 complex). When present at < 30 weeks, the positive predictive value for complex gastroschisis was 75%. Two patients with necrosis and one atresia had IABD and collapsed extra-abdominal bowel from < 30 weeks. Conclusion: Early delivery is associated with prolonged ENT/LOS, suggesting elective delivery at < 37 weeks is not beneficial. Combined IABD/EABD or IABD/collapsed extra-abdominal bowel is suggestive of complex gastroschisis.

Original language	English
Pages (from-to)	928-933
Number of pages	6
Journal	Journal of Pediatric Surgery
Volume	49
Issue number	6
DOIs	https://doi.org/10.1016/j.jpedsurg.2014.01.027
Publication status	Published - Jun 2014
Event	65th Annual Meeting of the Section-on-Surgery - American-Academy-of-Pediatrics - Orlando, United Kingdom Duration: 25 Oct 2013 → 27 Oct 2013

Keywords

Gastroschisis
Gestational age
Preterm delivery
Intra-abdominal bowel dilatation
Extra-abdominal bowel dilatation
Bowel inflammation
Post-natal outcome
Antenatal ultrasound
Enteral feeding
ELECTIVE PRETERM DELIVERY
PRENATAL-DIAGNOSIS
GESTATIONAL-AGE
MANAGEMENT
FETAL
OUTCOMES
FETUSES
ATRESIA
INFANTS
CLOSURE

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10.1016/j.jpedsurg.2014.01.027

Cite this

Carnaghan, H., Pereira, S., James, C. P., Charlesworth, P. B., Ghionzoli, M., Mohamed, E., Cross, K. M. K., Kiely, E., Patel, S., Desai, A., Nicolaides, K., Curry, J. I., Ade-Ajayi, N., De Coppi, P., Davenport, M., David, A. L., Pierro, A., & Eaton, S. (2014). Is early delivery beneficial in gastroschisis? Journal of Pediatric Surgery, 49(6), 928-933. https://doi.org/10.1016/j.jpedsurg.2014.01.027

@article{f274174e94ee4ab9b8ca8e9bef737025,

title = "Is early delivery beneficial in gastroschisis?",

abstract = "Purpose: Gastroschisis neonates have delayed time to full enteral feeds (ENT), possibly due to bowel exposure to amniotic fluid. We investigated whether delivery at < 37 weeks improves neonatal outcomes of gastroschisis and impact of intra/extra-abdominal bowel dilatation (IABD/EABD). Methods: A retrospective review of gastroschisis (1992–2012) linked fetal/neonatal data at 2 tertiary referral centers was performed. Primary outcomes were ENT and length of hospital stay (LOS). Data (median [range]) were analyzed using parametric/non-parametric tests, positive/negative predictive values, and regression analysis. Results: Two hundred forty-six patients were included. Thirty-two were complex (atresia/necrosis/perforation/stenosis). ENT (p < 0.0001) and LOS (p < 0.0001) were reduced with increasing gestational age. IABD persisted to last scan in 92 patients, 68 (74%) simple (intact/uncompromised bowel), 24 (26%) complex. IABD or EABD diameter in complex patients was not significantly greater than simple gastroschisis. Combined IABD/EABD was present in 22 patients (14 simple, 8 complex). When present at < 30 weeks, the positive predictive value for complex gastroschisis was 75%. Two patients with necrosis and one atresia had IABD and collapsed extra-abdominal bowel from < 30 weeks. Conclusion: Early delivery is associated with prolonged ENT/LOS, suggesting elective delivery at < 37 weeks is not beneficial. Combined IABD/EABD or IABD/collapsed extra-abdominal bowel is suggestive of complex gastroschisis.",

keywords = "Gastroschisis, Gestational age, Preterm delivery, Intra-abdominal bowel dilatation, Extra-abdominal bowel dilatation, Bowel inflammation, Post-natal outcome, Antenatal ultrasound, Enteral feeding, ELECTIVE PRETERM DELIVERY, PRENATAL-DIAGNOSIS, GESTATIONAL-AGE, MANAGEMENT, FETAL, OUTCOMES, FETUSES, ATRESIA, INFANTS, CLOSURE",

author = "Helen Carnaghan and Susana Pereira and James, {Catherine P.} and Charlesworth, {Paul B.} and Marco Ghionzoli and Elkhouli Mohamed and Cross, {Kate M. K.} and Edward Kiely and Shailesh Patel and Ashish Desai and Kypros Nicolaides and Curry, {Joseph I.} and Niyi Ade-Ajayi and {De Coppi}, Paolo and Mark Davenport and David, {Anna L.} and Agostino Pierro and Simon Eaton",

year = "2014",

month = jun,

doi = "10.1016/j.jpedsurg.2014.01.027",

language = "English",

volume = "49",

pages = "928--933",

journal = "Journal of Pediatric Surgery",

issn = "0022-3468",

publisher = "W.B. Saunders Ltd",

number = "6",

note = "65th Annual Meeting of the Section-on-Surgery - American-Academy-of-Pediatrics ; Conference date: 25-10-2013 Through 27-10-2013",