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 journalArticlepeer-review

    47 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 languageEnglish
    Pages (from-to)928-933
    Number of pages6
    JournalJournal of Pediatric Surgery
    Volume49
    Issue number6
    DOIs
    Publication statusPublished - Jun 2014
    Event65th Annual Meeting of the Section-on-Surgery - American-Academy-of-Pediatrics - Orlando, United Kingdom
    Duration: 25 Oct 201327 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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