Validated outcome prediction for gastroschisis (GS) permits early risk stratification. The aim of our study was to determine whether the need for GS defect extension: (a) correlates with bowel injury severity at birth, and (b) predicts outcome.
A national dataset was used to study GS babies born between 2005 and 2010. The primary outcome was days of parenteral nutrition (PN). Outcomes were analyzed according to the need for fascial extension to facilitate closure or silo placement as follows: Group 1, no extension; Group 2A, extension 2 cm. Univariate and where appropriate, multivariate analyses were used.
Of 507 cases, 402 had complete defect extension data: Group 1, 297 (73%); Group 2A, 67 (17%); Group 2B, 42 (10%). Group 2B patients had higher rates of atresia, perforation and severe matting (P = 0.001) and required more days on PN compared to Group 1 (63.0 ± 100.4 vs. 39.7 ± 44.5 days: CI 1.2-45.1; P = 0.03). Multivariate analysis revealed that the presence of atresia (P = 0.01) and surgical site (P = 0.001) or bloodstream (P = 0.001) infections were predictive of prolonged PN; however, the need for fascial extension was not.
GS newborns who require fascial extension are more likely to have complicated GS and are at greater risk for adverse outcome, although it is not an independent predictor of the latter.
Outcomes studies for gastroschisis are constrained by small numbers, prolonged accrual, and nonstandardized data collection. The aim of this study is to create a national pediatric surgical network and database for gastroschisis (GS) that tracks cases from diagnosis to hospital discharge.
The 16-center network serves a population of 32 million. Gastroschisis cases are ascertained at prenatal diagnosis. Perinatal data include maternal risk and fetal ultrasound variables, delivery plan and outcome, a postnatal bowel injury score, intended and actual surgical treatment, and neonatal outcomes. Institutional review board-approved data collection conforms to regional privacy legislation. Deidentified data are centralized and accessible for research through the network steering committee.
To date, 114 cases of pre- and/or postnatal gastroschisis have been uploaded. Of 106 live-born infants (40 [38%] by cesarean delivery), 100 had complete records, and overall survival to discharge was 96%, with a mean survivor length of stay (LOS) of 46 days. Infants treated with attempted urgent closure (61%) had significantly shorter LOS (42 vs 57 days; P = .048) but comparable LOS compared with those treated with silos and delayed closure. Fetal bowel dilation 18 mm or greater did not predict a difference in outcome.
Population-based databases allow rapid case accrual and enable studies that should aid in the identification of optimal perinatal treatment.
The incidence of gastroschisis appears to be rising in developed nations, with epidemiological studies indicating association with young maternal age and smoking. Is there an association between maternal smoking and the development of complicated gastroschisis? A retrospective population-based review of all cases of gastroschisis over 11 years was conducted in three Canadian provinces. Complicated cases were defined as those with an associated intestinal atresia or other vascular compromise of the bowel, those requiring a prolonged time to full enteral feeding (>42 days). Univariate and multivariate regression analyses were conducted. Fifty-four cases of gastroschisis were treated. Seventeen patients had complicated gastroschisis (CG). 47.1% of infants were born to smoking mothers; of those 56.25% were in the CG group. On univariate analysis statistically significant associations with complicated cases were young maternal age (
To describe neonatal and childhood outcomes of a contemporary cohort of infants with gastroschisis.
Observational, single center, inception cohort of children born with gastroschisis from January 2005 to December 2008.
Of 63 infants, 61 survived to hospital discharge and 39 were seen for follow-up. Complications included sepsis (37%), necrotizing enterocolitis (10%), parenteral nutrition related cholestasis (25%), and short bowel syndrome (13%). Of survivors, 5% had visual impairment and 10% had hearing loss. No child tested had mental delay or cerebral palsy. Early gestational age predicted death or disability (OR 0.60, 95% CI 0.38, 0.96; p=0.033). There was a high incidence of prescription medications for presumed gastroesophageal reflux (90%). Some infants continued to require tube feeds (15%). There were improvements in longitudinal growth reflected in increasing z-scores.
Although children with gastroschisis are at risk for disability, childhood outcomes are encouraging.
AIM: To report the epidemiology, associated malformations, morbidity and mortality for the first 5 years of life for infants with gastrointestinal malformations (GIM). METHODS: Population-based study using data from a registry of congenital malformations (Eurocat) and follow-up data from hospital records. The study included livebirths, fetal deaths with a gestational age of 20 weeks and older and induced abortions after prenatal diagnosis of malformations born during the period 1980 - 1993. RESULTS: A total of 109 infants/fetuses with 118 GIM were included in the study giving a prevalence of 15.3 (12.6 - 18.5) cases per 10 000 births. Anal atresia was present in seven of the 9 cases with more than one GIM. There were 38 cases (35 %) with associated malformations and/or karyotype anomalies. Thirty-two of the 90 live-born infants died during the first 5 years of life with the majority of deaths during the first week of life. Mortality was significantly increased for infants with associated malformations or karyotype anomalies compared to infants with isolated GIM (p
Conflicting information exists regarding the effects of maternal substance abuse on gastroschisis. The objectives of this study are to determine if maternal smoking is associated with an increased risk of gastroschisis and whether substance abuse is associated with the severity of gastroschisis.
The Canadian Pediatric Surgery Network (CAPSNET) database was evaluated for associations between maternal substance abuse and the severity of the gastroschisis. We also compared smoking rates from this group to overall Canadian maternal smoking rates.
One hundred fourteen cases of gastroschisis acquired over 18 months were evaluated. After adjusting for covariates, illicit drug use was associated with bowel necrosis (OR, 9.4; 95% CI,1.3-70) and marijuana use with matting of the intestines (OR, 4.0; 95% CI, 1.0-16). Functional outcomes assessment revealed that slower initiation of enteral feeds was associated with maternal smoking (OR, 3.8; 95% CI, 1.4-10). The overall maternal smoking rate in this cohort (30.7%) was significantly higher than the known Canadian rate (13.4%). This may be accounted for by the considerably higher smoking rate of mothers 20 to 24 years of age in our cohort (48.9%).
Substance abuse and smoking are associated with a greater severity of gastroschisis in terms of both the degree of intestinal injury and functional outcomes. High smoking rates among young mothers may be putting children with gastroschisis at risk for poor outcomes.
OBJECTIVES: To determine the foetal incidence of isolated anterior abdominal wall defects (gastroschisis and omphalocele) in the Arkhangelskaja Oblast (AO) in Russia and in Norway, as well as to study the maternal-age distribution of these defects. STUDY DESIGN: A register-based incidence study. METHODS: All registered foetuses and newborns with at least 12 weeks of gestation in the populations of AO (141,159) and Norway (293,708) were included. The data covered the period 1995-2004 in AO and 1999-2003 in Norway and were obtained from the malformation register in AO and the Medical Birth Registry of Norway. RESULTS: The majority of the outcomes with a defect were liveborn in Norway (65%), while in AO the majority were spontaneously or medically aborted (59%). The incidence of anterior abdominal wall defects was 5.4/10,000 (95% confidence limits: +/- 1.7) in AO and 5.1/10,000 +/- 0.8) in Norway, and the ratio of omphalocele to gastroschisis was 1.2 in AO vs. 0.9 in Norway. Gastroschisis was inversely associated with maternal age in Norway. CONCLUSIONS: Despite a difference in maternal age distribution, there was no difference in the incidence of abdominal wall defects in AO and Norway. Gastroschisis was associated with young maternal age only in Norway, and the higher incidence in maternal age groups younger than 25 warrants further studies about aetiological factors associated with young maternal age.
The prevalence of gastroschisis in Norway, as reported to the Medical Birth Registry of Norway, increased regularly and sixfold from 0.5 to 2.9 per 10,000 births during 1967-1998. The prevalence was also consistently higher among children of younger mothers. The authors used age-period-cohort analysis to assess effects of both parents' age and year of birth (parental cohorts). Mother's and father's age were included in three different regression models. Apart from a significantly higher risk at a young maternal age, the authors also found higher risk at a young paternal age (1.6-fold per 10 years' reduction in father's age, 95% confidence interval: 1.0, 2.4). The time trend was highly significant regardless of whether it was ascribed to period, mother's year of birth, or father's year of birth. However, when father's year of birth was used to describe the time trend, no apparent additional effect of father's age was found, only for mother's age. The time trend is likely caused by environmental factors. Persistently increasing risks among children of young mothers may hypothetically be related to lifestyle factors. A contribution to risk also from fathers born in more recent years or from young fathers increases the likelihood that a factor related to modern lifestyles of young couples may be related to risk.
Gastroschisis is increasing in incidence worldwide. There is a need for a disease-specific, population-based approach to determining factors linked with gastroschisis and its outcome.
To examine racial, socioeconomic, health and geographic predictors of gastroschisis and its outcome in Canada.
535 cases of gastroschisis from the Canadian Pediatric Surgery Network national database were included from May 2005 to May 2010. Baseline characteristics of mothers were compared with those reported by Statistics Canada. Factors associated with adverse neonatal outcomes were examined using regression analyses.
Mothers of infants with gastroschisis are young, often from small communities. Smoking (37%) and illicit drug use are common in this population. Single mothers receive less perinatal care (OR 0.06; 95% CI 0.02-0.28). Geographically isolated mothers are more likely to undergo caesarian section (OR 3.84; 95% CI 1.26-11.74). Cocaine use predicts a lower odds of delivering at a planned center (OR 0.25; 95% CI 0.08-0.79), and is also associated with an increased likelihood of intestinal injury at birth (OR 6.26; 95% CI 1.52-25.72). Infants of mothers from isolated communities will spend a mean of 31.9 days longer in hospital. Aboriginal status is not independently predictive of perinatal or neonatal outcome.
Gastroschisis in Canada occurs frequently in young mothers, aboriginals and smokers. Features associated with worse outcomes include single parent status, cocaine use and maternal hometown geographic isolation.
Optimal perinatal treatment in gastroschisis remains uncertain. We sought to determine the effect of gestational age (GA), birth weight (BW), and intended and actual route of delivery on outcomes in gastroschisis.
Cases were abstracted from a national gastroschisis database. Outcomes analyzed by route of delivery, delivery plan conformity, BW, and GA included survival, closure success, ventilation days, total parenteral nutrition days, and length of hospital stay. Logistic regression for continuous and categorical variables was performed.
One hundred ninety-two babies (56% male) born at mean GA of 36.1 +/- 2.1 weeks, with mean BW of 2536 +/- 557 g, were included. One hundred eighty-three (95%) survived. Of 145 pregnancies with an antenatal delivery plan, vaginal delivery was intended in 77% and actually occurred in 119 pregnancies, with the remainder being planned (33; 17%) or emergency (40; 21%) cesarean deliveries. A delivery conforming to the antenatal plan occurred in 74 (51%). Birth weight and GA were significant inverse predictors of ventilator and total parenteral nutrition days and length of hospital stay, but not survival. Delivery route did not predict any outcome; however, "nonconformers" were born at lower BW and GA than "conformers," and they showed trends toward poorer nonmortality outcomes.
Gestational age, BW, and conformity to an antenatal birth plan are predictors of outcome in gastroschisis, whereas actual route of delivery is not.