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J Pediatr Surg. 2014 Jun;49(6):928-33; discussion 933. doi: 10.1016/j.jpedsurg.2014.01.027.

Is early delivery beneficial in gastroschisis?

Author information

1
UCL Institute of Child Health and Great Ormond Street Hospital for Children, London, UK.
2
The Harris Birthright Centre for Fetal Medicine, King's College Hospital, London, UK.
3
Fetal Medicine Unit, University College London Hospital, London, UK.
4
Paediatric Surgery Unit, King's College Hospital, London, UK.
5
Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.
6
UCL Institute of Child Health and Great Ormond Street Hospital for Children, London, UK. Electronic address: s.eaton@ucl.ac.uk.

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 <37weeks 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 <30weeks, the positive predictive value for complex gastroschisis was 75%. Two patients with necrosis and one atresia had IABD and collapsed extra-abdominal bowel from <30weeks.

CONCLUSION:

Early delivery is associated with prolonged ENT/LOS, suggesting elective delivery at <37weeks is not beneficial. Combined IABD/EABD or IABD/collapsed extra-abdominal bowel is suggestive of complex gastroschisis.

KEYWORDS:

Antenatal ultrasound; Bowel inflammation; Enteral feeding; Extra-abdominal bowel dilatation; Gastroschisis; Gestational age; Intra-abdominal bowel dilatation; Post-natal outcome; Preterm delivery

PMID:
24888837
DOI:
10.1016/j.jpedsurg.2014.01.027
[Indexed for MEDLINE]
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