Outcomes in Neonates with Gastroschisis in U.S. Children's Hospitals

Abstract

Our objectives are to report patient characteristics, comorbidities, and outcomes for gastroschisis patients and analyze factors associated with mortality and sepsis. Using Pediatric Health Information System data, we examined neonates with both an International Classification of Diseases, 9th Revision diagnosis (756.79) and procedure (54.71) code for gastroschisis (2003 to 2008). We examined descriptive characteristics and conducted multivariate regression models examining risk factors for mortality, during the birth hospitalization, and sepsis. Analysis of 2490 neonates with gastroschisis found 90 deaths (3.6%) and sepsis in 766 (31%). Critical comorbidities and procedures are cardiovascular defects (15%), pulmonary conditions (5%), intestinal atresia (11%), intestinal resection (12.5%), and ostomy formation (8.3%). Factors associated with mortality were large bowel resection (odds ratio [OR] 8.26, 95% confidence interval [CI] 1.17 to 58.17), congenital circulatory (OR 5.62, 95% CI 2.11 to 14.91), and pulmonary (OR 8.22, 95% CI 2.75 to 24.58) disease, and sepsis (OR 3.87, 95% CI 1.51 to 9.91). Factors associated with sepsis include intestinal ostomy (OR 2.94, 95% CI 1.71 to 5.05), respiratory failure (OR 2.48, 95% CI 1.85 to 3.34), congenital circulatory anomalies (OR 1.58, 95% CI 1.10 to 2.28), and necrotizing enterocolitis (OR 4.38, 95% CI 2.51 to 7.67). Further investigation into modifiable factors such as small bowel ostomy and prevention of sepsis and necrotizing enterocolitis is warranted to guide surgical decision making and postoperative management.

Pathogenic implications of remnant vitelline structures in gastroschisis

“…Gastroschisis represents an asymmetrical abdominal wall defect localized to the right of an intact umbilicus with viscera herniation. Unlike omphalocele, gastroschisis represents an isolated defect without associated anomalies, although around 10% of the cases are complicated by bowel atresia [7]. Epidemiologic studies have shown that chromosome abnormalities and single gene disorders are rarely associated with gastroschisis [8].…”

Predictive factors at birth of the severity of gastroschisis

“…but the mortality rate reported in our study (11.7%) tallies with the values reported in most studies. Prematurity, intrauterine growth retardation and the presence of a congenital circulatory or pulmonary anomaly are external factors associated with a poorer outcome for children born with GS [3] . In our study, three babies (3/68) showed concomitant fetal abnormalities incompatible with life; finally, five babies died from GS and associated bowel complications (5/68, 7.3%).…”

“…Prolonged TPN, with its risk of sepsis, is directly related to intestinal recuperation, and the morbidity of GS is closely related to intestinal damage [20] . While gastrointestinal complications such as matting between the loops, malrotation, volvulus, perforations and atresia increase the complexity of early management [19,21] , later management may be complicated by the presence of problems of absorption, intestinal dysmotility, obstruction, NEC, infarction and stenosis [1,3,9] . The pathogenesis of secondary bowel lesions is not fully understood, but both chemical and mechanical origins are concerned [2] .…”

“…The amniotic fluid creates an inflammation of the bowel wall, called perivisceritis [2] . Associated with intestinal abnormalities are malrotation and a degree of short bowel: Volvulus, perforation and atresia may also be found [3] . The degree of inflammation of the bowel and the presence of intestinal abnormalities are supposed to reflect the severity of the malformation, determining the surgical procedure and affecting the clinical outcome [4] .…”

Congenital defects of abdominal wall

“…В этой научной работе также установлено, что у детей с «осложненным гастрошизисом» в 6 раз чаще развиваются заболевания печени, вследствие длительного паренте-рального питания. В другом исследовании отмечены вы-сокая частота развития катетер-ассоциированного сепси-са, длительное время до перехода на энтеральное питание и увеличение длительности госпитализации больных с атрезией и некрозом кишечника [71]. Гастрошизис по-прежнему является наиболее частой причиной транс-плантации кишечника у детей [72].…”