The contemporary outcome of gastroschisis.
BACKGROUND
The aim of this study was to evaluate the contemporary outcome in the management of gastroschisis.


METHODS
A retrospective analysis was conducted of 91 babies admitted over a 7-year period to a single neonatal surgical unit with a diagnosis of gastroschisis.


RESULTS
An antenatal diagnosis was made in 89 (98%) cases. Surgical intervention occurred in 90 babies, at a mean of 5 hours (range, 0.5 to 17) postdelivery. In 72 (80%) cases, primary closure of the abdominal defect was achieved, with a silo fashioned in the remaining 18 (20%). One child died before abdominal closure. The median time to full oral feeding was 30 days (range, 5 to 160 days), and to discharge was 42 days (range, 11 to 183 days). Those children who required a silo, took longer to feed (P =.008) and stayed longer in the hospital (P =.021). The 8 (8.8%) children with an intestinal atresia, required significantly more operative procedures (P =.0001) and took significantly longer to achieve full oral feeding (P =.04), but the presence of an atresia was not an independent risk factor for mortality. There were 7 deaths (7.7%), 3 within the first 7 days. Of the deaths, 5 (71%) were caused by overwhelming sepsis.


CONCLUSIONS
The contemporary mortality rate from gastroschisis is less than 8%, and minimizing septic complications would contribute significantly to reducing this. Strategies designed to improve morbidity must focus on optimizing management of those factors associated with a prolonged recovery, namely intestinal atresia, prematurity, and the use of a silo.
Driver
C P
CP
Neonatal Surgical Unit, St Mary's Hospital, Manchester, England.
Bruce
J
J
Bianchi
A
A
Doig
C M
CM
Dickson
A P
AP
Bowen
J
J
D001724:Birth Weight; D020139:Gastroschisis / Q000601:surgery*; D005865:Gestational Age; D006801:Humans; D007223:Infant; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome