Mode of delivery and neonatal survival of infants with gastroschisis in Australia and New Zealand.
OBJECTIVE
The aim of the study was to examine the short-term outcome of infants with gastroschisis by route of delivery, comparing vaginal delivery vs elective and emergency cesarean delivery (CD).


METHODS
Six hundred thirty-one infants with gastroschisis (International Classification of Diseases, 10th Revision: Q79.3) were admitted to the Australian and New Zealand Neonatal Network during 1997 to 2005. Multivariate Cox proportional hazards regression analysis was performed to adjust for case-mix and significant baseline characteristics.


RESULTS
During the study period, 631 infants with gastroschisis were admitted to the collaborating centers. Of these, 343 (54.4%) infants were delivered vaginally, whereas 288 (45.6%) were delivered by cesarean birth. Of the latter, 148 (23.4%) were elective and 140 (22.2%) were emergency. There was an increasing trend of CD from 41.1% in 1997 to 69.0% in 2005. Forty-seven (7.4%) infants died; 30 (8.7%) in the vaginal, 9 (6.4%) in the emergency, and 8 (5.4%) in the elective CD group. There was no difference in rate of proven infection, duration of ventilation, or length of neonatal intensive care unit stay between the 3 groups. After controlling for prematurity, low birth weight, and outborn birth, the risk for neonatal demise was similar in both the vaginal and CD infants (adjusted hazard ratio, 1.486; 95% confidence interval, 0.814-2.713; P = .197). Stratifying the CD (emergency vs elective) gave similar results.


CONCLUSIONS
Infants with gastroschisis appear to be safely delivered vaginally.
Abdel-Latif
Mohamed E
ME
Department of Newborn Care, Royal Hospital for Women, Randwick, NSW 2031, Australia.
Bolisetty
Srinivas
S
Abeywardana
Samanthi
S
Lui
Kei
K
D000328:Adult; D001315:Australia; D002585:Cesarean Section; D036861:Delivery, Obstetric; D004638:Emergency Treatment; D005260:Female; D020139:Gastroschisis / Q000401:mortality*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009520:New Zealand; D012189:Retrospective Studies; D015996:Survival Rate