title: Risk stratification in gastroschisis: can prenatal evaluation or early postnatal factors predict outcome?
abstract: OBJECTIVE
  The prenatal or postnatal factors that predict complex gastroschisis in patients (atresia, volvulus, necrotic bowel and bowel perforation) remain controversial. We evaluated the prognostic value of prenatal ultrasonographic parameters and early postnatal factors in predicting clinical outcomes.
  
  
  METHODS
  We analyzed maternal and neonatal records of 46 gastroschisis patients treated from 1998 to 2007. Information regarding demographics, prenatal ultrasound data when available, intrapartum and postnatal course was abstracted from medical records. Outcome variables included survival, ventilator days, TPN days, time to full enteral feeds, complications and length of stay. Univariate or multivariate analysis was used, with P < 0.05 considered as significant.
  
  
  RESULTS
  A total of 75% of complex patients were categorized within 1 week of life. Interestingly, prenatal bowel dilation (>17 mm) and thickness (>3 mm) did not correlate with outcome or risk stratification into simple versus complex (P < 0.05). Complex patients had increased morbidity compared to simple patients (sepsis 58 versus 18%; P = 0.021, NEC 42 versus 9%; P = 0.020, short bowel syndrome 58 versus 3%; P = 0.0001, ventilator days 24 versus 10; P = 0.021; TPN days 178 versus 38; P = 0.0001 and days to full feeds 171 versus 31; P = 0.0001; and length of stay 90 versus 39 days, P = 0.0001).
  
  
  CONCLUSIONS
  Prenatal bowel wall dilation and/or thickness did not predict complex patients or adverse outcome. Complex gastroschisis patients can be identified postnatally and have substantial morbidity.
authors.affiliation: Section of Pediatric Surgery, Department of Surgery, University of Michigan Hospitals, Mott Children's Hospital F3970, Box 0245, Ann Arbor, MI 48109, USA. ryda@med.umich.edu
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Davis
authors.forename: Marjorie C
authors.initials: MC
authors.lastname: Treadwell
authors.forename: Robert A
authors.initials: RA
authors.lastname: Drongowski
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Teitelbaum
authors.forename: George B
authors.initials: GB
authors.lastname: Mychaliska
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D020139:Gastroschisis / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D016216:Ultrasonography, Prenatal / Q000379:methods; D014481:United States / Q000453:epidemiology; D055815:Young Adult