Predicting the outcome of newborns with gastroschisis.
OBJECTIVE
The objective of the study was to determine factors predicting outcome in newborns with gastroschisis.


METHODS
A retrospective analysis of 155 consecutive cases admitted from 1 January 1990 to 31 December 2007 was performed. Prenatal ultrasound findings were available for 89 of 155 (57%) patients and were compared with final outcome. Both univariate and multiple regression analyses were used.


RESULTS
All patients survived to discharge home. The primary outcome measure was length of stay. Multiple regression identified 4 factors associated with length of stay: (1) gestational age (P = .004), (2) nonelective silo (P < .001), (3) gastrointestinal (GI) complication (intestinal atresia, perforation, or resection) (P < .001), and (4) non-GI anomaly (P = .029). Non-GI anomalies occurred in 17 of 155 (11%) patients and tended to increase the risk of a nonelective silo or GI complication (59% vs 39%, P = .190). Dilated bowel (>10 mm) on prenatal ultrasound was associated with GI complications (22% vs 3%, P = .010). However, 78% of patients with dilated bowel on prenatal ultrasound did not have a GI complication. The absence of dilated bowel on prenatal ultrasound accurately predicted the absence of GI complications in 97% of cases.


CONCLUSIONS
Prematurity, nonelective silo, GI complications, and non-GI anomalies predict the short-term outcome of newborns with gastroschisis. Prenatal ultrasound serves primarily to predict the absence of GI complications.
Division of Neonatology, Children's Hospital and Clinics of Minnesota, Minneapolis, MN 55404, USA. rob.payne@childrensmn.org
Nathaniel R
NR
Payne
Kathleen
K
Pfleghaar
Barbara
B
Assel
Aubrey
A
Johnson
R Hampton
RH
Rich
D000015:Abnormalities, Multiple / Q000453:epidemiology; D000328:Adult; D004065:Digestive System Abnormalities / Q000453:epidemiology; D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging / Q000196:embryology; D005260:Female; D020139:Gastroschisis / Q000000981:diagnostic imaging / Q000196:embryology / Q000453:epidemiology / Q000601:surgery*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D008423:Maternal Age; D008910:Minnesota / Q000453:epidemiology; D011247:Pregnancy; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016216:Ultrasonography, Prenatal