Perinatal predictors of outcome in gastroschisis.
OBJECTIVE
To identify perinatal risk variables predictive of outcome in gastroschisis.


METHODS
Gastroschisis cases were collected over a 3-year period from a national database. Risk variables evaluated included gestational age (GA), birth weight, time of birth, admission illness severity (score for neonatal acute physiology-II, SNAP-II) score, and abdominal closure type. Mortality and survival outcomes were analyzed. Multivariate analyses were performed.


RESULTS
In all, 239 infants were survived (96%). SNAP-II score predicted mortality (relative risk (RR)=1.07, 95% confidence interval (CI)=1.0 to 1.1). Length of hospital stay (LOS) and ventilation days were predicted by GA and by SNAP-II score. SNAP-II score predicted total parenteral nutrition (TPN) days (P=0.006). Severe cholestasis (conjugated bilirubin of >10 mg per 100 ml) was inversely related to GA (RR=0.77, 95% CI=0.61 to 0.97) and directly to categorical SNAP-II score (RR=3.4, 95% CI=1.2 to 10.1). Urgent closure predicted fewer TPN days (P=0.003) and shorter LOS (P=0.0002).


CONCLUSIONS
SNAP-II scores significantly predict mortality and survival outcomes. Urgent closure favors fewer TPN days and shorter LOS. Our data refute routine preterm delivery in gastroschisis.
Mills
J A
JA
Department of Surgery, BC Children's Hospital, University of British Columbia, 4480 Oak Street, Vancouver, BC, Canada.
Lin
Y
Y
Macnab
Y C
YC
Skarsgard
E D
ED
D001724:Birth Weight; D002245:Carbon Dioxide / Q000097:blood; D005260:Female; D020139:Gastroschisis / Q000401:mortality* / Q000601:surgery*; D005865:Gestational Age; D006305:Health Status Indicators; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007902:Length of Stay; D008297:Male; D010100:Oxygen / Q000097:blood; D010289:Parenteral Nutrition, Total; D011183:Postoperative Complications / Q000401:mortality*; D012307:Risk Factors; D015996:Survival Rate
D002245:Carbon Dioxide; D010100:Oxygen