title: Clinical features of newborns with gastroschisis and outcomes of different initial interventions: primary closure versus staged repair.
abstract: BACKGROUND
  Gastroschisis requires surgical management soon after birth. Few publications have reached conclusion regarding the differences of outcomes between primary closure (PC) and a staged repair with silo pouch reduction (SR); as the initial management of gastroschisis.
  
  
  METHODS
  A retrospective review was conducted in 44 newborns with gastroschisis between 1996 and 2007 at Chang Gung Children's Hospital. We recorded and analyzed basic demographic data, including birth body weight, gestational age, size of the wall defect, initial operative procedure, outcomes, and mortality.
  
  
  RESULTS
  The male-to-female ratio was 21:23. Patients had a low birth body weight (2263 ± 539g, mean ± SD) and were borderline premature (gestational age = 36.3 ± 1.86 weeks). Thirty-two patients received PC and 12 received SR as the initial treatment. Seven of the newborn infants died because of delayed initial surgical intervention (n = 2), operation-related complications (n = 4), or underlying multiple congenital anomalies (n = 1). The mortality rate was 16%. When comparing PC and SR (excluding "complicated" gastroschisis), there were no significant differences in survival, days of ventilator use, days to reach full enteral feeding, and hospitalization.
  
  
  CONCLUSIONS
  PC and SR are comparable as initial treatment modalities for gastroschisis. In addition to underlying gastrointestinal anomalies, the factors that led to significant morbidity in our study were bowel gangrene or perforation resulting from postponed surgical management and the development of abdominal compartment syndrome.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chiayi, Taiwan.
authors.forename: Ming-Horng
authors.initials: MH
authors.lastname: Tsai
authors.forename: Hsuan-Rong
authors.initials: HR
authors.lastname: Huang
authors.forename: Shih-Ming
authors.initials: SM
authors.lastname: Chu
authors.forename: Pong-Hong
authors.initials: PH
authors.lastname: Yang
authors.forename: Reyin
authors.initials: R
authors.lastname: Lien
mesh_terms: D058107:Abdominal Wound Closure Techniques; D015331:Cohort Studies; D005260:Female; D020139:Gastroschisis / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome