Effects of multidisciplinary prenatal care and delivery mode on gastroschisis outcomes.
OBJECTIVE
This study examined the effects of multidisciplinary prenatal care and delivery mode on gastroschisis outcomes, with adjustment for key confounding variables.


METHODS
This retrospective cohort study included all gastroschisis patients treated at a single tertiary children's hospital between 1999 and 2009. Prenatal care, delivery mode (vaginal vs cesarean section before labor vs after labor), patient characteristics, and clinical outcomes were determined by chart review. Time to discontinuation of parenteral nutrition (PN) was the primary outcome of interest. Effects of multidisciplinary prenatal care and delivery mode were evaluated using Cox proportional hazards regression models that included gestational age, birth weight, sex, concomitant intestinal complications, and year of admission.


RESULTS
Of 167 patients included, 46% were delivered vaginally, 69% received multidisciplinary prenatal care, and median time to PN discontinuation was 38 days. On multivariable modeling, gestational age, uncomplicated gastroschisis, and year of admission were significant predictors of early PN independence. Delivery mode and prenatal care had no independent effect on outcomes, although patients receiving multidisciplinary prenatal care were more likely to be born at term (49% vs 27%, P = .01).


CONCLUSIONS
Gestational age and intestinal complications are the major determinants of outcome in gastroschisis. Multidisciplinary prenatal care may facilitate term delivery.
Division of Pediatric Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35233, USA.
Christopher W
CW
Snyder
Christopher W
CW
Synder
Joseph R
JR
Biggio
Phillip
P
Brinson
Leandra A
LA
Barnes
Donna T
DT
Bartle
Keith E
KE
Georgeson
Oliver J
OJ
Muensterer
D002585:Cesarean Section / Q000379:methods; D015897:Comorbidity; D003376:Counseling / Q000706:statistics & numerical data; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D020139:Gastroschisis / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010288:Parenteral Nutrition / Q000706:statistics & numerical data; D010348:Patient Care Team / Q000706:statistics & numerical data; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000379:methods*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal