Is complex gastroschisis predictable by prenatal ultrasound?
OBJECTIVE
To establish a correlation between prenatal ultrasound findings and postnatal outcome in neonates with gastroschisis (GS).


METHODS
Retrospective case-control study.


METHODS
Prenatal ultrasound reports, labour and neonatal intensive care unit notes, and paediatric surgical clinic records were reviewed.


METHODS
Neonates with an antenatal diagnosis of isolated GS.


METHODS
The neonates were divided into two groups: one with associated bowel complications including intestinal atresia, perforation, necrosis or volvulus ('complex' GS), and the second without bowel complication ('simple' GS). Prenatal ultrasound markers: small-for-gestational-age, intra-abdominal and extra-abdominal bowel dilatation (>6 mm), thickened intestinal wall and stomach dilatation were correlated with outcome.


METHODS
Fetal or neonatal death in complex versus simple GS. Time on parenteral nutrition and duration of hospital stay were also noted.


RESULTS
In all, 105 cases were eligible for analysis. Survival rate was 101/105 (96.2%). None of the ultrasound markers was predictive of fetal or neonatal death. Fourteen of 103 live-born babies (14.6%) had complex GS, which was associated with longer time on parenteral nutrition [8.0 (51.5-390) versus 33.5 (25.3-53.3) days, P<0.001] and longer duration of hospital stay [85.3 (55.5-210) versus 41.5 (33.0-64.8) days, P<0.001]. Infants with complex GS were more likely to require bowel resection and stoma placement (P<0.05). Intra-abdominal bowel dilatation was the only predictive ultrasound marker of complex GS (odds ratio 4.13, 95% CI 1.32-12.90; P=0.018). Receiver operating characteristic curve for observed/expected bowel diameter yielded 6 as the cutoff value for predicting complex GS (odds ratio 7.9, 95% CI 2.3-27.3; P=0.001) with 54% and 88% for sensibility and specificity, respectively.


CONCLUSIONS
Intra-abdominal bowel dilatation is the only ultrasound marker predictive of complex GS but it is a strong marker.
Department of Obstetrics, Hôpital Necker Enfants Malades, Assistance Publique, Hôpitaux de Paris, Université Paris Descartes Société Française pour l'Amélioration des Pratiques Echographiques, Paris, France.
M
M
Kuleva
N
N
Khen-Dunlop
Y
Y
Dumez
Y
Y
Ville
L J
LJ
Salomon
D000328:Adult; D016022:Case-Control Studies; D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging; D005260:Female; D020139:Gastroschisis / Q000000981:diagnostic imaging* / Q000401:mortality; D005865:Gestational Age; D006801:Humans; D007902:Length of Stay; D010288:Parenteral Nutrition / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome; D012372:ROC Curve; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal; D055815:Young Adult