title: Preclosure fluid resuscitation influences outcome in gastroschisis.
abstract: Optimal preclosure fluid resuscitation in gastroschisis (GS) is unknown. The purpose of our study was to evaluate effects of preclosure intravenous fluid resuscitation on GS outcome. Cases were accrued from a national GS database. Risk variables analyzed included gestational age (GA), birth weight (BW), neonatal illness severity score, and bolus fluid administration within 6 hours of neonatal intensive care unit admission. Outcomes analyzed included closure success, days of ventilation/total parenteral nutrition (TPN), and bacteremic episodes. Linear and logistic regression analyses were performed. Four hundred seven live-born GS cases were identified (362 with complete resuscitative fluids data). Mean BW, GA, and Score for Neonatal Acute Physiology-II score were 2562 ± 539 g, 36.17 ± 1.95 weeks, and 9.97 ± 12.65, respectively. One hundred sixty-two patients received no supplemental fluid, and 200 patients received a mean of 21.49 (0.81 to 134.81) mL/kg of intravenous fluid. Multivariate outcomes analyses demonstrated a significant, direct relationship between resuscitative volume and days of postclosure ventilation, TPN, length of hospital stay, and bacteremic episodes; specifically, every 17 mL/kg of fluid predicted one additional ventilation day (p = 0.002), TPN day (p = 0.01), and hospital day (p = 0.01) and 0.02 odds increase of an episode of bacteremia (p = 0.03). Judicious, preclosure fluid resuscitation is essential in early GS management. Excessive fluid is associated with several adverse survival outcomes.
authors.affiliation: Department of Surgery, BC Children's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Leigh A
authors.initials: LA
authors.lastname: Jansen
authors.forename: Arash
authors.initials: A
authors.lastname: Safavi
authors.forename: Yi
authors.initials: Y
authors.lastname: Lin
authors.forename: Ying C
authors.initials: YC
authors.lastname: MacNab
authors.forename: Erik D
authors.initials: ED
authors.lastname: Skarsgard
mesh_terms: D016470:Bacteremia; D001724:Birth Weight; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005440:Fluid Therapy / Q000379:methods*; D020139:Gastroschisis / Q000601:surgery*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007430:Intraoperative Care / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D010289:Parenteral Nutrition, Total / Q000706:statistics & numerical data; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome