Gastroschisis with intestinal atresia--predictive value of antenatal diagnosis and outcome of postnatal treatment.
OBJECTIVE
The purpose of this study is to evaluate (1) the predictive value of fetal bowel dilatation (FBD) for intestinal atresia in gastroschisis and (2) the postnatal management and outcome of this condition.


METHODS
A retrospective review of all gastroschisis cases diagnosed in our fetal medicine unit between 1992 and 2010 and treated postnatally in our center was performed.


RESULTS
One hundred thirty cases had full postnatal data available. Intestinal atresia was found at surgery in 14 neonates (jejunum, n = 6; ileum, n = 3; ascending colon, n = 3; multiple, n = 2). Polyhydramnios and FBD were more likely in the atresia group compared with infants with no atresia (P = .0003 and P = .005, respectively). Fetal bowel dilatation had 99% negative predictive value (95% confidence interval, 0.9-0.99) and 17% positive predictive value (95% confidence interval, 0.1-0.3) for atresia. Treatment of intestinal atresia included primary anastomosis (n = 5), delayed anastomosis (n = 2), and stoma formation followed by anastomosis (n = 7). Infants with atresia had longer duration of parenteral nutrition, higher incidence of sepsis, and cholestasis compared with infants with no atresia (P = .0003). However, the presence of atresia did not increase mortality.


CONCLUSIONS
Polyhydramnios and FBD are associated with atresia. Absence of FBD in gastroschisis excludes intestinal atresia. In our experience, atresia is associated with a longer duration of parenteral nutrition but does not influence mortality. These findings may be relevant for antenatal counseling.
Surgery Unit, Institute of Child Health and Great Ormond Street Hospital, London, WC1N 1EH, England.
Marco
M
Ghionzoli
Catherine P
CP
James
Anna L
AL
David
Dimple
D
Shah
Aileen W C
AW
Tan
Joseph
J
Iskaros
David P
DP
Drake
Joseph I
JI
Curry
Edward M
EM
Kiely
Kate
K
Cross
Simon
S
Eaton
Paolo
P
De Coppi
Agostino
A
Pierro
D000015:Abnormalities, Multiple / Q000000981:diagnostic imaging* / Q000196:embryology / Q000601:surgery; D000714:Anastomosis, Surgical / Q000706:statistics & numerical data; D002585:Cesarean Section / Q000706:statistics & numerical data; D002779:Cholestasis / Q000453:epidemiology; D003106:Colon / Q000002:abnormalities; D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging / Q000196:embryology; D005260:Female; D020139:Gastroschisis / Q000000981:diagnostic imaging* / Q000196:embryology / Q000601:surgery; D006801:Humans; D007082:Ileum / Q000002:abnormalities; D007231:Infant, Newborn; D007409:Intestinal Atresia / Q000000981:diagnostic imaging* / Q000196:embryology / Q000601:surgery; D007583:Jejunum / Q000002:abnormalities; D007751:Labor, Induced / Q000706:statistics & numerical data; D054843:Negative-Pressure Wound Therapy; D010289:Parenteral Nutrition, Total / Q000706:statistics & numerical data; D006831:Polyhydramnios / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology; D011237:Predictive Value of Tests; D011247:Pregnancy; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal