Contemporary 2-year outcomes of complex gastroschisis.
OBJECTIVE
Outcomes of gastroschisis are influenced by associated intestinal complications. We present a detailed analysis of complex gastroschisis.


METHODS
A retrospective study of all patients with gastroschisis treated at 2 university neonatal intensive care units between January 1, 2001, and March 31, 2007, was performed.


RESULTS
Of 83 patients, 19 (23%) had complex gastroschisis, including atresias (68%), gangrene (37%), closing gastroschisis (32%), perforation (21%), strictures (21%), and volvulus (11%). Prenatal ultrasound did not predict complications. Fifty-three percent underwent primary closure. Duration of mechanical ventilation and total parenteral nutrition (TPN) was 14.4 ± 1.9 days and 90.7 ± 9.0 days, respectively. Enteral feeds started at 35.9 ± 4.6 days. Hospital stay was 104.4 ± 9.6 days. Patients underwent a median of 3 abdominal procedures (range, 2-5) before discharge. Ninety-five percent survived to discharge; 33% and 67% were discharged on TPN and gastrostomy feeds, respectively. Two-year survival was 89%, with 82% on full oral feeding, 12% on a combination of oral and gastrostomy feeding, and 1 patient (who received a liver/bowel transplant) on a combination of enteral and parenteral nutrition.


CONCLUSIONS
Complex gastroschisis continues to produce significant morbidity. However, most of the patients are TPN free by 2 years of age.
Division of Pediatric Surgery, University of California Irvine School of Medicine, Orange, California, USA. Sherif.Emil@McGill.ca
Sherif
S
Emil
Noah
N
Canvasser
Tiffany
T
Chen
Esther
E
Friedrich
Wendy
W
Su
D015897:Comorbidity; D004750:Enteral Nutrition / Q000706:statistics & numerical data; D005260:Female; D005734:Gangrene / Q000453:epidemiology; D020139:Gastroschisis / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000601:surgery; D007409:Intestinal Atresia / Q000453:epidemiology; D007416:Intestinal Perforation / Q000453:epidemiology; D045822:Intestinal Volvulus / Q000453:epidemiology; D007422:Intestines / Q000637:transplantation; D007902:Length of Stay / Q000706:statistics & numerical data; D016031:Liver Transplantation; D008297:Male; D010289:Parenteral Nutrition, Total / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012127:Respiratory Distress Syndrome, Newborn / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome