title: Is early delivery beneficial in gastroschisis?
abstract: OBJECTIVE
  Gastroschisis neonates have delayed time to full enteral feeds (ENT), possibly due to bowel exposure to amniotic fluid. We investigated whether delivery at <37weeks improves neonatal outcomes of gastroschisis and impact of intra/extra-abdominal bowel dilatation (IABD/EABD).
  
  
  METHODS
  A retrospective review of gastroschisis (1992-2012) linked fetal/neonatal data at 2 tertiary referral centers was performed. Primary outcomes were ENT and length of hospital stay (LOS). Data (median [range]) were analyzed using parametric/non-parametric tests, positive/negative predictive values, and regression analysis.
  
  
  RESULTS
  Two hundred forty-six patients were included. Thirty-two were complex (atresia/necrosis/perforation/stenosis). ENT (p<0.0001) and LOS (p<0.0001) were reduced with increasing gestational age. IABD persisted to last scan in 92 patients, 68 (74%) simple (intact/uncompromised bowel), 24 (26%) complex. IABD or EABD diameter in complex patients was not significantly greater than simple gastroschisis. Combined IABD/EABD was present in 22 patients (14 simple, 8 complex). When present at <30weeks, the positive predictive value for complex gastroschisis was 75%. Two patients with necrosis and one atresia had IABD and collapsed extra-abdominal bowel from <30weeks.
  
  
  CONCLUSIONS
  Early delivery is associated with prolonged ENT/LOS, suggesting elective delivery at <37weeks is not beneficial. Combined IABD/EABD or IABD/collapsed extra-abdominal bowel is suggestive of complex gastroschisis.
authors.affiliation: UCL Institute of Child Health and Great Ormond Street Hospital for Children, London, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Carnaghan
authors.affiliation: The Harris Birthright Centre for Fetal Medicine, King's College Hospital, London, UK.
authors.forename: Susana
authors.initials: S
authors.lastname: Pereira
authors.affiliation: Fetal Medicine Unit, University College London Hospital, London, UK.
authors.forename: Catherine P
authors.initials: CP
authors.lastname: James
authors.affiliation: Paediatric Surgery Unit, King's College Hospital, London, UK.
authors.forename: Paul B
authors.initials: PB
authors.lastname: Charlesworth
authors.affiliation: UCL Institute of Child Health and Great Ormond Street Hospital for Children, London, UK.
authors.forename: Marco
authors.initials: M
authors.lastname: Ghionzoli
authors.affiliation: Fetal Medicine Unit, University College London Hospital, London, UK.
authors.forename: Elkhouli
authors.initials: E
authors.lastname: Mohamed
authors.affiliation: UCL Institute of Child Health and Great Ormond Street Hospital for Children, London, UK.
authors.forename: Kate M K
authors.initials: KM
authors.lastname: Cross
authors.affiliation: UCL Institute of Child Health and Great Ormond Street Hospital for Children, London, UK.
authors.forename: Edward
authors.initials: E
authors.lastname: Kiely
authors.affiliation: Paediatric Surgery Unit, King's College Hospital, London, UK.
authors.forename: Shailesh
authors.initials: S
authors.lastname: Patel
authors.affiliation: Paediatric Surgery Unit, King's College Hospital, London, UK.
authors.forename: Ashish
authors.initials: A
authors.lastname: Desai
authors.affiliation: The Harris Birthright Centre for Fetal Medicine, King's College Hospital, London, UK.
authors.forename: Kypros
authors.initials: K
authors.lastname: Nicolaides
authors.affiliation: UCL Institute of Child Health and Great Ormond Street Hospital for Children, London, UK.
authors.forename: Joseph I
authors.initials: JI
authors.lastname: Curry
authors.affiliation: Paediatric Surgery Unit, King's College Hospital, London, UK.
authors.forename: Niyi
authors.initials: N
authors.lastname: Ade-Ajayi
authors.affiliation: UCL Institute of Child Health and Great Ormond Street Hospital for Children, London, UK.
authors.forename: Paolo
authors.initials: P
authors.lastname: De Coppi
authors.affiliation: Paediatric Surgery Unit, King's College Hospital, London, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Davenport
authors.affiliation: Fetal Medicine Unit, University College London Hospital, London, UK.
authors.forename: Anna L
authors.initials: AL
authors.lastname: David
authors.affiliation: Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Agostino
authors.initials: A
authors.lastname: Pierro
authors.affiliation: UCL Institute of Child Health and Great Ormond Street Hospital for Children, London, UK. Electronic address: s.eaton@ucl.ac.uk.
authors.forename: Simon
authors.initials: S
authors.lastname: Eaton
mesh_terms: D036861:Delivery, Obstetric / Q000379:methods*; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D020139:Gastroschisis / Q000000981:diagnostic imaging*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D011237:Predictive Value of Tests; D011247:Pregnancy; D012189:Retrospective Studies; D013997:Time Factors; D016216:Ultrasonography, Prenatal / Q000379:methods*
keywords: Antenatal ultrasound; Bowel inflammation; Enteral feeding; Extra-abdominal bowel dilatation; Gastroschisis; Gestational age; Intra-abdominal bowel dilatation; Post-natal outcome; Preterm delivery