title: Spontaneous onset of labor, not route of delivery, is associated with prolonged length of stay in babies with gastroschisis.
abstract: OBJECTIVE
  We studied obstetric delivery practices for fetal gastroschisis and correlated this with neonatal outcomes. Our objectives were to identify changes in delivery practices over time and to determine if these changes resulted in improved neonatal outcomes.
  
  
  METHODS
  After IRB approval, maternal and neonatal records from 219 gastroschisis births between 1990 and 2008 were reviewed. Obstetrical data and neonatal data were collected. Univariate comparisons were made between maternal delivery variables and neonatal outcomes. Significant and clinically relevant obstetrical variables were combined for multivariate linear regression modeling.
  
  
  RESULTS
  The practice of elective cesarean delivery (ELCS) shifted to spontaneous vaginal delivery (sVD) over time (p <0.001). Babies born by sVD had longer hospitalization than those born by ELCS (median 36.0 vs 21.6days, p <0.05). Gestational age (GA) and birth weight were similar between groups. Babies born by induced VD (iVD) had short hospitalization (median 22.5days). A linear regression model demonstrated that spontaneous onset of labor (SOL) and GA were independently related to LOS.
  
  
  CONCLUSIONS
  Over nearly two decades, delivery of gastroschisis babies shifted from ELCS to sVD, a practice associated with a significantly longer LOS. Regression models suggest that shorter LOS could be achieved if elective delivery modes are utilized prior to SOL.
authors.affiliation: Department of Pediatric Surgery, Children's Hospital of Illinois, Peoria, Illinois, 61603. Electronic address: edyang@att.net.
authors.forename: Edmund Y
authors.initials: EY
authors.lastname: Yang
authors.affiliation: Saint Louis University School of Medicine, Saint Louis, Missouri, 63104.
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Davies
authors.affiliation: Saint Louis University Center for Outcomes Research, Saint Louis, Missouri, 63104.
authors.forename: Paula
authors.initials: P
authors.lastname: Buchanan
authors.affiliation: Department of Surgery, Vanderbilt University School of Medicine, 37212.
authors.forename: Catherine
authors.initials: C
authors.lastname: Kling
authors.affiliation: Center for Tissue Engineering, University of California, Irvine, Irvine, California, 92868.
authors.forename: Derek A
authors.initials: DA
authors.lastname: Banyard
authors.affiliation: Department of Surgery, Oregon Health and Sciences University, Portland, Oregon, 97239.
authors.forename: Theresa
authors.initials: T
authors.lastname: Ramones
mesh_terms: D000328:Adult; D001724:Birth Weight; D036861:Delivery, Obstetric; D005260:Female; D015391:Gastroplasty; D020139:Gastroschisis / Q000601:surgery*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007902:Length of Stay / Q000639:trends*; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Elective delivery; Gastroschisis; Gestational age; Labor; Pregnancy outcomes; regressions analysis