title: Sonographic markers associated with adverse neonatal outcomes among fetuses with gastroschisis: an 11-year, single-center review.
abstract: BACKGROUND
  Gastroschisis complicates 1 in 2000 births and is readily identifiable during prenatal ultrasound scans. Outcomes in fetuses that are affected by gastroschisis vary widely from stillbirth or neonatal death to uncomplicated surgical correction, which makes prenatal counseling challenging.
  
  
  OBJECTIVE
  The goal of our study was to identify sonographic markers that are associated with perinatal death and morbidity that include significant bowel injury, necrotizing enterocolitis, and the need for bowel resection in fetuses with gastroschisis.
  
  
  METHODS
  We identified a cohort of fetuses that were diagnosed with gastroschisis from 2003-2014. Sonographic markers that were reviewed included growth restriction, abdominal circumference, oligohydramnios, bowel dilation, and gastric bubble characteristics. We evaluated these markers both at diagnosis and near delivery. Four adverse perinatal outcomes were assessed: perinatal death, necrotizing enterocolitis, need for bowel resection, and a composite of significant bowel injury, which included a diagnosis of bowel atresia or necrosis at the time of surgical exploration. Logistic regression was performed to calculate odds ratios and 95% confidence intervals for each marker and outcome.
  
  
  RESULTS
  One hundred seventy-seven patients were identified, and 154 of these patients met inclusion criteria after exclusions for delivery <24 weeks gestation, other associated anomalies, lethal karyotype, or lost to follow-up evaluation. Markers at the time of diagnosis (median gestational age, 21 weeks [25th,75th interquartile range, 19, 24 weeks]) that were associated with perinatal death were abdominal circumference <5th percentile (odds ratio, 5.56; 95% confidence interval, 1.25-24.76), abnormal gastric bubble (odds ratio, 11.20; 95% confidence interval, 2.15-58.33), and abnormal stomach location (odds ratio, 17.1; 95% confidence interval, 2.99-97.85). An abnormal stomach location (odds ratio, 5.53; 95% confidence interval, 1.03-29.72) before delivery was associated with perinatal death. Gastric dilation before delivery (odds ratio, 4.36; 95% confidence interval, 1.10-17.34)] was associated with the need for bowel resection.
  
  
  CONCLUSIONS
  Early sonographic markers of increased perinatal mortality rates include abdominal circumference <5th percentile and an abnormal gastric bubble.
authors.affiliation: Department of Obstetrics and Gynecology, TriHealth Hospital, Cincinnati, OH.
authors.forename: Rachel G
authors.initials: RG
authors.lastname: Sinkey
authors.affiliation: Cincinnati Fetal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Mounira A
authors.initials: MA
authors.lastname: Habli
authors.affiliation: Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Andrew P
authors.initials: AP
authors.lastname: South
authors.affiliation: Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, OH.
authors.forename: Wei W
authors.initials: WW
authors.lastname: Gibler
authors.affiliation: Cincinnati Fetal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Patricia W
authors.initials: PW
authors.lastname: Burns
authors.affiliation: TriHealth Hatton Research Institute, Cincinnati, OH.
authors.forename: Michaela A
authors.initials: MA
authors.lastname: Eschenbacher
authors.affiliation: Cincinnati Fetal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. Electronic address: eaglercr@ucmail.uc.edu.
authors.forename: Carri R
authors.initials: CR
authors.lastname: Warshak
mesh_terms: D000005:Abdomen / Q000000981:diagnostic imaging*; D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D020345:Enterocolitis, Necrotizing / Q000000981:diagnostic imaging* / Q000453:epidemiology; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging* / Q000453:epidemiology; D020139:Gastroschisis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D007409:Intestinal Atresia / Q000000981:diagnostic imaging* / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D016104:Oligohydramnios / Q000000981:diagnostic imaging* / Q000453:epidemiology; D009929:Organ Size; D066087:Perinatal Death; D011247:Pregnancy; D012189:Retrospective Studies; D018570:Risk Assessment; D050497:Stillbirth / Q000453:epidemiology*; D016216:Ultrasonography, Prenatal; D055815:Young Adult
keywords: bowel dilation; diagnosis; dilated stomach; gastric bubble; gastroschisis; prenatal; ultrasound scan