Outcome of isolated gastroschisis; an international study, systematic review and meta-analysis.
To determine outcome of children born with isolated gastroschisis (no extra-gastrointestinal congenital abnormalities).



International cohort study and meta-analysis.



time to full enteral feeding (TFEF); secondary outcomes: Duration of mechanical ventilation, length of stay (LOS), mortality and differences in outcome between simple and complex gastroschisis (complex; born with bowel atresia, volvulus, perforation or necrosis). To compare the cohort study results with literature three databases were searched. Studies were eligible for inclusion if cases were born in developed countries with isolated gastroschisis after 1990, number of cases >20 and TFEF was reported.



The cohort study included 204 liveborn cases of isolated gastroschisis. The TFEF, median duration of ventilation and LOS was, 26days (range 6-515), 2days (range 0-90) and 33days (range 11-515), respectively. Overall mortality was 10.8%. TFEF and LOS were significantly longer (P<0.0001) and mortality was fourfold higher in the complex group. Seventeen studies, amongst the current study, were included for further meta-analysis comprising a total of 1652 patients. Mean TFEF was 35.3±4.4days, length of ventilation was 5.5±2.0days, LOS was 46.4±5.2days and mortality risk was 0.06 [0.04-0.07 95%CI]. Outcome of simple and complex gastroschisis was described in five studies. TFEF, ventilation time, LOS were significant longer and mortality rate was 3.64 [1.95-6.83 95%CI] times higher in complex cases.



These results give a good indication of the expected TFEF, ventilation time and LOS and mortality risk in children born with isolated gastroschisis, although ranges remain wide. This study shows the importance of dividing gastroschisis into simple and complex for the prediction of outcome.
University Medical Center Utrecht, Division Woman and Baby, Department of Obstetrics, Utrecht, The Netherlands.. Electronic address: c.c.m.m.lap@umcutrecht.nl.
Chiara C M M
CC
Lap
Department of Obstetrics and Gynaecology, Hospital das Clínicas, São Paulo University Medical School, São Paulo, SP, Brazil.. Electronic address: mlbrizot@uol.com.br.
Maria L
ML
Brizot
University Medical Center Utrecht, Division Woman and Baby, Department of Obstetrics, Utrecht, The Netherlands.; University of Stellenbosch, Department of Obstetrics and Gynaecology, Stellenbosch, South Africa.. Electronic address: lou@maternalfetal.co.za.
Lourens R
LR
Pistorius
University Medical Center Utrecht, Department of Paediatric Surgery, Utrecht, The Netherlands.. Electronic address: wlm.kramer@solcon.nl.
William L M
WL
Kramer
Maastricht University Medical Center+, Department of Anesthesiology, Maastricht, The Netherlands.. Electronic address: i.b.teeuwen@gmail.com.
Ivo B
IB
Teeuwen
University Medical Center Utrecht, Biostatistics and Research Support, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands.. Electronic address: M.J.C.Eijkemans@umcutrecht.nl.
Marinus J
MJ
Eijkemans
University Medical Center Utrecht, Division Woman and Baby, Department of Neonatology, Utrecht, The Netherlands.. Electronic address: H.A.A.Brouwers@umcutrecht.nl.
Hens A A
HA
Brouwers
Academic Medical Center Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, The Netherlands.. Electronic address: e.pajkrt@amc.uva.nl.
Eva
E
Pajkrt
Emma Children's Hospital, Academic Medical Center Amsterdam, Department of Neonatology, Amsterdam, The Netherlands.. Electronic address: a.h.vankaam@amc.uva.nl.
Anton H
AH
van Kaam
Leiden University Medical Center, Department of Obstetrics and Gynaecology, Leiden, The Netherlands.. Electronic address: P.N.Adama_van_Scheltema@lumc.nl.
Phebe N Adama
PN
van Scheltema
Radboud University Medical Center, Department of Obstetrics and Gynaecology, Nijmegen, The Netherlands.; Erasmus MC University Medical Centre Rotterdam, Department of Obstetrics and Gynaecology, Rotterdam, The Netherlands.. Electronic address: a.eggink@erasmusmc.nl.
Alex J
AJ
Eggink
Radboud University Medical Center, Department of Neonatology, Nijmegen, The Netherlands.. Electronic address: arno.vanheijst@erasmusmc.nl.
Arno F
AF
van Heijst
Leiden University Medical Center, Department of Obstetrics and Gynaecology, Leiden, The Netherlands.; VU University Medical Center Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, The Netherlands.. Electronic address: mc.haak@xs4all.nl.
Monique C
MC
Haak
VU University Medical Center Amsterdam, Department of Neonatology, Amsterdam, The Netherlands.. Electronic address: M.vanWeissenbruch@vumc.nl.
Mirjam M
MM
van Weissenbruch
Pediatric Surgical Center of Amsterdam, Emma Children's Hospital University Medical Center and VU Medical Center, Amsterdam, the Netherlands.. Electronic address: Chr.Sleeboom@vumc.nl.
Christien
C
Sleeboom
Maastricht University Medical Center+, Department of Obstetrics and Gynaecology, Maastricht, The Netherlands.. Electronic address: c.willekes@mumc.nl.
Christine
C
Willekes
Maastricht University Medical Center+, Department of Neonatology, Maastricht, The Netherlands.. Electronic address: m.vander.hoeven@mumc.nl.
Mark A
MA
van der Hoeven
Maastricht University Medical Center+, Department of Paediatric Surgery, Maastricht, The Netherlands.; Pediatric Surgical Center of Amsterdam, Emma Children's Hospital University Medical Center and VU Medical Center, Amsterdam, The Netherlands.. Electronic address: e.vanheurn@amc.nl.
Ernst L
EL
van Heurn
University Medical Center Groningen, Department of Obstetrics and Gynaecology, Groningen, The Netherlands.. Electronic address: c.m.bilardo@umcg.nl.
Catherina M
CM
Bilardo
University Medical Center Groningen, University of Groningen, Department of Neonatology Beatrix Children's Hospital, Groningen, The Netherlands.. Electronic address: p.h.dijk@umcg.nl.
Peter H
PH
Dijk
University Medical Center Groningen, University of Groningen, Department of Paediatric Surgery, Groningen, The Netherlands.. Electronic address: r.van.baren@chir.umcg.nl.
Robertine
R
van Baren
Department of Obstetrics and Gynaecology, Hospital das Clínicas, São Paulo University Medical School, São Paulo, SP, Brazil.. Electronic address: rossana.francisco@hc.fm.usp.br.
Rossana P V
RP
Francisco
Department of Pediatric, Pediatric Surgery Division, São Paulo University Medical School, São Paulo, SP, Brazil.
Ana C A
AC
Tannuri
University Medical Center Utrecht, Division Woman and Baby, Department of Obstetrics, Utrecht, The Netherlands.. Electronic address: G.H.A.Visser@umcutrecht.nl.
Gerard H A
GH
Visser
University Medical Center Utrecht, Division Woman and Baby, Department of Obstetrics, Utrecht, The Netherlands.. Electronic address: G.T.R.Manten@umcutrecht.nl.
Gwendolyn T R
GT
Manten
D020139:Gastroschisis / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data; D010288:Parenteral Nutrition / Q000706:statistics & numerical data; D012121:Respiration, Artificial / Q000706:statistics & numerical data
Gastroschisis; Meta analysis; Perinatal outcome; Systematic review