title: Management and outcome challenges in newborns with gastroschisis: A 6-year retrospective French study.
abstract: OBJECTIVE
  To identify the gestational age (GA) at which risk of mortality and severe outcome was minimized comparing preterm delivery and expectant management.
  
  
  METHODS
  Retrospective study performed between 2009 and 2014 of newborns with gastroschisis in three large French level III neonatal intensive care units. Each department followed two distinct strategies: elective delivery at 35 weeks' GA and a delayed approach.
  
  
  RESULTS
  We included 69 gastroschisis cases. The lengths of stay lasting more than 60 days were significantly greater in the planned delivery group than in the expectant approach group (18/30 (60%) vs. 8/39 (20.5%), p = 0.001). Gastroschisis cases receiving antenatal corticoids during the last two weeks of gestation required significantly less surgeries during their initial stay (p = 0.003) as well as shorter parenteral feedings (p = 0.002). A multivariate logistic regression showed that a GA of less than 36 weeks' GA was is a pejorative factor for a stay above 60 days, regardless of whether it was a simple or complex gastroschisis, (OR= 3.8; p = 0.021). A complex gastroschisis was a risk factor for significantly longer parenteral feedings, regardless of the center where patient is treated (Beta = -0.3, p = 0.035).
  
  
  CONCLUSIONS
  Future research should focus on decisions about delivery timing by incorporating risk of neonatal morbidity.
authors.affiliation: a Department of Neonatology , Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University , Marseille , France.
authors.forename: Barthelemy
authors.initials: B
authors.lastname: Tosello
authors.affiliation: b Self-Perceived Health Assessment Research Unit, Aix-Marseille University , Marseille , France.
authors.forename: Meriem
authors.initials: M
authors.lastname: Zahed
authors.affiliation: a Department of Neonatology , Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University , Marseille , France.
authors.forename: Floriane
authors.initials: F
authors.lastname: Guimond
authors.affiliation: b Self-Perceived Health Assessment Research Unit, Aix-Marseille University , Marseille , France.
authors.forename: Karine
authors.initials: K
authors.lastname: Baumstarck
authors.affiliation: c Department of Pediatric Surgery , Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University , Marseille , France.
authors.forename: Alice
authors.initials: A
authors.lastname: Faure
authors.affiliation: d Pediatric Intensive Care Unit, Hôpital de la Timone, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University , Marseille , France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Michel
authors.affiliation: e Department of Neonatology , Hospices Civils de Lyon, Hôpital Femme Mère Enfant , Bron , France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Claris
authors.affiliation: a Department of Neonatology , Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University , Marseille , France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Gire
authors.affiliation: f Department of Obstetrics and Gynecology , Hospices Civils de Lyon, Hôpital Femme Mère Enfant , Bron , France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Berakdar
authors.affiliation: f Department of Obstetrics and Gynecology , Hospices Civils de Lyon, Hôpital Femme Mère Enfant , Bron , France.
authors.forename: Jerome
authors.initials: J
authors.lastname: Massardier
authors.affiliation: g Department of Obstetrics and Gynecology , Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University , Marseille , France.
authors.forename: Claude
authors.initials: C
authors.lastname: D'Ercole
authors.affiliation: c Department of Pediatric Surgery , Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University , Marseille , France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Merrot
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D020139:Gastroschisis / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Gastroschisis; delivery timing; neonatal outcome; postnatal outcome; preterm delivery