Morbidity in infants with antenatally-diagnosed anterior abdominal wall defects

Abstract

The aims of this study were to compare the morbidity of infants with gastroschisis (GS) with that of infants with exomphalos (EX) without lethal abnormalities and to identify factors predictive of adverse outcome: a requirement for parenteral nutrition (PN) for over 1 month and hospital admission for over 2 months. The medical records of 45 infants with anterior wall defects (32 with GS) diagnosed antenatally who consecutively received intensive care in one institution from 1993 were reviewed. Both the GS and EX infants had a median gestational age of 37 weeks, but the former were lighter at birth (P < 0.01). Fourteen infants (all with GS) were able to start feeds only after 2 weeks; 10 (8 with GS) developed liver dysfunction; and 5 (all with GS) died. The GS compared to the EX infants required a longer period of PN (median 20 vs 10 days, P < 0.01) and longer hospital admission (median 40 vs 25 days, P < 0.01). In the GS group the time to start feeding related independently to prolonged hospital stay, and the existence of structural bowel abnormalities (SBA) related independently to both measures of adverse outcome, with a positive predictive value of 100%. We conclude that infants with GS, particularly those with SBA, suffer greater morbidity than infants with EX without lethal abnormalities.