Gastroschisis: early enteral feeds may improve outcome

Abstract

Objective: Population-based retrospective review of gastroschisis from 1986 to 1996.

Methods: This was a retrospective review of gastroschisis. Seventy cases were identified from the Birth Defects Registry of Western Australia (WA). Hospital medical records of live-born cases were reviewed.

Results: The live-born incidence of gastroschisis in WA was 2.1 per 10,000 live births for the period 1986-96. The incidence in mothers aged less than 20 years was 8.3-fold that of women aged over 30 years (P < 0.0001). The incidence rate for the period 1995-96 was over twice the rate for 1986-88. Age at first enteral feed was significantly related with length of hospital stay and duration of total parental nutrition (TPN). Each day delay in commencing enteral feed was associated with an increase in hospital stay of 1.05 days and an increase in TPN duration of 1.06 days. The method of delivery of the infant, age at repair, length of anaesthetic time, duration of postoperative paralysis and gestational age was not associated with length of stay or TPN duration. The data were divided into two cohorts: (i) 1986-90; and (ii) 1991-96. There was a statistically significant reduction in hospital stay from a geometric mean of 45.7 (1986-90) to 22.9 days (1991-96).

Conclusions: Gastroschisis has a favourable outlook, with 89.7% survival of live births. Over the 10 year period studied, there has been a reduction in length of hospital stay and duration of TPN. The age at which the infant is first fed enteral feeds appears to be important in affecting the length of hospital stay and the duration of TPN, with delays associated with a longer hospital stay and longer TPN duration.