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. 2018 Jun 11;18(1):222.
doi: 10.1186/s12884-018-1867-1.

Complexity of gastroschisis predicts outcome: epidemiology and experience in an Australian tertiary centre

Sarah J Melov  1 , Irene Tsang  2 , Ralph Cohen  2   3 , Nadia Badawi  4   3   5 , Karen Walker  4   3   5 , Soundappan S V Soundappan  2   3 , Thushari I Alahakoon  6   3
Affiliations

Complexity of gastroschisis predicts outcome: epidemiology and experience in an Australian tertiary centre

Sarah J Melov et al. BMC Pregnancy Childbirth. .

Abstract

Background: Gastroschisis is a congenital anomaly of the fetal abdominal wall, usually to the right side of umbilical insertion. It is often detected by routine antenatal ultrasound. Significant maternal and pediatric resources are utilised in the care of women and infants with gastroschisis. Increasing rates of gastroschisis worldwide have led institutions to review local data and investigate outcomes. A collaborative project was developed to review local epidemiology and investigate antenatal and neonatal factors influencing hospital length of stay (LOS) and total parental nutrition (TPN) in infants born with gastroschisis.

Methods: We performed a five-year review of infants born with gastroschisis (2011-2015) at a major Australian centre. Complex gastroschisis was defined as involvement of stenosis, atresia, ischemia, volvulus or perforation and closed or vanishing gastroschisis. We extracted data from files and databases at the two participating hospitals, a major maternal fetal medicine centre and the affiliated children's hospital.

Results: There were 56 infants antenatally diagnosed with gastroschisis with no terminations, one stillbirth (2%) and one infant with 'vanishing' gastroschisis. The mean maternal age was 23.9 years (range, 15-39 years). The mean gestation at delivery was 36 weeks (range, 25-39+ 3 weeks). Of the 55 neonates who received surgical management, 62% had primary closure. The median LOS was 33 (IQR, 23-45) days and the median duration of TPN was 26 (IQR, 17-36) days. Longer days on TPN (median 35 vs 16 days, P = 0.03) was associated with antenatal finding of multiple dilated bowel loops. Postnatal diagnosis of complex gastroschisis was made in 16% of cases and was associated with both longer LOS (median 89 vs 30 days, P = 0.003) and days on TPN (median 46 vs 21 days, P = 0.009).

Conclusion: Complex gastroschisis was associated with greater days on TPN and LOS. We found no late-gestation stillbirths and a low overall rate of 1.8%, suggesting the risk for stillbirth associated with gastroschisis is lower than previously documented. This information may assist counselling families. Improved data collection worldwide may reveal causative factors and enable antenatal outcome predictors.

Keywords: Antenatal diagnosis; Congenital anomaly; Gastroschisis; Incidence; Length of stay; Outcome; Stillbirth.

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Conflict of interest statement

Authors’ information

Sarah Jane Melov, RM RN, Master of Nursing, Grad. Dip. Midwifery, Women’s Health Research MFM, Clinical Midwife Consultant, Westmead Institute for Maternal and Fetal Medicine, Westmead Hospital.

Irene Tsang, RN, BN, Master of Health Science(CDM), Research Nurse, Dep. Surgery, The Children’s Hospital at Westmead, Sydney Children's Hospital Network.

Ralph Cohen, MB BS, BMedSci, MS, FRACS (Paed), Clinical Professor of Surgery, The University of Sydney, Dep. of Paediatric Surgery, The Children’s Hospital at Westmead, Sydney Children's Hospital Network.

Nadia Badawi, PhD, FRACP, Macquarie Group Foundation Professor and Chair of Cerebral Palsy, Cerebral Palsy Alliance Research Institute, Medical Director, Co-Head, Grace Centre for Newborn Intensive Care, The Children’s Hospital at Westmead, Sydney Children's Hospital Network, Clinical Professor, Paediatrics & Child Health, The University of Sydney.

Karen Walker, PhD MClinNurs BAppSc (Nurs) RGN RSCN, Clinical Associate Professor, Discipline of Child and Adolescent Health, The University of Sydney, Senior Research Fellow, IMPACT for Cerebral Palsy, Cerebral Palsy Alliance Research Institute, Research Manager, Grace Centre for Newborn Intensive Care, The Children’s Hospital Westmead, Sydney Children's Hospital Network.

Soundappan S.V. Soundappan, MB BS, MS(Gen Surg), MCh (Paed), FRACS (Paed), Senior Lecturer Paediatrics & Child Health, The University of Sydney, Surgeon, Dep. of Surgery, The Children’s Hospital at Westmead, Sydney Children's Hospital Network.

Thushari Indika Alahakoon, PhD, MB BS, FRANZCOG, CMFM, DDU, Head of Maternal Fetal Medicine, Westmead Institute for Maternal and Fetal Medicine, Westmead Hospital, Clinical Senior Lecturer Obstetrics, Gynaecology and Neonatology, The University of Sydney.

Ethics approval and consent to participate

The study was approved in 2016 by the Sydney Children’s Hospitals Network Human Research Ethics Committee (reference no 113) and Western Sydney Local Health District (reference no 4691).

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
The primary outcomes length of stay in hospital (LOS) and days on total parenteral nutrition (TPN) for the live-born babies with simple and complex gastroschisis. a: Results for LOS (median and interquartiles). b: Results for TPN (median and interquartiles). Both outcomes were noted to be more than doubled with complex gastroschisis. *Significant difference P = < 0.05
See this image and copyright information in PMC

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