Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2022 Jun;181(6):2291-2298.
doi: 10.1007/s00431-022-04416-9. Epub 2022 Feb 28.

Outcome and management in neonates with gastroschisis in the third millennium-a single-centre observational study

Lotta Räsänen  1 , Helene Engstrand Lilja  2   3
Affiliations
Observational Study

Outcome and management in neonates with gastroschisis in the third millennium-a single-centre observational study

Lotta Räsänen et al. Eur J Pediatr. 2022 Jun.

Abstract

Gastroschisis is one of the most common congenital malformations in paediatric surgery. However, there is no consensus regarding the optimal management. The aims of this study were to investigate the management and outcome and to identify predictors of outcome in gastroschisis. A retrospective observational study of neonates with gastroschisis born between 1999 and 2020 was undertaken. Data was extracted from the medical records and Cox regression analysis was used to identify predictors of outcome measured by length of hospital stay (LOS) and duration of parenteral nutrition (PN). In total, 114 patients were included. Caesarean section was performed in 105 (92.1%) at a median gestational age (GA) of 36 weeks (range 29-38) whereof (46) 43.8% were urgent. Primary closure was achieved in 82% of the neonates. Overall survival was 98.2%. One of the deaths was caused by abdominal compartment syndrome and one patient with intestinal failure-associated liver disease died from sepsis. None of the deceased patients was born after 2005. Median time on mechanical ventilation was 22 h. Low GA, staged closure, intestinal atresia, and sepsis were independent predictors of longer LOS and duration on PN. In addition, male sex was an independent predictor of longer LOS.

Conclusion: Management of gastroschisis according to our protocol was successful with a high survival rate, no deaths in neonates born after 2005, and favourable results in LOS, duration on PN, and time on mechanical ventilation compared to other reports. Multicentre registry with long-term follow-up is required to establish the best management of gastroschisis.

What is known: • Gastroschisis is one of the most common congenital malformations in paediatric surgery with increasing incidence. • There is no consensus among clinicians regarding the optimal management of gastroschisis.

What is new: • Although primary closure was achieved in 82% of the patients, mortality rate was very low (1.8%) with no deaths in neonates born after 2005 following the introduction of measurement of intraabdominal pressure at closure. • Low gestational age, staged closure, intestinal atresia, sepsis, and male sex were independent predictors of longer length of hospital stay.

Keywords: Gastroschisis; Morbidity; Mortality; Neonatal; Predictors.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Kaplan–Meier analysis of gastroschisis patients and association between gestational age, duration of parenteral nutrition (PN), and length of hospital stay
See this image and copyright information in PMC

References

    1. Jones AM, Isenburg J, Salemi JL, Arnold KE, Mai CT, Aggarwal D, Arias W, Carrino GE, Ferrell E, Folorunso O, Ibe B, Kirby RS, Krapfl HR, Marengo LK, Mosley BS, Nance AE, Romitti PA, Spadafino J, Stock J, Honein MA. Increasing prevalence of gastroschisis–14 states, 1995–2012. MMWR Morb Mortal Wkly Rep. 2016;65(2):23–26. doi: 10.15585/mmwr.mm6502a2. - DOI - PubMed
    1. Stallings EB, Isenburg JL, Short TD, Heinke D, Kirby RS, Romitti PA, Canfield MA, O’Leary LA, Liberman RF, Forestieri NE, Nembhard WN, Sandidge T, Nestoridi E, Salemi JL, Nance AE, Duckett K, Ramirez GM, Shan X, Shi J, Lupo PJ. Population-based birth defects data in the United States, 2012–2016: a focus on abdominal wall defects. Birth Defects Res. 2019;111:1436–1447. doi: 10.1002/bdr2.1607. - DOI - PMC - PubMed
    1. Oakes MC, Porto M, Chung JH. Advances in prenatal and perinatal diagnosis and management of gastroschisis. Semin Pediatr Surg. 2018;27(5):289–299. doi: 10.1053/j.sempedsurg.2018.08.006. - DOI - PubMed
    1. Emil S. Surgical strategies in complex gastroschisis (2018) Semin Pediatr Surg 27(5):309–315. 10.1053/j.sempedsurg.2018.08.003 - PubMed
    1. Kassa AM, Lilja HE. Predictors of postnatal outcome in neonates with gastroschisis (2011) J Pediatr Surg 46(11):2108–2114. 10.1016/j.jpedsurg.2011.07.012 - PubMed

Publication types