Faculty Collaboration Database

Outcome of neonates with gastroschisis at different gestational ages using a national database. J Pediatr Surg 2018 Apr;53(4):661-665

Date

08/07/2017

Pubmed ID

28780310

DOI

10.1016/j.jpedsurg.2017.07.015

Scopus ID

2-s2.0-85026649313 (requires institutional sign-in at Scopus site)   17 Citations

Abstract

BACKGROUND/PURPOSE: The optimal time for delivery of neonates with a prenatal diagnosis of gastroschisis (GS) is controversial. We compared the outcomes for GS at three different gestational ages (GAs), 33-34 weeks, 35-36 weeks, and ≥ 37 weeks.

METHODS: We analyze hospital discharge data of neonates with GS using the 2006, 2009 and 2012 Healthcare Cost and Utilization Project Kids' Inpatient Database (HCUPKIDS). Multivariable analysis was used to compare the association between GS outcomes and the three GAs.

RESULTS: Significantly higher number of 33-34 week infants had coexisting morbidities like respiratory distress syndrome, bronchopulmonary dysplasia, small bowel atresia, stenosis, or stricture, large bowel atresia and/or stenosis, malrotation, and atrial septal defect. In multivariable logistic regression, 33-34 week infants had higher NEC (p value = 0.002, 95% CI1.64-10.32), small bowel resection (0.024, 1.12-5.25) and pRBCs transfusion (0.024, 1.05-2.11). No differences were found between 35-36 weeks and ≥37 weeks gest infants for NEC, malabsorption, small bowel resection, TPN cholestasis, sepsis, CLABSI, number of pRBCs transfusion, length of stay and total charges.

CONCLUSION: We did not show benefit for delivering early and in the absence of data, delivery at ≥37 weeks was noninferior to 35-36 weeks. We suggest that waiting for spontaneous onset of labor may be a better approach to balance the effects of prematurity and possible ongoing in utero bowel damage/stillbirth.

LEVELS OF EVIDENCE: Level 3 (Retrospective comparative study).

Author List

Gupta R, Cabacungan ET

Authors

Erwin Cabacungan MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Ruby Gupta MBBS Associate Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Databases, Factual
Delivery, Obstetric
Female
Gastroschisis
Gestational Age
Humans
Infant
Infant, Newborn
Infant, Premature, Diseases
Logistic Models
Male
Pregnancy
Prenatal Diagnosis
Retrospective Studies
Treatment Outcome
United States