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Outcomes of gastroschisis early delivery: A systematic review and meta-analysis. J Pediatr Surg 2017 Dec;52(12):1962-1971

Date

09/28/2017

Pubmed ID

28947324

DOI

10.1016/j.jpedsurg.2017.08.068

Scopus ID

2-s2.0-85029694772   11 Citations

Abstract

BACKGROUND/PURPOSE: Elective preterm delivery (EPD) of a fetus with gastroschisis may prevent demise and ameliorate intestinal injury. While the literature on optimal timing of delivery varies, we hypothesize that a potential benefit may be found with EPD.

METHODS: A meta-analysis of publications describing timing of delivery in gastroschisis from 1/1990 to 8/2016 was performed, including studies where either elective preterm delivery (group 1, G1) or preterm gestational age (GA) (group 2, G2) were evaluated against respective comparators. The following outcomes were analyzed: total parenteral nutrition (TPN), first enteral feeding (FF), length of stay, ventilator days, fetal demise, complex gastroschisis, sepsis, and death.

RESULTS: Eighteen studies describing 1430 gastroschisis patients were identified. G1 studies found less sepsis (p<0.01), fewer days to FF (p=0.03), and 11days less of TPN (p=0.07) in the preterm cohort. Comparatively, G2 studies showed less days to FF in term GA (p=0.02).Whereas G1 BWs were similar, G2 preterm had a significantly lower BW compared to controls (p=0.001).

CONCLUSIONS: Elective preterm delivery appears favorable with respect to feeding and sepsis. However, benefits are lost when age is used as a surrogate of EPD. A randomized, prospective, multi-institutional trial is necessary to delineate whether EPD is advantageous to neonates with gastroschisis.

TYPE OF STUDY: Treatment study.

LEVEL OF EVIDENCE: Level III.

Author List

Landisch RM, Yin Z, Christensen M, Szabo A, Wagner AJ

Authors

Aniko Szabo PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Amy Wagner MD Associate Professor in the Surgery department at Medical College of Wisconsin




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

Cesarean Section
Elective Surgical Procedures
Female
Gastroschisis
Humans
Infant, Newborn
Male
Parenteral Nutrition, Total
Parturition
Pregnancy
Prospective Studies
Retrospective Studies
Sepsis
jenkins-FCD Prod-482 91ad8a360b6da540234915ea01ff80e38bfdb40a