Abstract
In gastroschisis, there is evidence to suggest that gut dysfunction develops secondary to bowel inflammation; we aimed to evaluate the effect of maternal antenatal corticosteroids administered for obstetric reasons on time to full enteral feeds in a multicenter cohort study of gastroschisis infants. A three center, retrospective cohort study (1992-2013) with linked fetal/neonatal gastroschisis data was conducted. The primary outcome measure was time to full enteral feeds (a surrogate measure for bowel function) and secondary outcome measure was length of hospital stay. Analysis included Mann-Whitney and Cox regression. Of 500 patients included in the study, 69 (GA at birth 34 [25-38] weeks) received antenatal corticosteroids and 431 (GA at birth 37 [31-41] weeks) did not. Antenatal corticosteroids had no effect on the rate of reaching full feeds (Hazard ratio HR 1.0 [95% CI: 0.8-1.4]). However, complex gastroschisis (HR 0.3 [95% CI: 0.2-0.4]) was associated with an increased time to reach full feeds and later GA at birth (HR 1.1 per week increase in GA [95% CI: 1.1-1.2]) was associated with a decreased time to reach full feeds. Maternal antenatal corticosteroids use, under current antenatal steroid protocols, in gastroschisis is not associated with an improvement in neonatal outcomes such as time to full enteral feeds or length of hospital stay.
Highlights
The most common postnatal gastroschisis-related morbidity is intestinal dysmotility with 50% of neonates taking >28 days to attain full enteral autonomy,[1,2] which carries a risk of central line sepsis and liver dysfunction from prolonged parenteral nutrition (PN)
Data collected included gestational age (GA) at birth, timing, dosage and reason for maternal antenatal corticosteroid administration and gastroschisis complexity
Those born at
Summary
The most common postnatal gastroschisis-related morbidity is intestinal dysmotility with 50% of neonates taking >28 days to attain full enteral autonomy,[1,2] which carries a risk of central line sepsis and liver dysfunction from prolonged parenteral nutrition (PN). Improved neonatal care and the advent of PN has reduced gastroschisis mortality from 60% in the 1960s to 3% to 10% in the 1990s,1 there have been no advances in reducing gastroschisis-related intestinal dysfunction (GRID) and the time to achieve full enteral feeds. Data are very limited but a single center prospective study of gastroschisis cases reported that maternal antenatal corticosteroids reduced duration of PN, time to full enteral feeds and length of hospital stay (Polnik et al [unpublished] presentation at the Joint European Paediatric Surgeons' Association/British Association of Paediatric Surgeons Congress, Rome). We aimed to determine whether or not maternal antenatal corticosteroids were associated with an improvement in postnatal intestinal function (measured as time to full enteral feeds) in infants with gastroschisis
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