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Abstract
Survival in infants with gastroschisis is increasing although little is known about early childhood morbidity. In the context of a hypothesized link between the gastrointestinal (GI) tract and immune function, this study explores rates of GI and respiratory infections in children with gastroschisis. We conducted a population-based retrospective cohort study using data from the Health Improvement Network, a large database of UK primary care medical records. We identified children born from 1990 to 2013, and extracted follow-up data to their fifth birthday. We calculate incidence rates (IR) of GI and respiratory tract infections, overall and stratified by age, sex, socioeconomic status, and gestational age at birth, and compared these between children with and without gastroschisis by calculating adjusted incidence rate ratios (aIRR). Children with gastroschisis had a 65% higher IR of GI infection compared to children without (aIRR 1.65, 95% confidence interval [CI] 1.37-1.99, P < 0.001). Children with gastroschisis had a 27% higher IR of all respiratory tract infections (aIRR 1.27, 95% CI 1.12-1.44, P < 0.001) and more than 2-fold increase in lower respiratory tract infections compared to children without the condition (aIRR 2.15, 95% CI 1.69-2.74, P < 0.001). Children born with gastroschisis have a significantly higher incidence of GI and respiratory tract infections compared to children without gastroschisis. This association requires further investigations but could be related to the neonatal care they receive such as delayed enteral feeding or frequent antibiotic courses altering the gut microbiome and developing immune system.
Highlights
In early childhood, children with gastroschisis have higher incidence rates of GI and respiratory infections recorded in primary care than children without gastroschisis
Gastroschisis is a congenital defect of the anterior abdominal wall with an incidence of 1 in 2,500 births[1] equating to approximately 300 babies per year in the United Kingdom (UK)
The overall incidence rate of GI infection per 10 person years in children born with gastroschisis was 2.64 per 10 person years, higher than the rate of 1.61 in children without gastroschisis (Table 2)
Summary
Gastroschisis is a congenital defect of the anterior abdominal wall with an incidence of 1 in 2,500 births[1] equating to approximately 300 babies per year in the United Kingdom (UK). After undergoing corrective surgery most children require total parenteral nutrition (TPN), until the establishment of enteral feeds, which brings attendant risks of catheter related sepsis[4]. These infants can remain in the neonatal unit for many weeks or months and often require multiple courses of antibiotics[5], potentially altering their gut microbial flora and long-term immune function[6]. Long-term outcomes in children with gastroschisis have focused on recurring abdominal pain or functional gastrointestinal (GI) symptoms, such as indigestion, chronic diarrhoea and constipation[7,8,9,10,11,12,13]. The majority of these studies are small, based on single centres, and many have pooled children born with gastroschisis with children born with omphalocele, despite their different embryological origins and clinical courses[7,10,11,12,13]
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