Abstract
Objectives. The aim of this review was to identify clinically significant ultrasound predictors of adverse neonatal outcome in fetal gastroschisis. Methods. A quasi-systematic review was conducted in PubMed and Ovid using the key terms “gastroschisis,” “predictors,” “outcome,” and “ultrasound.” Results. A total of 18 papers were included. The most common sonographic predictors were intra-abdominal bowel dilatation (IABD), intrauterine growth restriction (IUGR), and bowel dilatation not otherwise specified (NOS). Three ultrasound markers were consistently found to be statistically insignificant with respect to predicting adverse outcome including abdominal circumference, stomach herniation and dilatation, and extra-abdominal bowel dilatation (EABD). Conclusions. Gastroschisis is associated with several comorbidities, yet there is much discrepancy in the literature regarding which specific ultrasound markers best predict adverse neonatal outcomes. Future research should include prospective trials with larger sample sizes and use well-defined and consistent definitions of the adverse outcomes investigated with consideration given to IABD.
Highlights
Gastroschisis is a congenital abdominal wall defect occurring in approximately 5 in 10,000 live births [1]
The pathophysiology of gastroschisis continues to elude clinicians and researchers risk factors that are consistently associated with the development of this defect include young maternal age, low body mass index (BMI), race, smoking, low socioeconomic status, recreational drug use, and alcohol consumption during pregnancy [3]
The survival rate for infants born with gastroschisis is approximately 90% it is associated with significant morbidity resulting from prolonged hospital stay, delay in time to start oral feeding, time on ventilator, long-term use of total parenteral nutrition (TPN), multiple surgical interventions, and neonatal complications including sepsis, necrotizing enterocolitis, and short bowel syndrome [4, 5]
Summary
Gastroschisis is a congenital abdominal wall defect occurring in approximately 5 in 10,000 live births [1]. As a full thickness defect in the anterior abdominal wall gastroschisis is almost invariably located to the right of the umbilical ring and is characterized by the extrusion of the midgut from the coelom with the absence of a membranous covering (Figure 1) [2]. The pathophysiology of gastroschisis continues to elude clinicians and researchers risk factors that are consistently associated with the development of this defect include young maternal age, low BMI, race, smoking, low socioeconomic status, recreational drug use, and alcohol consumption during pregnancy [3]. Optimal management for neonates with gastroschisis is unclear given the controversy in literature regarding which factors most accurately predict neonatal outcomes [7]. An improved ability to predict which fetuses are at an increased risk for neonatal complications may assist with appropriate triage, aid in prenatal counseling/medical management of gastroschisis, and encourage multisystem neonatal support to minimize postnatal complications [8, 9]
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