Influence of location of delivery on outcome in neonates with gastroschisis

Abstract

BackgroundIt is not clear in the literature whether infants with a prenatal diagnosis of gastroschisis should be delivered in a perinatal center with level 3 neonatal intensive care unit (NICU) and surgical facilities (“inborn”) or if they could be safely delivered in a more local hospital and then transferred to a perinatal center (“outborn”). Our goal was to determine the impact of delivery site on outcomes for neonates diagnosed as having gastroschisis. MethodsData were obtained from the Canadian Pediatric Surgery Network, covering the years 2005 to 2008 for 18 pediatric surgical centers. Inborn was defined as birth in a hospital with a NICU or connected to a NICU by a bridge or tunnel. Outborn was defined as requiring transfer by ambulance or flight. A P value less than .05 was considered significant. ResultsOf 395 infants with prenatally diagnosed gastroschisis, 237 were inborn and 158 were outborn. Univariate analysis demonstrated no significant difference between groups with respect to gestational age, birth weight, days on total parenteral nutrition, or length of hospital stay. There was a significant difference with regard to Score for Neonatal Acute Physiology–Version II, complication rates, comorbidities, and age at final closure. Logistic regression showed that location of delivery was a significant independent predictor for incidence of complications, as were Score for Neonatal Acute Physiology–Version II, comorbidities, and presence of bowel atresia or necrosis. The odds ratio of developing a complication when outborn was 1.6 (P = .05). ConclusionsDelivery outside a perinatal center is a significant predictor of complications for infants born with gastroschisis.