Abstract
Gastroschisis is one of the most common congenital malformations in paediatric surgery. However, there is no consensus regarding the optimal management. The aims of this study were to investigate the management and outcome and to identify predictors of outcome in gastroschisis. A retrospective observational study of neonates with gastroschisis born between 1999 and 2020 was undertaken. Data was extracted from the medical records and Cox regression analysis was used to identify predictors of outcome measured by length of hospital stay (LOS) and duration of parenteral nutrition (PN). In total, 114 patients were included. Caesarean section was performed in 105 (92.1%) at a median gestational age (GA) of 36 weeks (range 29–38) whereof (46) 43.8% were urgent. Primary closure was achieved in 82% of the neonates. Overall survival was 98.2%. One of the deaths was caused by abdominal compartment syndrome and one patient with intestinal failure–associated liver disease died from sepsis. None of the deceased patients was born after 2005. Median time on mechanical ventilation was 22 h. Low GA, staged closure, intestinal atresia, and sepsis were independent predictors of longer LOS and duration on PN. In addition, male sex was an independent predictor of longer LOS.Conclusion: Management of gastroschisis according to our protocol was successful with a high survival rate, no deaths in neonates born after 2005, and favourable results in LOS, duration on PN, and time on mechanical ventilation compared to other reports. Multicentre registry with long-term follow-up is required to establish the best management of gastroschisis.What is Known:• Gastroschisis is one of the most common congenital malformations in paediatric surgery with increasing incidence.• There is no consensus among clinicians regarding the optimal management of gastroschisis.What is New:• Although primary closure was achieved in 82% of the patients, mortality rate was very low (1.8%) with no deaths in neonates born after 2005 following the introduction of measurement of intraabdominal pressure at closure.• Low gestational age, staged closure, intestinal atresia, sepsis, and male sex were independent predictors of longer length of hospital stay.
Highlights
IntroductionGastroschisis is a congenital abdominal wall defect with herniated intraabdominal viscera exposed to amniotic fluid during pregnancy
Communicated by Piet LeroyGastroschisis is a congenital abdominal wall defect with herniated intraabdominal viscera exposed to amniotic fluid during pregnancy
Management of gastroschisis according to our protocol was successful with a high survival rate, no deaths in neonates born after 2005, and favourable results in length of hospital stay (LOS), duration on parenteral nutrition (PN), and time on mechanical ventilation compared to other reports
Summary
Gastroschisis is a congenital abdominal wall defect with herniated intraabdominal viscera exposed to amniotic fluid during pregnancy. The condition is one of the most common birth defects in paediatric surgery with a prevalence of 4.9 per 10,000 live births [1, 2]. Gastroschisis can be divided into two groups, complex and simple gastroschisis. Complex gastroschisis is usually defined by the presence. European Journal of Pediatrics (2022) 181:2291–2298 of intestinal atresia, perforation, necrotic segments, or volvulus [3, 4]. Complex gastroschisis is estimated to occur in one-third of pregnancies affected by gastroschisis [3]. Survival is more than 90% in neonates with gastroschisis [5–8], yet the condition is associated with significant morbidity [4, 9–13]. Intestinal dysfunction, sepsis, and reoperations result in prolonged duration of hospital stay and parenteral nutrition (PN) [4, 9–13]
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