Statistical Analysis of the Main Risk Factors of an Unfavorable Evolution in Gastroschisis.

Elena Ţarcă,Solange Tamara Roșu,Laura Trandafir,Valeriu Vasile Lupu,Elena Cojocaru,Lăcrămioara Ionela Butnariu,Ștefana Maria Moisă,Viorel Ţarcă,Valentin Munteanu,Alina Costina Luca

doi:10.3390/jpm11111168

Abstract

Gastroschisis is a congenital abdominal wall defect that presents an increasing occurrence at great cost for the health system. The aim of the study is to detect the main factors of an unfavorable evolution in the case of gastroschisis and to find the best predictors of death. Methods: we conducted a retrospective cohort study of neonates with gastroschisis treated in a tertiary pediatric center during the last 30 years; 159 patients were eligible for the study. Logistic regression was used to determine the risk of death, estimated based on independent variables previously validated by the chi-square test. Results: if the birth weight is below normal, then we find an increased risk (4.908 times) of evolution to death. Similarly, the risk of death is 7.782 times higher in the case of developing abdominal compartment syndrome, about 3 times in the case of sepsis and 7.883 times in the case of bronchopneumonia. All four independent variables contributed 47.6% to the risk of death. Conclusion: although in the past 30 years in our country we have seen transformational improvements in outcome of gastroschisis, survival rates increasing from 26% to 52%, some factors may still be ameliorated for a better outcome.

Highlights

Gastroschisis is a relatively benign malformation, but is associated with substantial perinatal morbidity and there is still no consensus about the best mode and time of delivery, about the algorithm for its treatment, and about the main risk factors for morbidities [1]
The survival rate in gastroschisis in developed countries is more than 90% [3], but still a very high morbidity and mortality is common in our country, because of the low rate of antenatal diagnosis, late closure of the abdominal wall, sepsis and abdominal compartment syndrome, with consequent morbidity and long period of hospitalization [4,5]
The aim of the present study is to detect the main factors of an unfavorable evolution in the case of gastroschisis and to find the best predictors of death, in order to subsequently improve the high rate of morbidity and mortality for this congenital malformation

Summary

Introduction

Gastroschisis is a relatively benign malformation, but is associated with substantial perinatal morbidity and there is still no consensus about the best mode and time of delivery, about the algorithm for its treatment, and about the main risk factors for morbidities [1]. The survival rate in gastroschisis in developed countries is more than 90% [3], but still a very high morbidity and mortality is common in our country, because of the low rate of antenatal diagnosis, late closure of the abdominal wall, sepsis and abdominal compartment syndrome, with consequent morbidity and long period of hospitalization [4,5]. The aim of the present study is to detect the main factors of an unfavorable evolution in the case of gastroschisis and to find the best predictors of death, in order to subsequently improve the high rate of morbidity and mortality for this congenital malformation

Objectives

Methods

Results

Discussion

Conclusion