Abstract
The aim of the present study was to assess the prognostic factors for the outcome of gastroschisis in Finland. A retrospective multicenter study of gastroschisis patients born between 1993 and 2015 in four Finnish university hospitals was undertaken, collecting perinatal, surgical, and clinical data of neonates for uni- and multifactorial modeling analysis. The aim of the present study was to identify risk factors for mortality and the composite adverse outcome (death and/or short bowel syndrome or hospital stay > 60 days). Of the 154 infants with gastroschisis, the overall survival rate was 90.9%. In Cox regression analysis, independent risk factors for mortality included liver herniation, pulmonary hypoplasia, relaparotomy for perforation or necrosis, abdominal compartment syndrome, and central line sepsis. Furthermore, a logistic regression analysis identified central line sepsis, abdominal compartment syndrome, complex gastroschisis, and a younger gestational age as independent predictors of the composite adverse outcome.Conclusion: The risk of death is increased in newborns with gastroschisis who have liver herniation, pulmonary hypoplasia, abdominal compartment syndrome, relaparotomy for perforation or necrosis, or central line–associated sepsis. Special care should be taken to minimize the risk of central line sepsis in the clinical setting.What is known:• Gastroschisis is a relatively rare congenital anomaly of the abdominal wall and its incidence is increasing.• Complex gastroschisis has been reported to increase risk of mortality and complications.What is new:• Central line sepsis was found to be independently associated with mortality in gastroschisis patients.• Liver herniation was also significantly associated with mortality.
Highlights
Gastroschisis is a congenital defect of the anterior abdominal wall allowing protrusion of the intestines and other abdominal organs out of the abdominal cavity
These were the gestational age at birth, Apgar score at 1 min of age, a staged closure with silo, liver herniation, pulmonary hypoplasia, silo complications, relaparotomy for bowel perforation or necrosis, abdominal compartment syndrome, and central line sepsis
We reported 76 (49.4%) patients with prolapsed organs which was slightly higher than the 40.6% observed by Koehler et al [11]
Summary
Gastroschisis is a congenital defect of the anterior abdominal wall allowing protrusion of the intestines and other abdominal organs out of the abdominal cavity. Prevalence of this condition varies from one to five in 10 000 live births and is increasing in the western countries [1,2,3,4,5]. The aim of the present study was, using a multicenter retrospective setting, to investigate perinatal and clinical factors that are independently associated with death or composite adverse outcome (death, short bowel syndrome, and/or hospital stay > 60 days) in infants with gastroschisis
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