The correlation between the time spent in utero and the severity of bowel matting in newborns with gastroschisis

Abstract

BackgroundOptimal timing of delivery in fetuses with gastroschisis (GS) is unknown. Some favor early induced delivery to prevent bowel injury. This study evaluates the correlation between bowel injury and the gestational age at birth using the Gastroschisis Prognostic Score (GPS). MethodsA national database was analyzed from 2005 to 2013. Patients were pooled based on their gestational age at birth. The mean GPS and % of patients with severe bowel matting were tabulated for each week in utero. Regression modeling was used to evaluate the relationship between the dependent (severe matting and GPS) and independent (gestational age) variables and the R2 coefficient of determination was derived to evaluate model strength. Additional factors influencing the timing of delivery were evaluated. ResultsOf 780 cases, 88 were excluded because of missing data. A linear relationship is seen between increasing gestational age and decreasing bowel matting (R2=0.66) and GPS (R2=0.72). For every week in utero, the % of patients with severe matting decreases by 3.6%. ConclusionEarly induced delivery simply to protect the bowel from ongoing in utero damage appears unfounded and should be reserved for evidence of closing gastroschisis or traditional obstetrical/fetal indications.