1. Management and outcome challenges in newborns with gastroschisis: A 6-year retrospective French study
- Author
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Olivier Claris, Thierry Merrot, Catherine Gire, Karine Baumstarck, Barthélémy Tosello, Meriem Zahed, Jerome Massardier, Floriane Guimond, Fabrice Michel, Claude D'Ercole, Isabelle Berakdar, Alice Faure, Hôpital Nord [CHU - APHM], Marseille medical genetics - Centre de génétique médicale de Marseille (MMG), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Aix Marseille Université (AMU), Anthropologie bio-culturelle, Droit, Ethique et Santé (ADES), Aix Marseille Université (AMU)-EFS ALPES MEDITERRANEE-Centre National de la Recherche Scientifique (CNRS), Service d'anesthésie et de réanimation [Hôpital de la Timone - APHM], Hôpital de la Timone [CHU - APHM] (TIMONE), Santé Individu Société (SIS), Université Lumière - Lyon 2 (UL2)-Université Jean Moulin - Lyon 3 (UJML), Université de Lyon-Université de Lyon-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Hospices Civils de Lyon (HCL)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Montpellier, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Hôpital Femme Mère Enfant [CHU - HCL] (HFME), Hospices Civils de Lyon (HCL), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Institut National de la Recherche Agronomique (INRA)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de gynécologie-obstétrique [Hôpital Nord - APHM], and Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM]
- Subjects
Male ,Adult ,Pediatrics ,medicine.medical_specialty ,Adolescent ,Cross-sectional study ,postnatal outcome ,delivery timing ,Outcome (game theory) ,France/epidemiology ,Infant, Newborn, Diseases ,neonatal outcome ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,030225 pediatrics ,Risk of mortality ,medicine ,Humans ,Diseases/*diagnosis/epidemiology/*therapy ,Young adult ,Preterm delivery ,Retrospective Studies ,Gastroschisis ,[SDV.MHEP.PED]Life Sciences [q-bio]/Human health and pathology/Pediatrics ,030219 obstetrics & reproductive medicine ,business.industry ,Infant, Newborn ,Obstetrics and Gynecology ,Gestational age ,Infant ,Retrospective cohort study ,medicine.disease ,Newborn ,Prognosis ,humanities ,Treatment Outcome ,Cross-Sectional Studies ,Pediatrics, Perinatology and Child Health ,Female ,France ,Gastroschisis/*diagnosis/epidemiology/*therapy ,business ,preterm delivery ,Follow-Up Studies - Abstract
Place: England; International audience; OBJECTIVE: To identify the gestational age (GA) at which risk of mortality and severe outcome was minimized comparing preterm delivery and expectant management. METHODS: Retrospective study performed between 2009 and 2014 of newborns with gastroschisis in three large French level III neonatal intensive care units. Each department followed two distinct strategies: elective delivery at 35 weeks' GA and a delayed approach. RESULTS: We included 69 gastroschisis cases. The lengths of stay lasting more than 60 days were significantly greater in the planned delivery group than in the expectant approach group (18/30 (60%) vs. 8/39 (20.5%), p = 0.001). Gastroschisis cases receiving antenatal corticoids during the last two weeks of gestation required significantly less surgeries during their initial stay (p = 0.003) as well as shorter parenteral feedings (p = 0.002). A multivariate logistic regression showed that a GA of less than 36 weeks' GA was is a pejorative factor for a stay above 60 days, regardless of whether it was a simple or complex gastroschisis, (OR= 3.8; p = 0.021). A complex gastroschisis was a risk factor for significantly longer parenteral feedings, regardless of the center where patient is treated (Beta = -0.3, p = 0.035). CONCLUSIONS: Future research should focus on decisions about delivery timing by incorporating risk of neonatal morbidity.
- Published
- 2017
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