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Is early delivery beneficial in gastroschisis?
- Source :
- Journal of Pediatric Surgery; Jun2014, Vol. 49 Issue 6, p928-933, 6p
- Publication Year :
- 2014
-
Abstract
- Abstract: Purpose: Gastroschisis neonates have delayed time to full enteral feeds (ENT), possibly due to bowel exposure to amniotic fluid. We investigated whether delivery at <37weeks improves neonatal outcomes of gastroschisis and impact of intra/extra-abdominal bowel dilatation (IABD/EABD). Methods: A retrospective review of gastroschisis (1992–2012) linked fetal/neonatal data at 2 tertiary referral centers was performed. Primary outcomes were ENT and length of hospital stay (LOS). Data (median [range]) were analyzed using parametric/non-parametric tests, positive/negative predictive values, and regression analysis. Results: Two hundred forty-six patients were included. Thirty-two were complex (atresia/necrosis/perforation/stenosis). ENT (p<0.0001) and LOS (p<0.0001) were reduced with increasing gestational age. IABD persisted to last scan in 92 patients, 68 (74%) simple (intact/uncompromised bowel), 24 (26%) complex. IABD or EABD diameter in complex patients was not significantly greater than simple gastroschisis. Combined IABD/EABD was present in 22 patients (14 simple, 8 complex). When present at <30weeks, the positive predictive value for complex gastroschisis was 75%. Two patients with necrosis and one atresia had IABD and collapsed extra-abdominal bowel from <30weeks. Conclusion: Early delivery is associated with prolonged ENT/LOS, suggesting elective delivery at <37weeks is not beneficial. Combined IABD/EABD or IABD/collapsed extra-abdominal bowel is suggestive of complex gastroschisis. [Copyright &y& Elsevier]
Details
- Language :
- English
- ISSN :
- 00223468
- Volume :
- 49
- Issue :
- 6
- Database :
- Supplemental Index
- Journal :
- Journal of Pediatric Surgery
- Publication Type :
- Academic Journal
- Accession number :
- 96317563
- Full Text :
- https://doi.org/10.1016/j.jpedsurg.2014.01.027