Document Detail

Influence of location of delivery on outcome in neonates with gastroschisis.
MedLine Citation:
PMID:  23163992     Owner:  NLM     Status:  In-Data-Review    
BACKGROUND: It is not clear in the literature whether infants with a prenatal diagnosis of gastroschisis should be delivered in a perinatal center with level 3 neonatal intensive care unit (NICU) and surgical facilities ("inborn") or if they could be safely delivered in a more local hospital and then transferred to a perinatal center ("outborn"). Our goal was to determine the impact of delivery site on outcomes for neonates diagnosed as having gastroschisis.
METHODS: Data were obtained from the Canadian Pediatric Surgery Network, covering the years 2005 to 2008 for 18 pediatric surgical centers. Inborn was defined as birth in a hospital with a NICU or connected to a NICU by a bridge or tunnel. Outborn was defined as requiring transfer by ambulance or flight. A P value less than .05 was considered significant.
RESULTS: Of 395 infants with prenatally diagnosed gastroschisis, 237 were inborn and 158 were outborn. Univariate analysis demonstrated no significant difference between groups with respect to gestational age, birth weight, days on total parenteral nutrition, or length of hospital stay. There was a significant difference with regard to Score for Neonatal Acute Physiology-Version II, complication rates, comorbidities, and age at final closure. Logistic regression showed that location of delivery was a significant independent predictor for incidence of complications, as were Score for Neonatal Acute Physiology-Version II, comorbidities, and presence of bowel atresia or necrosis. The odds ratio of developing a complication when outborn was 1.6 (P = .05).
CONCLUSIONS: Delivery outside a perinatal center is a significant predictor of complications for infants born with gastroschisis.
Ahmed Nasr; Jacob C Langer;
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of pediatric surgery     Volume:  47     ISSN:  1531-5037     ISO Abbreviation:  J. Pediatr. Surg.     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0052631     Medline TA:  J Pediatr Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2022-5     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 Elsevier Inc. All rights reserved.
Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada.
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