| Risk stratification in gastroschisis: can prenatal evaluation or early postnatal factors predict outcome? | |
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MedLine Citation:
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PMID: 19277683 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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PURPOSE: The prenatal or postnatal factors that predict complex gastroschisis in patients (atresia, volvulus, necrotic bowel and bowel perforation) remain controversial. We evaluated the prognostic value of prenatal ultrasonographic parameters and early postnatal factors in predicting clinical outcomes. METHODS: We analyzed maternal and neonatal records of 46 gastroschisis patients treated from 1998 to 2007. Information regarding demographics, prenatal ultrasound data when available, intrapartum and postnatal course was abstracted from medical records. Outcome variables included survival, ventilator days, TPN days, time to full enteral feeds, complications and length of stay. Univariate or multivariate analysis was used, with P < 0.05 considered as significant. RESULT: A total of 75% of complex patients were categorized within 1 week of life. Interestingly, prenatal bowel dilation (>17 mm) and thickness (>3 mm) did not correlate with outcome or risk stratification into simple versus complex (P < 0.05). Complex patients had increased morbidity compared to simple patients (sepsis 58 versus 18%; P = 0.021, NEC 42 versus 9%; P = 0.020, short bowel syndrome 58 versus 3%; P = 0.0001, ventilator days 24 versus 10; P = 0.021; TPN days 178 versus 38; P = 0.0001 and days to full feeds 171 versus 31; P = 0.0001; and length of stay 90 versus 39 days, P = 0.0001). CONCLUSIONS: Prenatal bowel wall dilation and/or thickness did not predict complex patients or adverse outcome. Complex gastroschisis patients can be identified postnatally and have substantial morbidity. |
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Authors:
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Ryan P Davis; Marjorie C Treadwell; Robert A Drongowski; Daniel H Teitelbaum; George B Mychaliska |
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Publication Detail:
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Type: Comparative Study; Journal Article Date: 2009-03-10 |
Journal Detail:
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Title: Pediatric surgery international Volume: 25 ISSN: 1437-9813 ISO Abbreviation: Pediatr. Surg. Int. Publication Date: 2009 Apr |
Date Detail:
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Created Date: 2009-03-30 Completed Date: 2009-09-22 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8609169 Medline TA: Pediatr Surg Int Country: Germany |
Other Details:
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Languages: eng Pagination: 319-25 Citation Subset: IM |
Affiliation:
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Section of Pediatric Surgery, Department of Surgery, University of Michigan Hospitals, Mott Children's Hospital F3970, Box 0245, Ann Arbor, MI 48109, USA. ryda@med.umich.edu |
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Female Follow-Up Studies Gastroschisis / diagnosis*, epidemiology, prevention & control Humans Infant, Newborn Male Middle Aged Morbidity / trends Pregnancy Pregnancy Outcome Prenatal Care / methods* Prognosis Retrospective Studies Risk Assessment / methods* Ultrasonography, Prenatal / methods United States / epidemiology Young Adult |
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