Is early delivery beneficial in gastroschisis?

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• 作者：Helen Carnaghan^a ; Susana Pereira^b ; Catherine P. James^c ; Paul B. Charlesworth^d ; Marco Ghionzoli^a ; Elkhouli Mohamed^c ; Kate M.K. Cross^a ; Edward Kiely^a ; Shailesh Patel^d ; Ashish Desai^d ; Kypros Nicolaides^b ; Joseph I. Curry^a ; Niyi Ade-Ajayi^d ; Paolo De Coppi^a ; Mark Davenport^d ; Anna L. David^c ; Agostino Pierro^e ; Simon Eaton^a ; ^{s.eaton@ucl.ac.uk" class="auth_mail}
• 关键词：Gastroschisis ; Gestational age ; Preterm delivery ; Intra-abdominal bowel dilatation ; Extra-abdominal bowel dilatation ; Bowel inflammation ; Post-natal outcome ; Antenatal ultrasound ; Enteral feeding
• 刊名：Journal of Pediatric Surgery
• 出版年：June 2014
• 年：2014
• 卷：49
• 期：6
• 页码：928-933
• 全文大小：355 K

文摘

Gastroschisis neonates have delayed time to full enteral feeds (ENT), possibly due to bowel exposure to amniotic fluid. We investigated whether delivery at < 37 weeks 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 < 30 weeks, the positive predictive value for complex gastroschisis was 75%. Two patients with necrosis and one atresia had IABD and collapsed extra-abdominal bowel from < 30 weeks.

Conclusion

Early delivery is associated with prolonged ENT/LOS, suggesting elective delivery at < 37 weeks is not beneficial. Combined IABD/EABD or IABD/collapsed extra-abdominal bowel is suggestive of complex gastroschisis.