Subscribe to RSS
DOI: 10.1055/s-0030-1262791
© Georg Thieme Verlag KG Stuttgart · New York
Factors Associated with Mortality in Neonates with Gastroschisis
Publication History
received May 16, 2010
accepted after revision June 18, 2010
Publication Date:
16 February 2011 (online)
Abstract
Purpose: The ongoing epidemic of gastroschisis has created multiple challenges and continues to raise questions concerning the optimal management of these high-risk patients. Although the overall survival rate has increased over the past 3 decades, morbidity and mortality remain significant. The purpose of this study was to analyze the main factors associated with mortality in neonates admitted to an intensive care unit for the management of this abdominal wall defect.
Methods: This study is a retrospective review of a large de-identified neonatal intensive care dataset encompassing 284 institutions in 32 states and Puerto Rico, from 1/1/1997 to 1/1/2010. Of the 629 440 neonates in the dataset, a total of 3 456 newborns were diagnosed with gastroschisis (5.5/1 000 hospital discharges). Of these, 685 were transferred to other centers and data was missing on 22, leaving 2 749 infants available for analysis.
Results: Out of these 2 749 infants of whom we knew the outcome, 115 (4.2%) died. Multivariate logistic regression showed that the factors independently associated with an increased risk of death were male gender, immature gestational age, low birth weight, low 5 min Apgar Score, the need for vasopressors during the first week after birth and the need for high levels of oxygen support. The presence of associated anomalies, vaginal delivery, treatment with surfactant and the need for ventilator support on the day of birth were not independent risk factors associated with an increased mortality.
Conclusion: Premature delivery and low birth weight are the most important factors associated with an increased risk of mortality. Cesarean section does not appear to reduce the risk.
Key words
neonate - gastroschisis - mortality
References
- 1 Castilla EE, Mastroiacovo P, Orioli IM. Gastroschisis: international epidemiology and public health perspectives. Am J Med Genet C Semin Med Genet. 2008; 148C 162-179
- 2 Draper ES, Rankin J, Tonks AM. et al . Recreational drug use: a major risk factor for gastroschisis?. Am J Epidemiol. 2008; 167 485-491
- 3 Boutros J, Regier M, Skarsgard ED. Is timing everything? The influence of gestational age, birth weight, route, and intent of delivery on outcome in gastroschisis. J Pediatr Surg. 2009; 44 912-917
- 4 Maramreddy H, Fisher J, Slim M. et al . Delivery of gastroschisis patients before 37 weeks of gestation is associated with increased morbidities. J Pediatr Surg. 2009; 44 1360-1366
- 5 Abrams ME, Meredith KS, Kinnard P. et al . Hydrops fetalis: a retrospective review of cases reported to a large national database and identification of risk factors associated with death. Pediatrics. 2007; 120 84-89
- 6 Cohen-Wolkowiez M, Smith PB, Mangum B. et al . Neonatal Candida meningitis: significance of cerebrospinal fluid parameters and blood cultures. J Perinatol. 2007; 27 97-100
- 7 Laughon M, Bose C, Clark R. Treatment strategies to prevent or close a patent ductus arteriosus in preterm infants and outcomes. J Perinatol. 2007; 27 164-170
- 8 Clark RH, Walker MW, Gauderer MW. Prevalence of gastroschisis and associated hospital time continue to rise in neonates who are admitted for intensive care. J Pediatr Surg. 2009; 44 1108-1112
- 9 Gelas T, Gorduza D, Devonec S. et al . Scheduled preterm delivery for gastroschisis improves postoperative outcome. Pediatr Surg Int. 2008; 24 1023-1029
- 10 Hadidi A, Subotic U, Goeppl M. et al . Early elective cesarean delivery before 36 weeks vs. late spontaneous delivery in infants with gastroschisis. J Pediatr Surg. 2008; 43 1342-1346
- 11 Lausman AY, Langer JC, Tai M. et al . Gastroschisis: what is the average gestational age of spontaneous delivery?. J Pediatr Surg. 2007; 42 1816-1821
Correspondence
Dr. Reese Hunter ClarkMD
Pediatrix Medical Group
Research and Education
Reserve Drive 141
29673 Piedmont
United States
Phone: +1 864 9079 887
Fax: +1 954 8392 556
Email: reese_clark@pediatrix.com