Critical Organ Dysfunction in Newborns with Gastroschisis

Abstract

Objective

Gastroschisis is the most common newborn abdominal wall defect. Gastroschisis classification is based on the absence (simple gastroschisis [SG]) or presence (complex gastroschisis [CG]) of bowel morbidity. The severity of critical organ dysfunction with gastroschisis is unknown.

Study Design

This was a multicenter, retrospective cohort study of infants with gastroschisis (birth weight ≥ 1.8 kg and gestational age ≥ 35 weeks) admitted to the University of Florida Health NICU between January 1, 2012, and April 1, 2023, and the Johns Hopkins NICU between July 1, 2016, and December 31, 2024. All data was collected from the electronic health record. CG was defined as the presence of atresia, necrosis, perforation, volvulus, jejunostomy, resection, or short bowel syndrome. Hourly organ dysfunction was quantified by the neonatal sequential organ failure assessment (nSOFA) score (measures respiratory, cardiovascular, and hematologic dysfunction with a range from 0 to 15 [severe]).

Results

We identified 120 patients with gastroschisis (49% male; 90 with SG). Compared with patients with SG, neonates with CG had greater maximum nSOFA scores (median: 2 [IQR]: [0, 4] vs. 3 [1, 7]; p = 0.02). The coefficient of variation on cumulative nSOFA scores calculated at 24-hour intervals after birth as a measure of organ dysfunction heterogeneity for SG patients was 278 to 332% and was 216 to 266% for CG patients.

Conclusion

This is the first high-granularity quantification of critical organ dysfunction in gastroschisis patients. We found a low overall severity of critical organ dysfunction among all patients. Substantial heterogeneity was present in both groups. The nSOFA may help to identify a subset of patients with critical organ dysfunction outside of bowel morbidity.

Key Points

• Gastroschisis is the most common abdominal wall defect; the severity of organ dysfunction is unclear.

• nSOFA measures critical organ dysfunction; its role in identifying high-risk gastroschisis is unknown.

• Most infants had minimal organ dysfunction; half of SG and one-third of CG had no organ failure.

• Organ dysfunction varied widely within groups; nSOFA may improve risk detection and trial design.

Keywords

neonate - gastroschisis - nSOFA - critical illness

Ethical Approval

This study protocol was reviewed and approved by the Institutional Review Board (IRB) at the University of Florida College of Medicine (approval number: IRB201902780). Because the retrospective study was deemed to be associated with no more than minimal risk, a waiver of written consent was granted by the IRB.

Authors' Contributions

J.L.W. conceived the study design. J.L.W., K.A., D.D.L.C., M.D., and E.K. performed the data extraction and analysis. D.D.L.C. and J.L.W. drafted the initial manuscript. All authors interpreted the data, critically reviewed and revised the manuscript, and approved the final manuscript as submitted and agreed to be responsible for all aspects of the work.

Publication History

Received: 08 May 2025

Accepted: 06 August 2025

Accepted Manuscript online:
08 August 2025

Article published online:
20 August 2025

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