PAPS PaperImproving gastroschisis outcomes: Does birth place matter?
Section snippets
Background
The incidence of gastroschisis is approximately 1 in 4000 live births [1], with many studies showing an increasing worldwide incidence [2], [3]. Appropriate care of these patients requires prompt surgical intervention, as some studies have shown improved outcomes with earlier definitive closure [4], [5]. Recently, there has been a drive towards regionalization of care in neonates with complex congenital anomalies, such as gastroschisis [6], [7]. However, the data to support a significant
Study design
After individual institutional Internal Review Board (IRB) approval, six institutions within the Pediatric Surgery Research Collaborative (PedSRC) reviewed patients treated for gastroschisis during a five-year period between 2008 and 2013.
Patients with gastroschisis were identified by International Classification of Disease version 9 (ICD-9) codes (756.7, 756.73, and 756.79). Patients found to have omphalocele or other congenital abdominal wall defects were excluded. Additionally, patients were
Demographics
A total of 524 patients within the six participating institutions were identified that met the inclusion criteria; 285 patients were defined as inborn and 239 were outborn. The inborn and outborn populations were similar at baseline with regards to gender, birth weight, and gestational age (Table 2). Within the inborn population there was a significantly higher rate of scheduled deliveries (44% vs 27%, p = 0.0001), prenatal diagnosis (95% vs 87%, p = 0.001), and intrauterine growth retardation
Discussion
There have been several studies that have examined whether birthplace affects outcomes, with differing results (Table 1). The first to address the issue of birthplace potentially affecting outcomes was Stringer et al. in 1990; in their review, they found a trend for improved outcomes in the patients transferred prenatally with more frequent primary repairs, less ventilation, and reduced hospital stays. They were, however, unable to find any statistically significant difference between groups [8]
Acknowledgments
We would like to thank Dr. Tamekia Jones for her assistance with statistical analysis. We would also like to thank the Children’s Foundation Research Institute Biomedical Informatics Core at Le Bonheur Children’s Hospital for their help with database set up and management.
References (23)
- et al.
The rising prevalence of gastroschisis and omphalocele in Tennessee
J Pediatr Surg
(2007) - et al.
Predictors of postnatal outcome in neonates with gastroschisis
J Pediatr Surg
(2011) - et al.
Effect of time to surgical evaluation on the outcomes of infants with gastroschisis
J Pediatr Surg
(2012) - et al.
Prenatal diagnosis and the pediatric surgeon: the impact of prenatal consultation on perinatal management
J Pediatr Surg
(1996) - et al.
Risk factors for adverse outcome of newborns with gastroschisis in a Brazilian hospital
J Pediatr Surg
(2001) - et al.
Improved outcome of preterm infants when delivered in tertiary care centers
Am Coll Obstet Gynecol
(2001) - et al.
Unsatisfactory experience with ‘minimal intervention management’ for gastroschisis
J Pediatr Surg
(2000) - et al.
The timing of delivery of infants with gastroschisis influences outcome
J Pediatr Surg
(2005) - et al.
Is timing everything? The influence of gestational age, birth weight, route, and intent of delivery on outcome in gastroschisis
J Pediatr Surg
(2009) - et al.
Gastroschisis: an update
Pediatr Surg Int
(2010)
Gastroschisis: international epidemiology and public health perspectives
Am J Med Genet C: Semin Med Genet
Cited by (28)
Relationship between volume and outcome for gastroschisis: A systematic review
2022, Journal of Pediatric SurgeryInfluence of birthplace on gastroschisis outcomes in a state in the southeastern region of Brazil
2021, Jornal de PediatriaCitation Excerpt :In this study, the rate of cesarean section performed in the inborn patients was higher than outborn, probably related to a low rate of antenatal diagnosis in the outborn group. In a high-income country study, there were no differences in the delivery route between both patients, however, scheduled delivery was higher (p < 0.01) in inborn patients.10 Delivery time and birth route are a controversial issue in gastroschisis cases.
Gastroschisis in the neonatal period: A prospective case-series in a Brazilian referral center
2020, Journal of Pediatric SurgeryAssessment of gastroschisis risk factors in Egypt
2020, Journal of Pediatric SurgeryPredicting Morbidity and Mortality in Neonates Born With Gastroschisis
2020, Journal of Surgical ResearchA Gastroschisis bundle: effects of a quality improvement protocol on morbidity and mortality
2018, Journal of Pediatric Surgery