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Outcomes of surgically treated babies with Gastroschisis – a 10 year experience

Presented at the Neonatal Society 2010 Spring Meeting.

Chandra P1, Rasiah SV1, Lander A2, Tonks A3, Kilby MD4,5, Ewer AK1,5

1 Department of Neonatology, Birmingham Women’s Foundation NHS Trust, Birmingham, UK
2 Department of Paediatric Surgery, Birmingham Children’s Foundation NHS Trust, Birmingham, UK
3 West Midlands Perinatal Institute, Birmingham, UK
4 Fetal Medicine Centre, Birmingham Women’s Foundation NHS Trust, Birmingham, UK
5 School of Clinical & Experimental Medicine, College of Medical & Dental Sciences, University of Birmingham, UK

Background: Gastroschisis is now a common anomaly and survival rates are high, but there is a spectrum of outcomes.

Aim: To define the outcomes to discharge of babies treated for gastroschisis over a ten year period. 

Methods: All babies born with gastroschisis and treated at the regional surgical unit between 01/01/1998 – 31/12/2007 were identified from the regional congenital anomaly register. Post-surgical outcomes were obtained retrospectively from the case notes with regional ethical committee approval.

Results: 128 babies had gastroschisis and complete data were available in 124 (97%). 1 of 4 with inadequate data died. Of the 124, 59 (48%) were boys. Median (range) gestation was 37 weeks (31-40), birth weight was 2300g (1400-4000), maternal age was 20 years (16-35), 118 (95%) were Caucasians. Primary closure was performed in 70 (57%) babies, 31 (25%) had silo reduction with secondary closure at a median of 7 days (4-21) and 23 (18%) babies had a Bianchi procedure. Bowel atresia was seen in 6 (5%) and one baby without an atresia had a perforation. Eighteen boys had 21 undescended testes (11 left, 4 right, 3 bilateral).

The median (range) stay in PICU was 2 days (0-80) and 73 (59%) were ventilated for 1 day (1-30). The median age to full feeds was 25 days (12-350) and 2 babies went home on PN. The babies required parenteral nutrition (PN) for a median of 24 days (10-350) and the post-surgical period was complicated by 37 episodes of line infection in 27 babies. There were 16 cases of cholestasis, 2 developed intestinal failure and liver disease, one requiring liver transplantation. 15 (12%) babies were diagnosed with NEC and 6 cases developed obstruction/stricture post-surgery (3 of these following NEC). The median age at discharge was 32 days (16-364). There were no significant differences in outcomes between those with and without atresias.

Conclusion: In this 10 year period gastroschisis was managed in 128 babies one of whom died. The median stay was 32 days but 8 (6%) babies stayed over 6 months, one had liver transplant and 2 had home PN. This information is important when counselling parents of babies with gastroschisis.

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