Presented at the Neonatal Society 2012 Summer Meeting.
O’Hare SS, Offord J, Tooley JR
NICU, St. Michael’s Hospital, Southwell Street, Bristol. BS2 8EG
Background: We aimed to examine the impact of a change in the surgical approach to gastroschisis from routine attempted primary closure in theatre, with application of a silo only if this fails, to management on the NICU with application of a silo unless primary reduction is easily achieved.
Methods: Our NICU admissions database was used to identify all admissions with gastroschisis between January 2000 and February 2011. Outcomes were compared for those born between January 2000 and December 2004 (when all patients had attempted primary closure in theatre) and those born between January 2005 and February 2011 (when increasing numbers had their procedure on NICU).
Results: 133 patients were identified for which notes were available for 116 (87%). There were 42 in the earlier cohort, 74 in the later cohort. Median maternal age was 21 years (15-35). 90/116 (78%) were firstborns. 114/116 (98%) were diagnosed antenatally. Median gestational age at delivery was 37 weeks (26-38). 67/116 (58%) were born by normal vaginal delivery. 104/116 (90%) were inborn. Rates of primary repair fell from 29/41 (71%) in the early cohort, to 33/74 (45%) in the later cohort, reflecting the change in surgical approach. Median duration of ventilation was 2 days (0.5->17) versus 3 days (0-16). In the later cohort, 8 babies undergoing primary closure (n=2) or silo (n=6) on NICU avoided ventilation. Median time to first feed was 9 days (3-52) versus 11 days (3-51). Sepsis (significant CRP rise and/or positive cultures) occurred in 16/37 (43%) versus 25/74 (34%). Morbidity included atresia (5/42 (12%) versus 3/74 (4%)) adhesions (3/42 (7%) versus 5/74 (7%)) necrotising enterocolitis (1/42 (2%) versus 2/74 (3%)) strictures (1/42 (2%) versus 2/74 (3%)) malrotation (2/42 (5%) versus 0/74 (0%)). Overall mortality was 5/116 (4%). Median time to discharge from our centre was 26 days (8-279) versus 26 days (3-125). Almost all babies were tolerating full feeds at discharge, though some were discharged to their local hospital.
Conclusion: The change in surgical approach to repair of gastroschisis, with many more babies having silo repairs on NICU has had no effect on outcomes.
Corresponding author: samohare@hotmail.com