Skip to main content

Advertisement

Log in

Gastroschisis: determinants of neonatal outcome

  • Original Article
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

Abstract.

This retrospective study elicits information regarding the dependence of neonatal outcome in gastroschisis upon: (1) the mode of delivery, (2) place of birth, (3) time for birth to surgery, (4) method of closure, (5) time from operation to commencement of first enteral feeds. The neonatal intensive care database from five major tertiary centres was used to identify 181 neonates with gastroschisis from 1990 to 2000. There were 8 deaths. There were no significant differences in outcome for infants delivered vaginally (102) versus Caesarean section (79), those born near the tertiary centre (133) as compared to infants born away (48), ones operated within 7 hours (125) compared with those operated after 7 hours (56), with delayed closure (30) versus primary closure (151). Neonates fed within 10 days of operation (85) had significantly lower incidence of sepsis, duration of TPN and hospital stay when compared to those fed after 10 days (96). Early commencement of feeds decreases the incidence of sepsis, duration of total parenteral nutrition (TPN) and hospital stay. Place of delivery, mode of delivery, time to surgery and type of closure do not influence neonatal outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1.
Fig. 2.

Similar content being viewed by others

References

  1. Lancaster P, Hurst T, Huang J, Shafir E (1994) Congenital malformations Australia 1993 and 1994. Australian institute of health and welfare national perinatal statistics Unit. Birth Defects 2: 103–105

  2. Stringer MD, Brereton RJ, Wright VM (1991) Controversies in the management of Gastroschisis: a study of 40 patients. Arch Dis Child 66: 34–36

    Google Scholar 

  3. Stoodley N, Sharma A, Noblett H, James D (1993) Influence of place of delivery on outcome in babies with Gastroschisis. Arch Dis Child 68: 321–323

    Google Scholar 

  4. Sakala EP, Erhard LN, White JJ (1993) Elective Caesarean section improves outcomes of neonates with Gastroschisis Am J Obs Gynecol 169: 1050–1053

    Google Scholar 

  5. Quirk JGJ, Fortney J, Collins HB, West J, Hassad SJ, Wagner C (1996) Outcome of newborns with gastroschisis: the effects of mode of delivery, site of delivery, and interval from birth to surgery. Am J Obs Gynecol 174: 1134–1138

    Google Scholar 

  6. Novotny DA, Klein RL, Boeckman CR (1993) Gastroschisis: an 18-year review. J Pediatr Surg 28: 650–652

    Google Scholar 

  7. Nicholls G, Upadhyaya V, Gornall P, Buick RG, Corkery JJ (1993) Is specialist centre delivery of Gastroschisis beneficial? Arch Dis Child 69: 71–72

    Google Scholar 

  8. Moretti M, Khoury A, Rodriquez J, Lobe T, Shaver D, Sibai B (1990) The effect of mode of delivery on the perinatal outcome in fetuses with abdominal wall defects. Am J Obs Gynecol 163: 833–838

    Google Scholar 

  9. Lewis DF, Towers CV, Garite TJ, Jackson DN, Nageotte MP, Major CA (1990) Fetal Gastroschisis and omphalocele: is Caesarean section the best mode of delivery? Am J Obs Gynecol 163: 773–775

    Google Scholar 

  10. Lenke RR, Hatch EI Jr (1986) Fetal Gastroschisis: a preliminary report advocating the use of Caesarean section. Obs Gynecol 67: 395–398

    Google Scholar 

  11. Heydanus R, Raats MA, Tibboel D, Los FJ, Wladimiroff JW (1980) Prenatal diagnosis of fetal abdominal wall defects: a retrospective analysis of 44 cases. Prenatal Diagnosis 16: 411–417

    Google Scholar 

  12. Fitzsimmons J, Nyberg DA, Cyr DR, Hatch E (1988) Perinatal management of Gastroschisis. Obs Gynecol 71: 910–913

    Google Scholar 

  13. Fasching G, Mayr J, Sauer J (1996) The effect of mode of delivery on outcome in fetuses with Gastroschisis. Pediatr Surg Int 11: 100–102

    Google Scholar 

  14. Di Lorenzo M, Yazbeck S, Ducharme JC (1987) Gastroschisis: a 15-year experience. J Pediatr Surg 22: 710–712

    Google Scholar 

  15. Coughlin JP, Drucker DE, Jewell MR, Evans MJ, Klein MD (1993) Delivery room repair of Gastroschisis. Surgery 114: 822–826

    Google Scholar 

  16. Shah R, Woolley MM (1991) Gastroschisis and intestinal atresia. J Pediatr Surg 26: 788–790

    Google Scholar 

  17. Fonkalsrud EW (1980) Selective repair of neonatal Gastroschisis based on degree of visceroabdominal disproportion. Ann Surg 191: 139–144

    Google Scholar 

  18. Hagberg S, Hokegard KH, Rubenson A, Sillen U (1988) Prenatally diagnosed Gastroschisis – a preliminary report advocating the use of elective caesarean section. Zeitschrift fur Kinderchirurgie 43: 419–421

    Google Scholar 

  19. Swift RI, Singh MP, Ziderman DA, Silverman M, Elder MA, Elder MG (1992) A new regime in the management of Gastroschisis. J Pediatr Surg 27: 61–63

    Google Scholar 

  20. Sipes SL, Weiner CP, Sipes DR, Grant SS, Williamson RA (1990) Gastroschisis and omphalocele: does either antenatal diagnosis or route of delivery make a difference in perinatal outcome? Obs Gynecol 76: 195–199

    Google Scholar 

  21. Novotny DA, Klein RL, Boeckman CR (1993) Gastroschisis: an 18-year review. J Pediatr Surg 28: 650–652

    Google Scholar 

  22. Meizner I, Bar-Ziv J (1986) Prenatal ultrasonic diagnosis of anterior abdominal wall defects. Eur J Obs Gynecol Reproduct Biol 22: 217–224

    Google Scholar 

  23. Kirk EP, Wah RM (1983) Obstetric management of the fetus with omphalocele or Gastroschisis: a review and report of one hundred twelve cases. Am J Obs Gynecol 146: 512–518

    Google Scholar 

  24. Davidson JM, Johnson TRJ, Rigdon DT, Thompson BH (1984) Gastroschisis and omphalocele: prenatal diagnosis and perinatal management. Prenatal Diagnosis 4: 355–363

    Google Scholar 

  25. Tawil KA, Gillam GL (1995) Gastroschisis: 13 years' experience at RCH Melbourne. J Paediatr Child Health 31: 553–556

    Google Scholar 

  26. Swift RI, Singh MP, Ziderman DA, Silverman M, Elder MA, Elder MG (1992) A new regime in the management of Gastroschisis. Journal of Pediatric Surgery 27: 61–63

    Google Scholar 

  27. Ein SH, Rubin SZ (1980) Gastroschisis: primary closure or Silon pouch. J Pediatr Surg 15: 549–552

    Google Scholar 

  28. Stringer MD, Brereton RJ, Wright VM (1991) Controversies in the management of Gastroschisis: a study of 40 patients. Arch Dis Child 66: 34–36

    Google Scholar 

  29. Schwartz MZ, Tyson KR, Milliorn K, Lobe TE (1983) Staged reduction using a Silastic sac is the treatment of choice for large congenital abdominal wall defects. J Pediatr Surg 18: 713–719

    Google Scholar 

  30. Filston HC (1983) Gastroschisis – primary fascial closure. The goal for optimal management. Ann Surg 197: 260–264

    Google Scholar 

  31. Denmark SM, Georgeson KE (1983) Primary closure Gastroschisis Facilitation with postoperative muscle paralysis. Arch Surg 118: 66–68

    Google Scholar 

  32. Canty TG, Collins DL (1983) Primary fascial closure in infants with Gastroschisis and omphalocele: a superior approach. J Pediatr Surg 18: 707–712

    Google Scholar 

  33. Bower RJ, Bell MJ, Ternberg JL, Cobb ML (1982) Ventilatory support and primary closure of Gastroschisis. Surgery 91: 52–55

    Google Scholar 

  34. Irving IM (1990) Umbilical Abnormalities. In: I Lister I, Irving IM (eds) Neonatal surgery. Butterworths, London, pp 376–402

  35. Driver CP, Bruce J, Bianchi A, Doig CM, Dickson AP, Bowen J (2000) The Contemporary Outcome of Gastroschisis. J Pediatr Surg 35: 1719–1723

    Google Scholar 

  36. Pierro A, Van Saene HK, Donnell SC, Hughes J, Ewan C, Nunn AJ, Lloyd a DA (1996) Microbial translocation in neonates and infants receiving long-term parenteral nutrition. Arch Surg 131: 176–179

    Google Scholar 

  37. Bastian L, Weimann A (1999) Practical aspects of early enteral feeding. Anaesthesiologie und Reanimation 24: 95–100

    Google Scholar 

  38. Olejnik J (1998) All-in-one parenteral nutrition and enteral nutrition – experience and risks in surgical clinical practice [Slovak]. Rozhledy V Chirurgii 77: 555–558

  39. Tomomasa T, Kuroume T (1994) Developmental Physiology. In: Hyman PE (ed) Pediatric gastronitestinal motility disorders. Academy professional information services, Inc, New York, pp 1–12

  40. Liang J, CO E, Zhang M, Pineda J, Chen JD (1998) Development of gastric slow waves in preterm infants measured by electrogastrography. Am J Physiol 274: G503–G508

    Google Scholar 

  41. Tawil Y, Berseth CL (1996) Gestational and postnatal maturation of duodenal motor responses to intragastric feeding. J Pediatrics 129: 374–381

    Google Scholar 

  42. Berseth CL (1989) Gestational evolution of small intestine motility in preterm and term infants. J Pediatr 115: 646–651

    Google Scholar 

  43. Berseth CL (1992) Effect of early feeding on maturation of the preterm infant's small intestine. J Pediatr 120: 947–953

    Google Scholar 

  44. Newell SJ (2000) Enteral feeding of the micropremie. CI Pernatol 27: 221–234

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to S. J. Singh.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Singh, S.J., Fraser, A., Leditschke, J.F. et al. Gastroschisis: determinants of neonatal outcome. Ped Surgery Int 19, 260–265 (2003). https://doi.org/10.1007/s00383-002-0886-0

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00383-002-0886-0

Keywords.

Navigation