A cross-sectional, case-control follow-up of infants with gastroschisis

Article type: Research Article

Authors: Payne, Nathaniel R. | Gilmore, Lois | Svobodny, Stacy | Perdue, Nina R. | Hoekstra, Ronald E. | Olsen, Sam | Moore, James R.

Affiliations: Division of Neonatology, Children's Hospital and Clinics of Minnesota, Minneapolis, MN, USA | Neonatal Follow-Up Clinic, Children's Hospital and Clinics of Minnesota, Minneapolis, MN, USA | Division of Developmental Pediatrics, Children's Hospital and Clinics of Minnesota, Minneapolis, MN, USA

Note: [] Corresponding author: Nathaniel R. Payne, MD, NICU Office, Children's Hospitals and Clinics of Minnesota, MS: 17-750, 2525 Chicago Avenue South, Minneapolis, MN 55404, USA. Tel.: +1 612 813 6985; Fax: +1 612 813 6983; E-mail: [email protected]

Abstract: Background: Gastroschisis is an increasingly prevalent congenital anomaly. Few reports have examined the long-term outcome associated with gastroschisis. Objective: To examine gastroschisis patients and matched controls to determine the influence of gastroschisis on re-hospitalizations, growth and development in infancy and early childhood. Methods: This was a cross-sectional, case-control study. Gastroschisis patients were categorized by neonatal course: 1) primary repair, 2) staged repair with a silo, and 3) intestinal complication (atresia, perforation, or intestinal resection). Controls were matched by gender, gestational age, and chronological age. We compared cases and controls using McNemar's chi-square tests or sign-rank tests. Outcomes by category were examined using chi-square or ANOVA. We adjusted chronological age for prematurity in infants < 24 months old at follow-up. Results: We enrolled 58 cases and 58 controls. Mean adjusted evaluation age was 39.1 ± 26.2 and 43.6 ± 24.9 months for cases and controls respectively (p = 0.081). Gastroschisis significantly increased re-hospitalization after initial discharge (45% vs. 17%, p < 0.001). Cases with intestinal complications in the neonatal period had the highest rate of re-hospitalization (75%), but 32% of cases with a primary repair also required re-hospitalization. Gastroschisis cases had an exam weight < 10th centile twice as commonly as controls (21% vs. 11%, p = 0.199). Weight < 10th centile did not differ by category: primary repair (20%), silo (19%), and neonatal intestinal complications (25%) (p = 0.915). Parents of gastroschisis patients with neonatal intestinal complications reported that they deferred subsequent childbearing in 5/12 (45%) cases. Gastroschisis appeared to increase the prevalence of growth and developmental problems, but these differences were not statistically significant. Conclusion: Our study indicates that the outcome of gastroschisis is generally encouraging. However, gastroschisis patients warrant close follow-up throughout childhood. Abbreviations: BW, birth weight; GI, gastrointestinal; IV days, total days on which parenteral fluids were given intravenously; LOS, length of hospital stay from birth to discharge home; LT, length/height; OFC, occipitofrontal circumference; SD, standard deviation; SGA, small for gestational age; WT, weight.

Keywords: Newborn, surgery, gastroschisis, follow-up, growth, development

DOI: 10.3233/NPM-2010-0117

Journal: Journal of Neonatal-Perinatal Medicine, vol. 3, no. 3, pp. 207-215, 2010