Outcomes in Neonates with Gastroschisis in U.S. Children's Hospitals

ABSTRACT

Our objectives are to report patient characteristics, comorbidities, and outcomes for gastroschisis patients and analyze factors associated with mortality and sepsis. Using Pediatric Health Information System data, we examined neonates with both an International Classification of Diseases, 9th Revision diagnosis (756.79) and procedure (54.71) code for gastroschisis (2003 to 2008). We examined descriptive characteristics and conducted multivariate regression models examining risk factors for mortality, during the birth hospitalization, and sepsis. Analysis of 2490 neonates with gastroschisis found 90 deaths (3.6%) and sepsis in 766 (31%). Critical comorbidities and procedures are cardiovascular defects (15%), pulmonary conditions (5%), intestinal atresia (11%), intestinal resection (12.5%), and ostomy formation (8.3%). Factors associated with mortality were large bowel resection (odds ratio [OR] 8.26, 95% confidence interval [CI] 1.17 to 58.17), congenital circulatory (OR 5.62, 95% CI 2.11 to 14.91), and pulmonary (OR 8.22, 95% CI 2.75 to 24.58) disease, and sepsis (OR 3.87, 95% CI 1.51 to 9.91). Factors associated with sepsis include intestinal ostomy (OR 2.94, 95% CI 1.71 to 5.05), respiratory failure (OR 2.48, 95% CI 1.85 to 3.34), congenital circulatory anomalies (OR 1.58, 95% CI 1.10 to 2.28), and necrotizing enterocolitis (OR 4.38, 95% CI 2.51 to 7.67). Further investigation into modifiable factors such as small bowel ostomy and prevention of sepsis and necrotizing enterocolitis is warranted to guide surgical decision making and postoperative management.

KEYWORDS

Gastroschisis - outcomes - mortality - sepsis - comorbidities

REFERENCES

• 1 Keys C, Drewett M, Burge D M. Gastroschisis: the cost of an epidemic.  J Pediatr Surg. 2008;  43 654-657
• 2 Collins S R, Griffin M R, Arbogast P G et al.. The rising prevalence of gastroschisis and omphalocele in Tennessee.  J Pediatr Surg. 2007;  42 1221-1224
• 3 Hougland K T, Hanna A M, Meyers R, Null D. Increasing prevalence of gastroschisis in Utah.  J Pediatr Surg. 2005;  40 535-540
• 4 Reid K P, Dickinson J E, Doherty D A. The epidemiologic incidence of congenital gastroschisis in Western Australia.  Am J Obstet Gynecol. 2003;  189 764-768
• 5 Suita S, Okamatsu T, Yamamoto T et al.. Changing profile of abdominal wall defects in Japan: results of a national survey.  J Pediatr Surg. 2000;  35 66-71 discussion 72
• 6 Alvarez S M, Burd R S. Increasing prevalence of gastroschisis repairs in the United States: 1996–2003.  J Pediatr Surg. 2007;  42 943-946
• 7 Donaldson L. Gastroschisis: a growing concern. CMO Annual Report. Department of Health 2004: 40-47
• 8 Minkes R K, Langer J C, Mazziotti M V, Skinner M A, Foglia R P. Routine insertion of a silastic spring-loaded silo for infants with gastroschisis.  J Pediatr Surg. 2000;  35 843-846
• 9 Sydorak R M, Nijagal A, Sbragia L et al.. Gastroschisis: small hole, big cost.  J Pediatr Surg. 2002;  37 1669-1672
• 10 Baerg J, Kaban G, Tonita J, Pahwa P, Reid D. Gastroschisis: a sixteen-year review.  J Pediatr Surg. 2003;  38 771-774
• 11 Abdullah F, Arnold M A, Nabaweesi R et al.. Gastroschisis in the United States 1988–2003: analysis and risk categorization of 4344 patients.  J Perinatol. 2007;  27 50-55
• 12 Arnold M A, Chang D C, Nabaweesi R et al.. Development and validation of a risk stratification index to predict death in gastroschisis.  J Pediatr Surg. 2007;  42 950-955 discussion 955-956
• 13 Arnold M A, Chang D C, Nabaweesi R et al.. Risk stratification of 4344 patients with gastroschisis into simple and complex categories.  J Pediatr Surg. 2007;  42 1520-1525
• 14 Molik K A, Gingalewski C A, West K W et al.. Gastroschisis: a plea for risk categorization.  J Pediatr Surg. 2001;  36 51-55
• 15 Kumaran N, Shankar K R, Lloyd D A, Losty P D. Trends in the management and outcome of jejuno-ileal atresia.  Eur J Pediatr Surg. 2002;  12 163-167
• 16 Eggink B H, Richardson C J, Malloy M H, Angel C A. Outcome of gastroschisis: a 20-year case review of infants with gastroschisis born in Galveston, Texas.  J Pediatr Surg. 2006;  41 1103-1108
• 17 Snyder C L. Outcome analysis for gastroschisis.  J Pediatr Surg. 1999;  34 1253-1256
• 18 van Eijck F C, Wijnen R M, van Goor H. The incidence and morbidity of adhesions after treatment of neonates with gastroschisis and omphalocele: a 30-year review.  J Pediatr Surg. 2008;  43 479-483
• 19 Moss R L, Dimmitt R A, Barnhart D C et al.. Laparotomy versus peritoneal drainage for necrotizing enterocolitis and perforation.  N Engl J Med. 2006;  354 2225-2234
• 20 Ein S H, Marshall D G, Girvan D. Peritoneal drainage under local anesthesia for perforations from necrotizing enterocolitis.  J Pediatr Surg. 1977;  12 963-967
• 21 Boloker J, Bateman D A, Wung J T, Stolar C J. Congenital diaphragmatic hernia in 120 infants treated consecutively with permissive hypercapnea/spontaneous respiration/elective repair.  J Pediatr Surg. 2002;  37 357-366
• 22 Williams C A, Hauser K W, Correia J A, Frias J L. Ascertainment of gastroschisis using the ICD-9-CM surgical procedure code.  Birth Defects Res A Clin Mol Teratol. 2005;  73 646-648