Gestational Age at Delivery and Neonatal Outcomes among Infants with Gastroschisis in the Children's Hospitals Neonatal Consortium (CHNC)

Abstract

Objective The effect of gestational age (GA) on gastroschisis outcomes is unclear and delivery timing varies in practice. We aimed to correlate clinical outcomes of infants with gastroschisis and GA at delivery in the Children's Hospitals Neonatal Consortium (CHNC).

Study Design This was a retrospective multicenter cohort study of infants with gastroschisis admitted to CHNC neonatal intensive care units (NICUs) from 2010 to 2016. Patients were categorized by GA: 32 to 34^6/7, 35 to 36^6/7, and ≥37 weeks. Respiratory and feeding interventions, mortality, length of stay, and common complications were compared.

Results In 2021 for patients with gastroschisis, median GA at delivery was 36.3 weeks (interquartile range [IQR] 35.1, 37.3) and mean birth weight 2,425 g (IQR 2,100, 2,766). Overall mortality was low and there was no difference across GA groups. Infants <35 weeks' gestation had the greatest need for respiratory and feeding interventions. Complications such as medical necrotizing enterocolitis (NEC), cholestasis, and central line-associated blood stream infection were less common in infants ≥37 weeks. Feeding initiation and full feeds were earliest in term infants, compared with infants between 35 and 36^6/7 weeks, and longest in infants <35 weeks. Prematurity had a significant negative association with breast milk exposure. Enteral feeding tube support at discharge increased with prematurity. Compared with term, infants born between 35 and 36^6/7 weeks' gestation had a higher incidence of medical NEC and lower exposure to mother's milk at discharge but the need for respiratory interventions or tube feeding at discharge was similar.

Conclusion Premature infants with gastroschisis had more neonatal complications including respiratory interventions, longer NICU stay, longer time to full enteral feeds, and higher need for tube feeds at discharge as compared with those delivered at term. Differences were greatest for those <35 weeks GA. While overall mortality remains low, these results provide additional information about GA at birth in gastroschisis, with no evidence of benefit from preterm delivery.

Key Points

• Respiratory support was greatest for those with <35 weeks gestation.

• NEC and cholestasis increase with prematurity.

• Term infants have better feeding outcomes.

Keywords

gastroschisis - prematurity - gestational age - Children's Hospitals Neonatal Consortium

Note

The site sponsors/contributors for the CHND include:

1. Children's Healthcare of Atlanta, Atlanta, GA (A.P.)

2. Children's Healthcare of Atlanta at Scottish Rite (G.S.)

3. Children's Hospital of Alabama, Birmingham, AL (C.C.)

4. Le Bonheur Children's Hospital, Memphis, TN (A.T.)

5. Children's Hospital Boston, Boston, MA (A.H. and T.H.)

6. Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL (K.M and G.F.)

7. Cincinnati Children's Hospital, Cincinnati, OH (B.H.)

8. Nationwide Children's Hospital, Columbus, OH (K.R.)

9. Children's Medical Center, Dallas, TX (R.S.)

10. Children's Hospital Colorado, Aurora, CO (T.G.)

11. Children's Hospital of Michigan, Detroit, MI (G.N.)

12. Cook Children's Health Care System, Fort Worth, TX (A.C. and Y.J.)

13. Texas Children's Hospital, Houston, TX (G.S.)

14. Riley Children's Hospital, Indianapolis, IN (W.E.)

15. Children's Mercy Hospitals & Clinics, Kansas City, MO (E.P.)

16. Arkansas Children's Hospital, Little Rock, AR (R.L. and B.R.)

17. Children's Hospital Los Angeles, Los Angeles, CA (R.C.)

18. American Family Children's Hospital, Madison, WI (J.L.)

19. Children's Hospital & Research Center Oakland, Oakland, CA (P.J.)

20. The Children's Hospital of Philadelphia, Philadelphia, PA (J.E., M.P., and D.M.)

21. St. Christopher's Hospital for Children, Philadelphia, PA (S.T.)

22. Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA (B.B.)

23. St. Louis Children's Hospital, St Louis, MO (R.R. and A.M.)

24. All Children's Hospital, St. Petersburg, FL (V.M.)

25. Rady Children's Hospital, San Diego, CA (M.S. and L.M.)

26. Children's National Medical Center, Washington, DC (B.S.)

27. AI DuPont Hospital for Children, Wilmington, DE (K.S.)

28. Primary Children's Medical Center, Salt Lake City, UT (C.Y.L.)

29. Children's Hospital of Wisconsin, Milwaukee, WI (M.U. and A.D.)

30. Children's Hospital of Omaha (L.W. and N.B.)

31. Florida Hospital for Children (R.W.)

32. Seattle Children's Hospital, Seattle, WA (E.J.-M. and R.D.)

33. Hospital for Sick Children, Toronto, ON (K.-S.L.)

34. Children's Hospital Orange County, Los Angeles, CA (M.M.)

Publikationsverlauf

Eingereicht: 05. August 2021

Angenommen: 15. Februar 2022

Artikel online veröffentlicht:
12. Mai 2022

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