Am J Perinatol 2010; 27(1): 097-101
DOI: 10.1055/s-0029-1241729
© Thieme Medical Publishers

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

Oliver B. Lao1 , Cindy Larison2 , Michelle M. Garrison2 , John H.T Waldhausen3 , Adam B. Goldin3
  • 1Department of Surgery, Seattle Children's Hospital, Seattle, Washington
  • 2Seattle Children's Hospital Research Institute, Seattle Children's Hospital, Seattle, Washington
  • 3General & Thoracic Surgery, Seattle Children's Hospital, Seattle, Washington
Further Information

Publication History

Publication Date:
28 October 2009 (online)

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.

REFERENCES

Oliver B LaoM.D. 

Department of Surgery, Seattle Children's Hospital

4800 Sand Point Way NE, W-7729, Seattle, WA 98105

Email: olao@u.washington.edu

    >