The timing of delivery of infants with gastroschisis influences outcome

Orkan Ergün, Edward Barksdale, Fisun Şenuzun Ergün, Tracy Prosen, Faisal G. Qureshi, Kim R. Reblock, Henri Ford, David J. Hackam

Research output: Contribution to journalArticle

74 Citations (Scopus)

Abstract

Background: The delayed onset of intestinal function in children with gastroschisis may be because of the injurious effects of amniotic fluid on the exposed bowel. This has led to consideration of early delivery to minimize intestinal damage and improve outcome, although this has not been carefully evaluated. The authors hypothesized that timing of delivery influences outcome in children with gastroschisis, and sought to evaluate the relative impact of factors that predict outcome in this disease. Methods: All consecutive patients with gastroschisis (1992-2002) were divided into those delivered before ("early") or after ("late") 36 weeks. Bowel peel was described as "thin" or "thick," based on operative reports. Individual measures were analyzed by univariate analyses (χ2/ Student's t test), and logistic regression was used to identify significant factors for the length of stay (LOS) longer than the population average of 55 days. Results: In 75 patients, 53.4% were "early" and 46.6% were "late." Groups were similar with respect to maternal age, birth weight, delivery mode, sex, and associated anomalies. Thickness of bowel peel was not affected by delivery time, yet "early" patients had significantly longer LOS and time to enteral feeds. Significant predictors of LOS more than 55 days included gestational age of 36 weeks or younger, time to enteral feeds of more than 26 days, and associated anomalies. Nonsignificant predictors included size of the defect, thickness of bowel peel, and need for silo. Conclusions: Delivery before 36 weeks is associated with longer hospitalization and increased tune to attainment of full feeds compared with later delivery. Fetal well-being should thus be the primary determinant of delivery for gastroschisis, as opposed to considerations regarding possible injurious effects to the bowel of prolonged gestation.

Original languageEnglish (US)
Pages (from-to)424-428
Number of pages5
JournalJournal of Pediatric Surgery
Volume40
Issue number2
DOIs
StatePublished - Jan 1 2005
Externally publishedYes

Fingerprint

Gastroschisis
Length of Stay
Small Intestine
Maternal Age
Amniotic Fluid
Birth Weight
Gestational Age
Hospitalization
Logistic Models
Students
Pregnancy
Population

Keywords

  • Antenatal ultrasound
  • Gastroschisis
  • Prematurity
  • Short bowel syndrome
  • Total parenteral nutrition

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Ergün, O., Barksdale, E., Ergün, F. Ş., Prosen, T., Qureshi, F. G., Reblock, K. R., ... Hackam, D. J. (2005). The timing of delivery of infants with gastroschisis influences outcome. Journal of Pediatric Surgery, 40(2), 424-428. https://doi.org/10.1016/j.jpedsurg.2004.10.013

The timing of delivery of infants with gastroschisis influences outcome. / Ergün, Orkan; Barksdale, Edward; Ergün, Fisun Şenuzun; Prosen, Tracy; Qureshi, Faisal G.; Reblock, Kim R.; Ford, Henri; Hackam, David J.

In: Journal of Pediatric Surgery, Vol. 40, No. 2, 01.01.2005, p. 424-428.

Research output: Contribution to journalArticle

Ergün, O, Barksdale, E, Ergün, FŞ, Prosen, T, Qureshi, FG, Reblock, KR, Ford, H & Hackam, DJ 2005, 'The timing of delivery of infants with gastroschisis influences outcome', Journal of Pediatric Surgery, vol. 40, no. 2, pp. 424-428. https://doi.org/10.1016/j.jpedsurg.2004.10.013
Ergün O, Barksdale E, Ergün FŞ, Prosen T, Qureshi FG, Reblock KR et al. The timing of delivery of infants with gastroschisis influences outcome. Journal of Pediatric Surgery. 2005 Jan 1;40(2):424-428. https://doi.org/10.1016/j.jpedsurg.2004.10.013
Ergün, Orkan ; Barksdale, Edward ; Ergün, Fisun Şenuzun ; Prosen, Tracy ; Qureshi, Faisal G. ; Reblock, Kim R. ; Ford, Henri ; Hackam, David J. / The timing of delivery of infants with gastroschisis influences outcome. In: Journal of Pediatric Surgery. 2005 ; Vol. 40, No. 2. pp. 424-428.
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abstract = "Background: The delayed onset of intestinal function in children with gastroschisis may be because of the injurious effects of amniotic fluid on the exposed bowel. This has led to consideration of early delivery to minimize intestinal damage and improve outcome, although this has not been carefully evaluated. The authors hypothesized that timing of delivery influences outcome in children with gastroschisis, and sought to evaluate the relative impact of factors that predict outcome in this disease. Methods: All consecutive patients with gastroschisis (1992-2002) were divided into those delivered before ({"}early{"}) or after ({"}late{"}) 36 weeks. Bowel peel was described as {"}thin{"} or {"}thick,{"} based on operative reports. Individual measures were analyzed by univariate analyses (χ2/ Student's t test), and logistic regression was used to identify significant factors for the length of stay (LOS) longer than the population average of 55 days. Results: In 75 patients, 53.4{\%} were {"}early{"} and 46.6{\%} were {"}late.{"} Groups were similar with respect to maternal age, birth weight, delivery mode, sex, and associated anomalies. Thickness of bowel peel was not affected by delivery time, yet {"}early{"} patients had significantly longer LOS and time to enteral feeds. Significant predictors of LOS more than 55 days included gestational age of 36 weeks or younger, time to enteral feeds of more than 26 days, and associated anomalies. Nonsignificant predictors included size of the defect, thickness of bowel peel, and need for silo. Conclusions: Delivery before 36 weeks is associated with longer hospitalization and increased tune to attainment of full feeds compared with later delivery. Fetal well-being should thus be the primary determinant of delivery for gastroschisis, as opposed to considerations regarding possible injurious effects to the bowel of prolonged gestation.",
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AU - Ergün, Fisun Şenuzun

AU - Prosen, Tracy

AU - Qureshi, Faisal G.

AU - Reblock, Kim R.

AU - Ford, Henri

AU - Hackam, David J.

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AB - Background: The delayed onset of intestinal function in children with gastroschisis may be because of the injurious effects of amniotic fluid on the exposed bowel. This has led to consideration of early delivery to minimize intestinal damage and improve outcome, although this has not been carefully evaluated. The authors hypothesized that timing of delivery influences outcome in children with gastroschisis, and sought to evaluate the relative impact of factors that predict outcome in this disease. Methods: All consecutive patients with gastroschisis (1992-2002) were divided into those delivered before ("early") or after ("late") 36 weeks. Bowel peel was described as "thin" or "thick," based on operative reports. Individual measures were analyzed by univariate analyses (χ2/ Student's t test), and logistic regression was used to identify significant factors for the length of stay (LOS) longer than the population average of 55 days. Results: In 75 patients, 53.4% were "early" and 46.6% were "late." Groups were similar with respect to maternal age, birth weight, delivery mode, sex, and associated anomalies. Thickness of bowel peel was not affected by delivery time, yet "early" patients had significantly longer LOS and time to enteral feeds. Significant predictors of LOS more than 55 days included gestational age of 36 weeks or younger, time to enteral feeds of more than 26 days, and associated anomalies. Nonsignificant predictors included size of the defect, thickness of bowel peel, and need for silo. Conclusions: Delivery before 36 weeks is associated with longer hospitalization and increased tune to attainment of full feeds compared with later delivery. Fetal well-being should thus be the primary determinant of delivery for gastroschisis, as opposed to considerations regarding possible injurious effects to the bowel of prolonged gestation.

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