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Morbidity, Mortality, and Management of Gastroschisis: A Multicenter Cohort Analysis
*Brenna S Fullerton1, *Cristine S Velazco1, *Eric A Sparks1, *Kate A Morrow2, *Erika M Edwards2,3, *Roger F Soll2,3, Biren P Modi1, *Jeffrey D Horbar2,3, Tom Jaksic1
1Center for Advanced Intestinal Rehabilitation, Department of Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, MA;2Vermont Oxford Network, Burlington, VT;3University of Vermont, Burlington, VT

Objective: To quantify gastroschisis outcomes and analyze factors predictive of morbidity and mortality.
Design: Inception cohort.
Setting: 175 North American centers with neonatal intensive care units participating in a prospective clinical data collection.
Patients: Neonates with gastroschisis and birth weight >1500g born 2009-2014 at a participating center or transferred to a participating center within 28 days of birth.
Interventions: n/a
Main Outcome Measure (s): Survival (discharge home or alive in hospital at one year), length of stay, sepsis (defined by positive blood or cerebrospinal fluid culture), major congenital anomalies, necrotizing enterocolitis, surgical procedures, mode of delivery, weight-for-age at discharge.
Results: Gastroschisis was diagnosed in 4,420 neonates with median birth weight 2,410g (IQR 2,105-2,747). Survival was 97.8%, with a 37 day median LOS (IQR 27-59). Sepsis was the only significant independent predictor of mortality (P=0.04). Significant independent determinants of LOS and the percentage of neonates affected were as follows: bowel resection (9.8%, P<0.0001), sepsis (8.6%, P<0.0001), presence of other congenital anomalies (7.6%, of which 73% were intestinal atresias, P<0.0001), necrotizing enterocolitis (4.5%, P<0.0001), and small for gestational age (37.3%, P=0.0006). Abdominal surgery in addition to gastroschisis repair occurred in 22.3%, with 6.4% receiving gastrostomy or jejunostomy tubes and 6.3% requiring ostomy creation. At discharge, 57% were <10th percentile weight-for-age. Mode of delivery (52.4% caesarean section) was not associated with any differences in outcome.
Conclusions: This large multicenter cohort demonstrates that although neonates with gastroschisis have excellent overall survival they remain at risk for: death from sepsis, prolonged hospitalizations, multiple abdominal operations, and malnutrition at discharge. Outcomes appear unaffected by the use of cesarean section. Further opportunities for quality improvement include sepsis prevention and enhanced nutritional support.


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