Benefits of term delivery in infants with antenatally diagnosed gastroschisis

• Published in: Obstetrics and gynecology (New York. 1953) Vol. 100; no. 4; pp. 695 - 699
• Main Authors: Huang, Jasmine, Kurkchubasche, Arlet G, Carr, Stephen R, Wesselhoeft, Conrad W, Tracy, Thomas F, Luks, Francois I
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-10-2002; The American College of Obstetricians and Gynecologists; Elsevier Science
• Subjects: Biological and medical sciences; Delivery, Obstetric; Female; Gastroschisis - diagnosis; Gastroschisis - physiopathology; Gastroschisis - surgery; Gestational Age; Gynecology. Andrology. Obstetrics; Humans; Infant Care; Infant, Newborn; Length of Stay; Management. Prenatal diagnosis; Medical sciences; Pregnancy; Pregnancy. Fetus. Placenta; Prenatal Diagnosis; Retrospective Studies; Survival Rate; Human; Gestational age; Gastrochisis; Prenatal; Malformation; Term pregnancy; Abdominal disease; Surgery; Abdominal wall; Evolution; Fetus; Diagnosis; Cesarean section; Comparative study
• ISSN: 0029-7844; 1873-233X
• DOI: 10.1016/S0029-7844(02)02170-1

OBJECTIVE:
To test the hypothesis that term gestation offers the best outcome. The relationship between gestational age and the extent of bowel injury in fetuses with gastroschisis is a matter of debate. Early delivery and cesarean delivery have been recommended to limit intestinal damage, but their benefits are unclear.
METHODS:
Data on all patients with gastroschisis seen at our institution from 1991 through 2001 were included. Patients were compared based on gestational age: less than 35 weeks, 35–37 weeks, and term (more than 37 weeks) with regard to age at definitive closure, age at first and full feedings, and hospital stay. Statistical significance (P < .05) was determined by analysis of variance and χ2 analysis.
RESULTS:
Of the 57 patients, 19.3%, 43.8%, and 36.9% were born at less than 35 weeks, 35–37 weeks, and more than 37 weeks, respectively. Age at definitive closure was significantly higher at 35–37 weeks (5.9 ± 4.6 days) than at more than 37 weeks (1.5 ± 2.3 days) and less than 35 weeks (2.6 ± 2.5 days) (P < .05). A prosthetic pouch (silo) was used more often at 35–37 weeks than at more than 37 weeks or less than 35 weeks (P = .03, χ2). Age at first (P = .04) and full feedings (P < .01) and length of hospitalization (P < .01) were all significantly higher at 35–37 weeks than at more than 37 weeks.
CONCLUSION:
Based on a homogeneous cohort of patients in whom gastroschisis was diagnosed antenatally, term delivery results in earlier closure of the defect and shorter time to full feedings. The benefit of early delivery postulated by others cannot be substantiated.