T. Nice1, R. Russell1, N. Fineberg2, D. Rogers1, C. Martin1, B. Chaignaud1, S. Anderson1, M. Chen1, E. Beierle1 1University Of Alabama At Birmingham,Pediatric Surgery,Birmingham, AL, USA 2University Of Alabama At Birmingham,School Of Public Health,Birmingham, AL, USA
Introduction:
There has been little information focused on the management of gastroschisis in extremely premature infants. The purpose of this study was to identify potential differences in treatments and outcomes of gastroschisis in very premature versus later gestational age infants.
Methods:
A retrospective review of all infants with gastroschisis was performed from October 1999 to December 2012 (IRB # X100817009). Infants were stratified based on gestational age: group 1 (very premature <32 weeks); group 2 (near-term 32-37 weeks); and group 3 (term > 37 weeks). Demographic and treatment data were collected. Complicated gastroschisis included cases with bowel perforation, necrosis, volvulus, or atresia. Outcome measures included length of stay, TPN days, total operations and non-central venous line (CVL)-related operations, sepsis, necrotizing enterocolitis (NEC), and death. Analysis was done using Chi square and ANOVA tests with Tukey HSD for post-hoc testing. (α=0.05)
Results:
A total of 247 infants were included: 13 very premature, 121 near-term, 113 term. Demographically the groups differed only by gestational age, birth weight, and lower APGAR scores in group 1. Treatment was similar across all groups with no statistical difference in operation type, timing, or use of mesh. Group 3 had a lower risk of complicated gastroschisis [Table 1]. Within the first year of life, non-CVL-related operations were required more often in group 1 (53.8%) compared to group 2 (39.7%) or group 3 (27.4%) [p=0.049]. Group 1 also experienced a longer length of stay (114.9 vs 57.3 vs 46.8), increased incidence of sepsis (53.8% vs 20.7% vs 23.9%) , and increased mortality (38.5% vs 4.1% vs 2.7%) [Table 1]. NEC accounted for a large portion of the sepsis events. Increased ventilator days (23.8 vs 4.6 vs 4.1, p<0.001) and increased TPN days (88.5 vs 48.4 vs 39.4, p<0.001) were also seen in group 1.
Conclusion:
Extremely premature infants with gastroschisis underwent similar treatment but required more operations, total parenteral nutrition and ventilator days, and had a higher risk for sepsis and death. While many did well, survival was markedly lower (62%). Incidence of necrotizing enterocolitis and mortality in this extremely premature infant population with gastroschisis were higher than previously reported for infants of this gestational age range. These results can be used to guide future efforts to improve the management of these patients and to improve counseling for their parents.
