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

Oliver B Lao; Cindy Larison; Michelle M Garrison; John H.T Waldhausen; Adam B Goldin

doi:10.1055/s-0029-1241729

American Journal of Perinatology, Table of Contents

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

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

Abstract

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.

KEYWORDS

Gastroschisis - outcomes - mortality - sepsis - comorbidities

Full Text

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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