Factors Associated With Gastroschisis Outcomes

Overcash, Rachael T. MD, MPH; DeUgarte, Daniel A. MD, MS; Stephenson, Megan L. MD; Gutkin, Rachel M. MD, MPH; Norton, Mary E. MD; Parmar, Sima MD; Porto, Manuel MD; Poulain, Francis R. MD; Schrimmer, David B. MD; for the University of California Fetal Consortium

Obstetrics & Gynecology:
doi: 10.1097/AOG.0000000000000425
Contents: Original Research
Abstract

OBJECTIVE: To identify perinatal variables associated with adverse outcomes in neonates prenatally diagnosed with gastroschisis.

METHODS: A retrospective review was conducted of all inborn pregnancies complicated by gastroschisis within the five institutions of the University of California Fetal Consortium from 2007 to 2012. The primary outcome was a composite adverse neonatal outcome comprising death, reoperation, gastrostomy, and necrotizing enterocolitis. Variables collected included antenatal ultrasound findings, maternal smoking or drug use, gestational age at delivery, preterm labor, elective delivery, mode of delivery, and birth weight. Univariate and multivariate analysis was used to assess factors associated with adverse outcomes. We also evaluated the association of preterm delivery with neonatal outcomes such as total parenteral nutrition cholestasis and length of stay.

RESULTS: There were 191 neonates born with gastroschisis in University of California Fetal Consortium institutions at a mean gestational age of 36 3/7±1.8 weeks. Within the cohort, 27 (14%) had one or more major adverse outcomes, including three deaths (1.6%). Early gestational age at delivery was the only variable identified as a significant predictor of adverse outcomes on both univariate and multivariate analysis (odds ratio 1.4, 95% confidence interval 1.1–1.8 for each earlier week of gestation). Total parenteral nutrition cholestasis was significantly more common in neonates delivered at less than 37 weeks of gestation (38/115 [33%] compared with 11/76 [15%]; P<.001).

CONCLUSION: In this contemporary cohort, earlier gestational age at delivery is associated with adverse neonatal outcomes in neonates with gastroschisis. Other variables, such as antenatal ultrasound findings and mode of delivery, did not predict adverse neonatal outcomes.

In Brief

Earlier gestational age at delivery is associated with adverse neonatal outcomes in neonates with gastroschisis.

Author Information

Division of Maternal Fetal Medicine, Department of Reproductive Medicine, University of California San Diego, San Diego, the Division of Pediatric Surgery, Department of Surgery and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California Los Angeles, Los Angeles, the Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, University of California Irvine, Irvine, the Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California San Francisco, San Francisco, and the Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology and the Division of Neonatology, Department of Pediatrics, University of California Davis, Davis, California.

Corresponding author: Daniel A. DeUgarte, MD, MS, Division of Pediatric Surgery—UCLA, Box 709818, 10833 Le Conte Avenue, Los Angeles, CA 90095-7098; e-mail: ddeugarte@mednet.ucla.edu.

* For a list of contributing members of the University of California Fetal Consortium, see the Appendix online at http://links.lww.com/AOG/A544.

The University of California Fetal Consortium is supported through the University of California Research Opportunity Fund through UCOP. This research has been supported by National Institutes of Health/National Center for Research Resources/National Center for Advancing Translational Sciences University of California Los Angeles (UCLA) CTSI Grant Number UL1TR000124.

The authors thank Tristan Grogan and David Elashoff from the UCLA Department of Medicine (Statistics Core) for their assistance with statistical analysis.

Financial Disclosure Dr. Norton's institution has received research support on her behalf from Natera (unrestricted research gift to institution or division) and Arisoa (funding for clinical trial related to noninvasive prenatal testing). The other authors did not report any potential conflicts of interest.

© 2014 by The American College of Obstetricians and Gynecologists.