A cross-sectional,case-control follow-up of infants with gastroschisis

Abstract

Background: Gastroschisis is an increasingly prevalent congenital anomaly. Few reports have examined the long-term outcome associated with gastroschisis.

Objective: To examine gastroschisis patients and matched controls to determine the influence of gastroschisis on re-hospitalizations, growth and development in infancy and early childhood.

Methods: This was a cross-sectional, case-control study. Gastroschisis patients were categorized by neonatal course: 1) primary repair, 2) staged repair with a silo, and 3) intestinal complication (atresia, perforation, or intestinal resection). Controls were matched by gender, gestational age, and chronological age. We compared cases and controls using McNemar's chi-square tests or sign-rank tests. Outcomes by category were examined using chi-square or ANOVA. We adjusted chronological age for prematurity in infants < 24 months old at follow-up.

Results: We enrolled 58 cases and 58 controls. Mean adjusted evaluation age was 39.1 ± 26.2 and 43.6 ± 24.9 months for cases and controls respectively (p = 0.081). Gastroschisis significantly increased re-hospitalization after initial discharge (45% vs. 17%, p < 0.001). Cases with intestinal complications in the neonatal period had the highest rate of re-hospitalization (75%), but 32% of cases with a primary repair also required re-hospitalization. Gastroschisis cases had an exam weight < 10th centile twice as commonly as controls (21% vs. 11%, p = 0.199). Weight < 10th centile did not differ by category: primary repair (20%), silo (19%), and neonatal intestinal complications (25%) (p = 0.915). Parents of gastroschisis patients with neonatal intestinal complications reported that they deferred subsequent childbearing in 5/12 (45%) cases. Gastroschisis appeared to increase the prevalence of growth and developmental problems, but these differences were not statistically significant.

Conclusion: Our study indicates that the outcome of gastroschisis is generally encouraging. However, gastroschisis patients warrant close follow-up throughout childhood.

Abbreviations: BW, birth weight; GI, gastrointestinal; IV days, total days on which parenteral fluids were given intravenously; LOS, length of hospital stay from birth to discharge home; LT, length/height; OFC, occipitofrontal circumference; SD, standard deviation; SGA, small for gestational age; WT, weight.