Westmead Institute for Maternal and Fetal Medicine, Women's and Newborn Health, Westmead Hospital, Research & Education Network Building, Hawkesbury Rd, PO Box 533, Westmead, NSW, 2145, Australia.
Department of Paediatric Surgery, The Children's Hospital at Westmead, The Sydney Children's Hospital Network, Hawkesbury Rd, Westmead, NSW, 2145, Australia.
BMC Pregnancy Childbirth. 2018 Jun 11;18(1):222. doi: 10.1186/s12884-018-1867-1.
Gastroschisis is a congenital anomaly of the fetal abdominal wall, usually to the right side of umbilical insertion. It is often detected by routine antenatal ultrasound. Significant maternal and pediatric resources are utilised in the care of women and infants with gastroschisis. Increasing rates of gastroschisis worldwide have led institutions to review local data and investigate outcomes. A collaborative project was developed to review local epidemiology and investigate antenatal and neonatal factors influencing hospital length of stay (LOS) and total parental nutrition (TPN) in infants born with gastroschisis.
We performed a five-year review of infants born with gastroschisis (2011-2015) at a major Australian centre. Complex gastroschisis was defined as involvement of stenosis, atresia, ischemia, volvulus or perforation and closed or vanishing gastroschisis. We extracted data from files and databases at the two participating hospitals, a major maternal fetal medicine centre and the affiliated children's hospital.
There were 56 infants antenatally diagnosed with gastroschisis with no terminations, one stillbirth (2%) and one infant with 'vanishing' gastroschisis. The mean maternal age was 23.9 years (range, 15-39 years). The mean gestation at delivery was 36 weeks (range, 25-39 weeks). Of the 55 neonates who received surgical management, 62% had primary closure. The median LOS was 33 (IQR, 23-45) days and the median duration of TPN was 26 (IQR, 17-36) days. Longer days on TPN (median 35 vs 16 days, P = 0.03) was associated with antenatal finding of multiple dilated bowel loops. Postnatal diagnosis of complex gastroschisis was made in 16% of cases and was associated with both longer LOS (median 89 vs 30 days, P = 0.003) and days on TPN (median 46 vs 21 days, P = 0.009).
Complex gastroschisis was associated with greater days on TPN and LOS. We found no late-gestation stillbirths and a low overall rate of 1.8%, suggesting the risk for stillbirth associated with gastroschisis is lower than previously documented. This information may assist counselling families. Improved data collection worldwide may reveal causative factors and enable antenatal outcome predictors.
先天性腹壁裂是一种胎儿腹壁的先天畸形，通常位于脐带插入部的右侧。它通常通过常规产前超声检测到。患有先天性腹壁裂的女性和婴儿需要大量的母婴资源来进行护理。全球先天性腹壁裂的发病率不断上升，促使各机构审查当地数据并调查影响住院时间（LOS）和总肠外营养（TPN）的围产期和新生儿因素。一个合作项目旨在审查当地流行病学，并调查影响患有先天性腹壁裂的婴儿住院时间和总肠外营养的围产期和新生儿因素。
我们对一家澳大利亚主要中心在 2011 年至 2015 年间出生的患有先天性腹壁裂的婴儿进行了为期五年的回顾。复杂的先天性腹壁裂定义为狭窄、闭锁、缺血、扭转或穿孔和闭合或消失的先天性腹壁裂。我们从两家参与医院（一家主要的母婴胎儿医学中心和附属儿童医院）的档案和数据库中提取数据。
56 例先天性腹壁裂的孕妇在产前诊断，无终止妊娠，1 例死产（2%），1 例婴儿有“消失”的先天性腹壁裂。母亲的平均年龄为 23.9 岁（15-39 岁）。分娩时的平均孕周为 36 周（25-39 周）。55 例接受手术治疗的新生儿中，62%行一期缝合。中位 LOS 为 33 天（IQR，23-45 天），中位 TPN 时间为 26 天（IQR，17-36 天）。接受 TPN 的天数较长（中位数 35 天 vs 16 天，P=0.03）与产前发现多个扩张肠袢有关。16%的病例在产后诊断为复杂的先天性腹壁裂，与 LOS 延长（中位数 89 天 vs 30 天，P=0.003）和 TPN 时间延长（中位数 46 天 vs 21 天，P=0.009）有关。
复杂的先天性腹壁裂与 TPN 和 LOS 天数延长有关。我们没有发现晚期死产，总发生率为 1.8%，表明先天性腹壁裂相关的死产风险低于以前的记录。这些信息可能有助于为家庭提供咨询。全世界更好的数据收集可能会揭示病因，并使产前结果预测成为可能。
