Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, QC, Canada.
Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, QC, Canada.
J Matern Fetal Neonatal Med. 2020 May;33(10):1725-1731. doi: 10.1080/14767058.2018.1529163. Epub 2018 Nov 26.
Gastroschisis is a rare congenital anomaly consisting of an abdominal wall defect resulting in extrusion of the abnormal organs. Survival of these infants exceeds 90%. Few large-scale studies have examined the predictors of mortality for these infants. Our objective was to conduct a population-based study to determine prevalence and predictors of mortality among infants born with gastroschisis. We used the "Period Linked Birth-Infant Death" database to create a cohort of all births occurring between 2009 and 2013. Infants were categorized by the presence of gastroschisis, excluding infants born at <24-week gestation. Baseline maternal and newborn characteristics were compared for infants who survived and those who died. Multivariate logistic regression models were used to estimate the effect of maternal and fetal factors on mortality, while adjusting for appropriate baseline characteristics. There were 4803 cases of gastroschisis, with 287 deaths. The prevalence of gastroschisis increased from 2.04 to 2.49/10,000 births over the study period. The rate of death stayed constant at about 5.9%. We found that 38.1% of these infants died on day 0 of life. Statistically significant predictors of mortality were the presence of an additional congenital anomaly, birth weight <2500 g, prepregnancy diabetes, gestational age <34 weeks, paying out of pocket for healthcare, and maternal obesity. The prevalence of gastroschisis in the USA increased, yet the mortality rate remained stable. Infants born preterm <34 weeks, with birth weights <2500 g, or with an additional congenital anomaly were at the highest risk of death.
先天性腹裂是一种罕见的先天畸形，其特征为腹壁缺损导致异常器官膨出。这些婴儿的存活率超过 90%。很少有大规模的研究检查过这些婴儿的死亡预测因素。我们的目的是进行一项基于人群的研究，以确定患有先天性腹裂的婴儿的死亡率及其预测因素。我们使用“时期链接出生-婴儿死亡”数据库创建了一个 2009 年至 2013 年期间所有出生婴儿的队列。排除胎龄<24 周的婴儿后，将婴儿分为存在腹裂和不存在腹裂两类。比较存活和死亡婴儿的基线产妇和新生儿特征。使用多变量逻辑回归模型来估计产妇和胎儿因素对死亡率的影响，同时调整适当的基线特征。共有 4803 例腹裂病例，其中 287 例死亡。在研究期间，腹裂的患病率从 2.04/10000 增加到 2.49/10000。死亡率保持在约 5.9%不变。我们发现，这些婴儿中有 38.1%在出生后的第 0 天死亡。死亡率的统计学显著预测因素是存在其他先天性异常、出生体重<2500g、孕前糖尿病、胎龄<34 周、自费支付医疗费用和产妇肥胖。美国腹裂的患病率增加，但死亡率保持稳定。出生时胎龄<34 周、出生体重<2500g 或存在其他先天性异常的婴儿死亡风险最高。
