Department of Obstetrics & Gynecology, Stanford University, Stanford, CA, USA.
Department of Pediatrics, Stanford University, Stanford, CA, USA.
J Matern Fetal Neonatal Med. 2021 Jul;34(13):2041-2046. doi: 10.1080/14767058.2019.1656191. Epub 2019 Sep 1.
To investigate the effect of preterm gestational age (GA) on neonatal outcomes of gastroschisis and to compare the neonatal outcomes after spontaneous labor versus iatrogenic delivery both in the preterm and early term gestational periods.
A retrospective study of prenatally diagnosed gastroschisis cases born at Loma Linda University Medical Center and Lucile Packard Children's Hospital (Loma Linda, CA) between January 2009 and October 2016. A total of 194 prenatally diagnosed gastroschisis cases were identified and included in the analysis. We compared infants delivered <37 0/7 to those ≥37 0/7 weeks' gestation. Adverse neonatal outcome was defined as any of: sepsis, short bowel syndrome, prolonged ventilation, or death. Prolonged length of stay (LOS) was defined as ≥75th percentile value. Outcomes following spontaneous versus iatrogenic delivery were compared. Analyses were performed using chi-squared test or Fisher's exact test for categorical variables, and Student's -test or Wilcoxon's rank-sum test for continuous variables.
One hundred and six neonates were born <37 weeks and 88 at ≥37 weeks. Adverse outcome was statistically similar among those born <37 weeks compared to ≥37 weeks (48 versus 34%, = .07). Prolonged LOS was more frequent among neonates delivered <37 weeks ( = .03). Among neonates born <37 weeks, bowel atresia was more frequent in those with spontaneous versus iatrogenic delivery ( = .04). There was no significant difference in the adverse neonatal composite outcome between those with spontaneous preterm labor versus planned iatrogenic delivery at <37 weeks ( = 30 (58%) versus = 21 (39%), = .08).
Neonates with gastroschisis delivered <37 weeks had prolonged LOS whereas the rate of adverse neonatal outcomes was similar between those delivered preterm versus term. Neonates born after spontaneous preterm labor had a higher rate of bowel atresia compared to those born after planned iatrogenic preterm delivery.
探讨早产胎龄（GA）对先天性腹裂新生儿结局的影响，并比较早产和早期足月产时自发性分娩与医源性分娩的新生儿结局。
回顾性分析 2009 年 1 月至 2016 年 10 月在洛马林达大学医学中心和露西尔·帕卡德儿童医院（加利福尼亚州洛马林达）出生的产前诊断为先天性腹裂的病例。共有 194 例产前诊断为先天性腹裂的病例被纳入分析。我们比较了<37 0/7 周和≥37 0/7 周分娩的婴儿。不良新生儿结局定义为：败血症、短肠综合征、长时间通气或死亡。延长住院时间（LOS）定义为≥第 75 百分位数。比较自发性分娩与医源性分娩的结局。采用卡方检验或 Fisher 确切概率法比较分类变量，采用 Student's t 检验或 Wilcoxon 秩和检验比较连续变量。
106 例新生儿<37 周，88 例新生儿≥37 周。与≥37 周分娩的新生儿相比，<37 周分娩的新生儿不良结局发生率无统计学差异（48%对 34%，= 0.07）。<37 周分娩的新生儿 LOS 延长更为常见（= 0.03）。<37 周分娩的新生儿中，自发性分娩与医源性分娩的肠闭锁发生率有差异（= 0.04）。在<37 周的自发性早产与计划医源性早产的新生儿中，不良新生儿复合结局无统计学差异（= 30（58%）对= 21（39%），= 0.08）。
<37 周分娩的先天性腹裂新生儿 LOS 延长，而早产儿与足月儿的新生儿不良结局发生率相似。自发性早产分娩的新生儿肠闭锁发生率高于计划医源性早产分娩的新生儿。
