Gastroschisis: A plea for risk categorization

K. A. Molik, C. A. Gingalewski, K. W. West, Frederick Rescorla, L. R. Scherer, S. A. Engum, J. L. Grosfeld

Research output: Contribution to journalArticle

174 Citations (Scopus)

Abstract

Background: The incidence of gastroschisis has increased in the past decade. A differing clinical course between "complex" (those with atresias, perforation, or stenosis) and "simple" cases has prompted a review of risk assessment factors. Methods: A retrospective chart review was conducted of 103 infants with gastroschisis over 5 years (1992 to 1997). Results: Of 103 infants, 52 were girls and 51 were boys. Seventy-one infants (69%) had a simple defect, and 32 (31%) were complex. The simple group had an average estimated gestational age of 37.5 weeks (range, 26 to 40), and a birth weight of 3.0 kg (range, 1.7 to 3.8). A total of 71% underwent primary repair, whereas 29% required a silo. Mechanical ventilation averaged 6.8 days (range, 1 to 19). Enteral feedings were initiated at 15 days (range, 3 to 27) with full enteral intake achieved by 22.4 days (range, 5 to 40). Three infants required home parenteral nutrition. The average length of stay (LOS) was 26.4 days (range, 10 to 57). Complications occurred in 26 infants (36%), including intravenous catheter sepsis (n = 15), pneumatosis (n = 2), pneumonia (n = 1), bowel obstruction (n = 7), wound infection (n = 5), and SVC thrombosis (n = 1). Survival rate was 100%. Thirty-two infants had complex defects; 27 patients had atresias, stenosis, or perforations; and 3 had volvulus. The average estimated gestational age was 34 weeks (range, 26 to 38), and birth weight was 2.0 kg (range, 0.9 to 4.0). Primary repair was performed in 65% and silo placement in 35%. Mechanical ventilation was required for 22.3 days (range, 2 to 14). Enteral feedings were initiated at 22.5 days (range, 6 to 56) with full feedings achieved at 50 days (range, 21 to 113). Fourteen infants required home total parenteral nutrition (TPN). The LOS was 85.4 days (range, 24 to 270). A total of 47 complications occurred in the complex group including catheter sepsis (n = 15), short bowel syndrome (n = 7), pneumatosis (n = 3), bowel obstruction (n = 4), pneumonia (n = 2), superior vena cava thrombosis (n = 1), enterocutaneous fistula (n = 1), and 9 deaths (28% mortality rate). Conclusions: These data indicate gastroschisis can be divided into low-risk (simple) and high-risk (complex) categories. These 2 groups have significant differences in clinical behavior, postsurgical complications, LOS, and mortality rate (0 v 28%). Although the overall survival rate was 91% (94 of 103), parents, referring physicians, and insurers must be made aware of the impact of risk categorization on the estimated cost, LOS, and outcomes.

Original languageEnglish
Pages (from-to)51-55
Number of pages5
JournalJournal of Pediatric Surgery
Volume36
Issue number1
DOIs
StatePublished - 2001

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Gastroschisis
Length of Stay
Enteral Nutrition
Artificial Respiration
Birth Weight
Gestational Age
Home Total Parenteral Nutrition
Sepsis
Pneumonia
Pathologic Constriction
Catheters
Survival Rate
Home Parenteral Nutrition
Superior Vena Cava Syndrome
Short Bowel Syndrome
Intestinal Fistula
Intestinal Volvulus
Insurance Carriers
Mortality
Wound Infection

Keywords

  • Gastroschisis
  • Intestinal atresia
  • Risk categories

ASJC Scopus subject areas

  • Surgery

Cite this

Molik, K. A., Gingalewski, C. A., West, K. W., Rescorla, F., Scherer, L. R., Engum, S. A., & Grosfeld, J. L. (2001). Gastroschisis: A plea for risk categorization. Journal of Pediatric Surgery, 36(1), 51-55. https://doi.org/10.1053/jpsu.2001.20004

Gastroschisis : A plea for risk categorization. / Molik, K. A.; Gingalewski, C. A.; West, K. W.; Rescorla, Frederick; Scherer, L. R.; Engum, S. A.; Grosfeld, J. L.

In: Journal of Pediatric Surgery, Vol. 36, No. 1, 2001, p. 51-55.

Research output: Contribution to journalArticle

Molik, KA, Gingalewski, CA, West, KW, Rescorla, F, Scherer, LR, Engum, SA & Grosfeld, JL 2001, 'Gastroschisis: A plea for risk categorization', Journal of Pediatric Surgery, vol. 36, no. 1, pp. 51-55. https://doi.org/10.1053/jpsu.2001.20004
Molik KA, Gingalewski CA, West KW, Rescorla F, Scherer LR, Engum SA et al. Gastroschisis: A plea for risk categorization. Journal of Pediatric Surgery. 2001;36(1):51-55. https://doi.org/10.1053/jpsu.2001.20004
Molik, K. A. ; Gingalewski, C. A. ; West, K. W. ; Rescorla, Frederick ; Scherer, L. R. ; Engum, S. A. ; Grosfeld, J. L. / Gastroschisis : A plea for risk categorization. In: Journal of Pediatric Surgery. 2001 ; Vol. 36, No. 1. pp. 51-55.
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T2 - A plea for risk categorization

AU - Molik, K. A.

AU - Gingalewski, C. A.

AU - West, K. W.

AU - Rescorla, Frederick

AU - Scherer, L. R.

AU - Engum, S. A.

AU - Grosfeld, J. L.

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N2 - Background: The incidence of gastroschisis has increased in the past decade. A differing clinical course between "complex" (those with atresias, perforation, or stenosis) and "simple" cases has prompted a review of risk assessment factors. Methods: A retrospective chart review was conducted of 103 infants with gastroschisis over 5 years (1992 to 1997). Results: Of 103 infants, 52 were girls and 51 were boys. Seventy-one infants (69%) had a simple defect, and 32 (31%) were complex. The simple group had an average estimated gestational age of 37.5 weeks (range, 26 to 40), and a birth weight of 3.0 kg (range, 1.7 to 3.8). A total of 71% underwent primary repair, whereas 29% required a silo. Mechanical ventilation averaged 6.8 days (range, 1 to 19). Enteral feedings were initiated at 15 days (range, 3 to 27) with full enteral intake achieved by 22.4 days (range, 5 to 40). Three infants required home parenteral nutrition. The average length of stay (LOS) was 26.4 days (range, 10 to 57). Complications occurred in 26 infants (36%), including intravenous catheter sepsis (n = 15), pneumatosis (n = 2), pneumonia (n = 1), bowel obstruction (n = 7), wound infection (n = 5), and SVC thrombosis (n = 1). Survival rate was 100%. Thirty-two infants had complex defects; 27 patients had atresias, stenosis, or perforations; and 3 had volvulus. The average estimated gestational age was 34 weeks (range, 26 to 38), and birth weight was 2.0 kg (range, 0.9 to 4.0). Primary repair was performed in 65% and silo placement in 35%. Mechanical ventilation was required for 22.3 days (range, 2 to 14). Enteral feedings were initiated at 22.5 days (range, 6 to 56) with full feedings achieved at 50 days (range, 21 to 113). Fourteen infants required home total parenteral nutrition (TPN). The LOS was 85.4 days (range, 24 to 270). A total of 47 complications occurred in the complex group including catheter sepsis (n = 15), short bowel syndrome (n = 7), pneumatosis (n = 3), bowel obstruction (n = 4), pneumonia (n = 2), superior vena cava thrombosis (n = 1), enterocutaneous fistula (n = 1), and 9 deaths (28% mortality rate). Conclusions: These data indicate gastroschisis can be divided into low-risk (simple) and high-risk (complex) categories. These 2 groups have significant differences in clinical behavior, postsurgical complications, LOS, and mortality rate (0 v 28%). Although the overall survival rate was 91% (94 of 103), parents, referring physicians, and insurers must be made aware of the impact of risk categorization on the estimated cost, LOS, and outcomes.

AB - Background: The incidence of gastroschisis has increased in the past decade. A differing clinical course between "complex" (those with atresias, perforation, or stenosis) and "simple" cases has prompted a review of risk assessment factors. Methods: A retrospective chart review was conducted of 103 infants with gastroschisis over 5 years (1992 to 1997). Results: Of 103 infants, 52 were girls and 51 were boys. Seventy-one infants (69%) had a simple defect, and 32 (31%) were complex. The simple group had an average estimated gestational age of 37.5 weeks (range, 26 to 40), and a birth weight of 3.0 kg (range, 1.7 to 3.8). A total of 71% underwent primary repair, whereas 29% required a silo. Mechanical ventilation averaged 6.8 days (range, 1 to 19). Enteral feedings were initiated at 15 days (range, 3 to 27) with full enteral intake achieved by 22.4 days (range, 5 to 40). Three infants required home parenteral nutrition. The average length of stay (LOS) was 26.4 days (range, 10 to 57). Complications occurred in 26 infants (36%), including intravenous catheter sepsis (n = 15), pneumatosis (n = 2), pneumonia (n = 1), bowel obstruction (n = 7), wound infection (n = 5), and SVC thrombosis (n = 1). Survival rate was 100%. Thirty-two infants had complex defects; 27 patients had atresias, stenosis, or perforations; and 3 had volvulus. The average estimated gestational age was 34 weeks (range, 26 to 38), and birth weight was 2.0 kg (range, 0.9 to 4.0). Primary repair was performed in 65% and silo placement in 35%. Mechanical ventilation was required for 22.3 days (range, 2 to 14). Enteral feedings were initiated at 22.5 days (range, 6 to 56) with full feedings achieved at 50 days (range, 21 to 113). Fourteen infants required home total parenteral nutrition (TPN). The LOS was 85.4 days (range, 24 to 270). A total of 47 complications occurred in the complex group including catheter sepsis (n = 15), short bowel syndrome (n = 7), pneumatosis (n = 3), bowel obstruction (n = 4), pneumonia (n = 2), superior vena cava thrombosis (n = 1), enterocutaneous fistula (n = 1), and 9 deaths (28% mortality rate). Conclusions: These data indicate gastroschisis can be divided into low-risk (simple) and high-risk (complex) categories. These 2 groups have significant differences in clinical behavior, postsurgical complications, LOS, and mortality rate (0 v 28%). Although the overall survival rate was 91% (94 of 103), parents, referring physicians, and insurers must be made aware of the impact of risk categorization on the estimated cost, LOS, and outcomes.

KW - Gastroschisis

KW - Intestinal atresia

KW - Risk categories

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