Birth Weight Compromised Bowel and Sepsis are the Main Variables Significantly Influencing Outcome in Gastroschisis
E. Ţarcă, I. Ciongradi, S.G. AproduOriginal article, no. 2, 2015
Background: The survival rate for gastroschisis has improvedto more than 90% in the developed countries, but increasedmortality, morbidity, consequent long hospitalisation andhigh costs are the rule in Romania.Methods: Analytic retrospective study of all patients withgastroschisis treated at our department between 1990 and2012. The study protocol included: demographic data, antenataldiagnosis, prematurity, mode of delivery, birth weight,associated anomalies, time to surgery, presence of compromisedbowel, type of repair, post-operative complications, timeto full enteral feeding, length of hospitalisation, mortality.Results: 115 newborns with gastroschisis were treated during23 years. Antenatal diagnosis was made only in 13 cases ata mean gestational age of 25 weeks. Delivery was vaginal in80.8%. Associated malformations were present in 47patients. Twenty-four patients had complex gastroschisis.Primary repair was done in 90 cases (79%) and in 24 patientsa silo was used. Overall survival was only 29.8%, the maincause of death being severe sepsis with multiple organ failure(61.4%) and bronchopneumonia (52.6%). The rate of complicationsassociated with closure, needing reinterventionwas 19.3%.Conclusions: Analysis of risk factors by logistic regressionshowed that low birth weight increased the risk of postoperativecomplications 17.4 times, sepsis increased the riskof complicated postoperative course 12.2 times, and thepresence of compromised intestinal loops (complexgastroschisis) 5.5 times.
