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Gastroschisis: can antenatal bowel dilatation predict neonatal outcome?
  1. E Greig,
  2. M Kulkarni,
  3. R Smith,
  4. C Bangham
  1. Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK

Abstract

Aim To correlate neonatal outcome with the presence or absence of antenatal bowel dilatation (BD) in gastroschisis.

Methods Retrospective review of antenatal scan reports, delivery-suite database, surgical operative notes and neonatal discharge summaries from a UK tertiary hospital between 2003 and 2009.

Results There were 30 cases of gastroschisis over 7 years. Two pregnancies were terminated, leaving 28 cases. Median maternal age was 21 years and 82% were primiparous. Scans were performed four weekly from diagnosis unless additional concerns arose. BD of ≥16 mm was present in 19 cases at the final scan. The median gestation at delivery was 35 weeks (range 29–38). Vaginal delivery was anticipated in 85.7% and achieved in 53.5%.

Analysis of outcome by presence or absence of BD was not conclusive (see table). Overall, 13 babies (50%) were discharged on full enteral feeds by day 30. Two babies died and five babies still required parenteral nutrition at 90 days. All babies (three) who had bowel resection at primary repair had BD; one in group A and two in group C.

ABCD
Complications delaying discharge (on full enteral feeds)
Bowel dilatationHome on full enteral feeds at 30 daysBowel relatedOtherParenteral nutrition >90 daysNeonatal deaths
Present (n=19)8 (42%)3 (16%)4 (21%)3 (16%)1 (5%)
Absent (n=9)5 (56%)003 (33%)1 (11%)
Total13346

Conclusion In our small study BD on its own was not consistently associated with adverse outcome.

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