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  • Prenatal ultrasonographic markers for prediction of complex gastroschisis and adverse perinatal outcomes: a systematic review and meta-analysis

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Original research
Prenatal ultrasonographic markers for prediction of complex gastroschisis and adverse perinatal outcomes: a systematic review and meta-analysis
  1. Raphael C Sun1,2,
  2. Kamran Hessami3,
  3. Eyal Krispin2,
  4. Mohan Pammi4,
  5. Shayan Mostafaei5,
  6. Luc Joyeux6,
  7. Jan Deprest7,8,
  8. Sundeep Keswani9,
  9. Timothy C Lee9,
  10. Alice King9,
  11. Michael A Belfort2,
  12. Alireza A Shamshirsaz2
  1. 1 Division of Pediatric Surgery, Doernbecher Children’s Hospital, Oregon Health & Science University, Portland, Oregon, USA
  2. 2 Division of Fetal Therapy and Surgery, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, USA
  3. 3 Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
  4. 4 Section of Neonatology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, USA
  5. 5 Department of Biostatistics, Faculty of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran (the Islamic Republic of)
  6. 6 MyFetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, Leuven, Belgium
  7. 7 Department of Obstetrics and Gynecology, Division Woman and Child, Fetal Medicine Unit, Katholieke Universiteit Leuven, Leuven, Belgium
  8. 8 Institute of Women’s Health, University College London Hospitals, University College London Medical School, London, UK
  9. 9 Division of Pediatric Surgery, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, USA
  1. Correspondence to Dr Alireza A Shamshirsaz, Baylor College of Medicine, Houston, TX 77030, USA; shamshir{at}bcm.edu

Abstract

Objective We sought to perform a meta-analysis of the predictive value of antenatal ultrasonographic markers of bowel dilation, gastric dilation, polyhydramnios and abdominal circumference that predict complex gastroschisis and adverse perinatal outcomes

Data sources PubMed, Web of Science, Scopus and Embase were searched for relevant articles up to December 2020. Studies reporting prenatal ultrasonographic markers including intra-abdominal bowel dilation (IABD), extra-abdominal bowel dilation (EABD), bowel wall thickness, polyhydramnios, abdominal circumference <5th percentile, gastric dilation (GD) and bowel dilation not otherwise specified (BD-NOS) were included. The primary outcome was prediction of complex gastroschisis; secondary outcomes were length of hospital stay for newborn, time to full enteral feeding, postnatal mortality rate, incidence of necrotising enterocolitis and short bowel syndrome.

Results Thirty-six studies were included in this meta-analysis. We found significant associations between complex gastroschisis and IABD (OR=5.42; 95% CI 3.24 to 9.06), EABD (OR=2.27; 95% CI 1.40 to 3.66), BD-NOS (OR=6.27; 95% CI 1.97 to 19.97), GD (OR=1.88; 95% CI 1.22 to 2.92) and polyhydramnios (OR=6.93; 95% CI 3.39 to 14.18). Second trimester IABD and EABD have greater specificity for the prediction of complex gastroschisis than third trimester values with specificity of 95.6% (95% CI 58.1 to 99.7) and 94.6% (95% CI 86.7 to 97.9) for the second trimester IABD and EABD, respectively.

Conclusion Prenatal ultrasonographic markers, especially the second trimester IABD and EABD, can identify fetuses that develop complex gastroschisis. Furthermore, these specific ultrasonographic markers can identify those babies at the highest risk for severe complications of this congenital anomaly and hence selected for future antenatal interventions.

  • neonatology
  • paediatrics
  • syndrome

Data availability statement

No data are available. All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/archdischild-2021-322612

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    Data availability statement

    No data are available. All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • Contributors RCS and AAS conceived and designed the study, contributed to draft the manuscript and approved the final manuscript as submitted. KH and SM analysed the data, contributed to draft the manuscript and interpret the results and approved the final manuscript as submitted. EK and MP reviewed search results and screened titles/abstracts, extracted key data from the included studies, contributed to draft the manuscript and approved the final manuscript as submitted. KH, LJ and JD conducted the literature search, reviewed search results and screened titles/abstracts, contributed to interpret the results, critically revised the manuscript and approved the final manuscript as submitted. SK, TCL and AK extracted key data from the included studies, contributed to interpret the results, critically revised the manuscript and approved the final manuscript as submitted. MAB critically revised the manuscript and approved the final manuscript as submitted. All authors are responsible for the accuracy and the integrity of the data.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.