Factors associated with mortality in neonates with gastroschisis.

PURPOSE: The ongoing epidemic of gastroschisis has created multiple challenges and continues to raise questions concerning the optimal management of these high-risk patients. Although the overall survival rate has increased over the past 3 decades, morbidity and mortality remain significant. The purpose of this study was to analyze the main factors associated with mortality in neonates admitted to an intensive care unit for the management of this abdominal wall defect.

METHODS

This study is a retrospective review of a large de-identified neonatal intensive care dataset encompassing 284 institutions in 32 states and Puerto Rico, from 1/1/1997 to 1/1/2010. Of the 629 440 neonates in the dataset, a total of 3 456 newborns were diagnosed with gastroschisis (5.5/1 000 hospital discharges). Of these, 685 were transferred to other centers and data was missing on 22, leaving 2 749 infants available for analysis.

RESULTS

Out of these 2 749 infants of whom we knew the outcome, 115 (4.2%) died. Multivariate logistic regression showed that the factors independently associated with an increased risk of death were male gender, immature gestational age, low birth weight, low 5 min Apgar Score, the need for vasopressors during the first week after birth and the need for high levels of oxygen support. The presence of associated anomalies, vaginal delivery, treatment with surfactant and the need for ventilator support on the day of birth were not independent risk factors associated with an increased mortality.

CONCLUSION

Premature delivery and low birth weight are the most important factors associated with an increased risk of mortality. Cesarean section does not appear to reduce the risk.