The impact of prenatal bowel dilation on clinical outcomes in neonates with gastroschisis.

PURPOSE: In fetuses with gastroschisis, the importance of ultrasonographic bowel dilation remains controversial. The outcome of patients with gastroschisis with and without prenatal bowel dilation is reported.

METHODS

From 2000 to 2004, 27 neonates with gastroschisis were followed at a single center. Thirteen patients had prenatal ultrasonographic bowel dilation (diameter, > or =6 mm; range, 6-35 mm). Outcomes of those with and without dilation were compared using 2 sample t tests and logistic regression.

RESULTS

Time to initiation of enteral nutrition varied significantly between groups (20.4 +/- 11.7 days vs 12.5 +/- 4.3 days, P < .05). A trend toward a reduced rate of primary closure was seen in those with dilation (23% vs 50%, P = .06). No significant difference was found when considering mortality, gestational age, time in the intensive care unit (ICU), time on parenteral nutrition, or length of stay. Prenatal bowel dilation, a longer ICU stay, and later gestational age independently predicted readmission for bowel obstruction (P < .001).

CONCLUSION

Infants with gastroschisis and prenatal bowel dilation were significantly slower to initiate enteral feeding and tended to have a reduced incidence of primary closure. This did not translate into increased mortality, time on parenteral nutrition, time in the ICU, or length of stay. However, dilation was associated with readmission for bowel obstruction.