Outcome analysis for gastroschisis
Background/Purpose : Several factors are reportedly associated with an adverse outcome in gastroschisis, including mode of delivery, in utero diagnosis, type of closure, concurrent anomalies, intestinal atresia, and necrotizing enterocolitis (NEC). Since 1969, the authors have treated 185 patients w...
Gespeichert in:
| Veröffentlicht in: | Journal of pediatric surgery 1999-08, Vol.34 (8), p.1253-1256 |
|---|---|
| 1. Verfasser: | |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 1256 |
|---|---|
| container_issue | 8 |
| container_start_page | 1253 |
| container_title | Journal of pediatric surgery |
| container_volume | 34 |
| creator | Snyder, Charles L |
| description | Background/Purpose
: Several factors are reportedly associated with an adverse outcome in gastroschisis, including mode of delivery, in utero diagnosis, type of closure, concurrent anomalies, intestinal atresia, and necrotizing enterocolitis (NEC). Since 1969, the authors have treated 185 patients who had gastroschisis. The authors analyzed their database to identify variables associated with increased morbidity and mortality.
Methods
: A retrospective study of all patients with gastroschisis treated at our institution in the last 30 years was performed. The characteristics of survivors and nonsurvivors were compared. A logistic regression analysis was performed, with survival as the dependent variable, and the following parameters as independent variables: in utero diagnosis, mode of delivery, gestational age and birth weight, era of repair, type of closure, presence of other associated anomalies, intestinal atresia, and development of necrotizing enterocolitis. Further logistic regression analysis was performed, with various indicators of morbidity as dependent variables. These included development of sepsis, bowel obstruction, and complications related to the closure or to the silo. No attempt at long-term follow-up was made.
Results
: A total of 185 infants with gastroschisis were treated at our institution from 1969 to 1999. Mean gestational age was 36.6 weeks, and the mean birth weight was 2,501 g. A total of 21 infants had intestinal atresia. NEC developed in 8 infants. Six infants had other serious anomalies. The overall survival rate was 91%. Survival improved in last 2 decades (94%). There were no differences in gestational age, birth weight and mode of delivery, method of closure, or presence of intestinal atresia between survivors and nonsurvivors. Only the era of repair (
P = .002), presence of necrotizing enterocolitis (
P = .044), and presence of other major anomalies (
P < .001) correlated with mortality in the logistic regression analysis. Sepsis, bowel obstruction, and closure complications accounted for most of the morbidity. Analysis of these three morbidity factors identified low gestational age (
P = .038) and development of necrotizing enterocolitis (
P = .020) as independent predictors of sepsis. Closure complications were only associated with lower birth weight (
P = .006). No predictors of bowel obstruction were identified.
Conclusions
: Mode of delivery, method of closure, birth weight and gestational age, and the presence of int |
| doi_str_mv | 10.1016/S0022-3468(99)90162-8 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_69999911</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0022346899901628</els_id><sourcerecordid>69999911</sourcerecordid><originalsourceid>FETCH-LOGICAL-c390t-b71cb5742c2f3d931af9fcb6e9dd6dd0e28209d54462ba6e07abee4cc6f9b7b93</originalsourceid><addsrcrecordid>eNqFkE1LxDAQhoMo7rr6E5RFRPRQTdI2bU4ii1-wsAf1HPIx0Ui7XZNW2H9vul3Um7kMvDwzmXkQOib4imDCrp8xpjRJM1ZecH7JY0STcgeNSZ6SJMdpsYvGP8gIHYTwgXGMMdlHI4IzxhhmY3S66Frd1DCVS1mtgwtT2_jpmwytb4J-dzE5RHtWVgGOtnWCXu_vXmaPyXzx8DS7nSc65bhNVEG0youMampTw1MiLbdaMeDGMGMw0JJibvIsY1RJBriQCiDTmlmuCsXTCTof5q5889lBaEXtgoaqkktouiAY7x8hEcwHUMcdgwcrVt7V0q8FwaKXIzZyRH-54Fxs5Igy9p1sP-hUDeZP12AjAmdbQAYtK-vlUrvwy_E82u2xmwGDaOPLgRdBO1hqMM6DboVp3D-bfANIhIBl</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>69999911</pqid></control><display><type>article</type><title>Outcome analysis for gastroschisis</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals Complete</source><creator>Snyder, Charles L</creator><creatorcontrib>Snyder, Charles L</creatorcontrib><description>Background/Purpose
: Several factors are reportedly associated with an adverse outcome in gastroschisis, including mode of delivery, in utero diagnosis, type of closure, concurrent anomalies, intestinal atresia, and necrotizing enterocolitis (NEC). Since 1969, the authors have treated 185 patients who had gastroschisis. The authors analyzed their database to identify variables associated with increased morbidity and mortality.
Methods
: A retrospective study of all patients with gastroschisis treated at our institution in the last 30 years was performed. The characteristics of survivors and nonsurvivors were compared. A logistic regression analysis was performed, with survival as the dependent variable, and the following parameters as independent variables: in utero diagnosis, mode of delivery, gestational age and birth weight, era of repair, type of closure, presence of other associated anomalies, intestinal atresia, and development of necrotizing enterocolitis. Further logistic regression analysis was performed, with various indicators of morbidity as dependent variables. These included development of sepsis, bowel obstruction, and complications related to the closure or to the silo. No attempt at long-term follow-up was made.
Results
: A total of 185 infants with gastroschisis were treated at our institution from 1969 to 1999. Mean gestational age was 36.6 weeks, and the mean birth weight was 2,501 g. A total of 21 infants had intestinal atresia. NEC developed in 8 infants. Six infants had other serious anomalies. The overall survival rate was 91%. Survival improved in last 2 decades (94%). There were no differences in gestational age, birth weight and mode of delivery, method of closure, or presence of intestinal atresia between survivors and nonsurvivors. Only the era of repair (
P = .002), presence of necrotizing enterocolitis (
P = .044), and presence of other major anomalies (
P < .001) correlated with mortality in the logistic regression analysis. Sepsis, bowel obstruction, and closure complications accounted for most of the morbidity. Analysis of these three morbidity factors identified low gestational age (
P = .038) and development of necrotizing enterocolitis (
P = .020) as independent predictors of sepsis. Closure complications were only associated with lower birth weight (
P = .006). No predictors of bowel obstruction were identified.
Conclusions
: Mode of delivery, method of closure, birth weight and gestational age, and the presence of intestinal atresia do not appear to correlate with survival in infants with gastroschisis. Only the presence of another major anomaly, the era of repair, and the development of necrotizing enterocolitis were associated with increased mortality. Degree of prematurity and development of enterocolitis were associated with an increased incidence of septic complications. Low birth weight was a marker for closure complications. Type of delivery (vaginal or cesarean section) had no influence on either morbidity or mortality.</description><identifier>ISSN: 0022-3468</identifier><identifier>EISSN: 1531-5037</identifier><identifier>DOI: 10.1016/S0022-3468(99)90162-8</identifier><identifier>PMID: 10466606</identifier><identifier>CODEN: JPDSA3</identifier><language>eng</language><publisher>Philadelphia, PA: Elsevier Inc</publisher><subject>Biological and medical sciences ; Birth Weight ; Case-Control Studies ; Databases, Factual - statistics & numerical data ; Delivery, Obstetric - statistics & numerical data ; Enterocolitis, Necrotizing - epidemiology ; Female ; Gastroenterology. Liver. Pancreas. Abdomen ; Gastroschisis - epidemiology ; Gastroschisis - mortality ; Humans ; Infant, Newborn ; Logistic Models ; Male ; Medical sciences ; Morbidity ; Other diseases. Semiology ; Outcome Assessment (Health Care) ; Retrospective Studies ; Risk Factors ; Stomach, duodenum, intestine, rectum, anus ; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the digestive system ; Survival Analysis</subject><ispartof>Journal of pediatric surgery, 1999-08, Vol.34 (8), p.1253-1256</ispartof><rights>1999</rights><rights>1999 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c390t-b71cb5742c2f3d931af9fcb6e9dd6dd0e28209d54462ba6e07abee4cc6f9b7b93</citedby><cites>FETCH-LOGICAL-c390t-b71cb5742c2f3d931af9fcb6e9dd6dd0e28209d54462ba6e07abee4cc6f9b7b93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/S0022-3468(99)90162-8$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3548,27922,27923,45993</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1951536$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10466606$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Snyder, Charles L</creatorcontrib><title>Outcome analysis for gastroschisis</title><title>Journal of pediatric surgery</title><addtitle>J Pediatr Surg</addtitle><description>Background/Purpose
: Several factors are reportedly associated with an adverse outcome in gastroschisis, including mode of delivery, in utero diagnosis, type of closure, concurrent anomalies, intestinal atresia, and necrotizing enterocolitis (NEC). Since 1969, the authors have treated 185 patients who had gastroschisis. The authors analyzed their database to identify variables associated with increased morbidity and mortality.
Methods
: A retrospective study of all patients with gastroschisis treated at our institution in the last 30 years was performed. The characteristics of survivors and nonsurvivors were compared. A logistic regression analysis was performed, with survival as the dependent variable, and the following parameters as independent variables: in utero diagnosis, mode of delivery, gestational age and birth weight, era of repair, type of closure, presence of other associated anomalies, intestinal atresia, and development of necrotizing enterocolitis. Further logistic regression analysis was performed, with various indicators of morbidity as dependent variables. These included development of sepsis, bowel obstruction, and complications related to the closure or to the silo. No attempt at long-term follow-up was made.
Results
: A total of 185 infants with gastroschisis were treated at our institution from 1969 to 1999. Mean gestational age was 36.6 weeks, and the mean birth weight was 2,501 g. A total of 21 infants had intestinal atresia. NEC developed in 8 infants. Six infants had other serious anomalies. The overall survival rate was 91%. Survival improved in last 2 decades (94%). There were no differences in gestational age, birth weight and mode of delivery, method of closure, or presence of intestinal atresia between survivors and nonsurvivors. Only the era of repair (
P = .002), presence of necrotizing enterocolitis (
P = .044), and presence of other major anomalies (
P < .001) correlated with mortality in the logistic regression analysis. Sepsis, bowel obstruction, and closure complications accounted for most of the morbidity. Analysis of these three morbidity factors identified low gestational age (
P = .038) and development of necrotizing enterocolitis (
P = .020) as independent predictors of sepsis. Closure complications were only associated with lower birth weight (
P = .006). No predictors of bowel obstruction were identified.
Conclusions
: Mode of delivery, method of closure, birth weight and gestational age, and the presence of intestinal atresia do not appear to correlate with survival in infants with gastroschisis. Only the presence of another major anomaly, the era of repair, and the development of necrotizing enterocolitis were associated with increased mortality. Degree of prematurity and development of enterocolitis were associated with an increased incidence of septic complications. Low birth weight was a marker for closure complications. Type of delivery (vaginal or cesarean section) had no influence on either morbidity or mortality.</description><subject>Biological and medical sciences</subject><subject>Birth Weight</subject><subject>Case-Control Studies</subject><subject>Databases, Factual - statistics & numerical data</subject><subject>Delivery, Obstetric - statistics & numerical data</subject><subject>Enterocolitis, Necrotizing - epidemiology</subject><subject>Female</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>Gastroschisis - epidemiology</subject><subject>Gastroschisis - mortality</subject><subject>Humans</subject><subject>Infant, Newborn</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Morbidity</subject><subject>Other diseases. Semiology</subject><subject>Outcome Assessment (Health Care)</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Stomach, duodenum, intestine, rectum, anus</subject><subject>Stomach. Duodenum. Small intestine. Colon. Rectum. Anus</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the digestive system</subject><subject>Survival Analysis</subject><issn>0022-3468</issn><issn>1531-5037</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1999</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkE1LxDAQhoMo7rr6E5RFRPRQTdI2bU4ii1-wsAf1HPIx0Ui7XZNW2H9vul3Um7kMvDwzmXkQOib4imDCrp8xpjRJM1ZecH7JY0STcgeNSZ6SJMdpsYvGP8gIHYTwgXGMMdlHI4IzxhhmY3S66Frd1DCVS1mtgwtT2_jpmwytb4J-dzE5RHtWVgGOtnWCXu_vXmaPyXzx8DS7nSc65bhNVEG0youMampTw1MiLbdaMeDGMGMw0JJibvIsY1RJBriQCiDTmlmuCsXTCTof5q5889lBaEXtgoaqkktouiAY7x8hEcwHUMcdgwcrVt7V0q8FwaKXIzZyRH-54Fxs5Igy9p1sP-hUDeZP12AjAmdbQAYtK-vlUrvwy_E82u2xmwGDaOPLgRdBO1hqMM6DboVp3D-bfANIhIBl</recordid><startdate>19990801</startdate><enddate>19990801</enddate><creator>Snyder, Charles L</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>19990801</creationdate><title>Outcome analysis for gastroschisis</title><author>Snyder, Charles L</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c390t-b71cb5742c2f3d931af9fcb6e9dd6dd0e28209d54462ba6e07abee4cc6f9b7b93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1999</creationdate><topic>Biological and medical sciences</topic><topic>Birth Weight</topic><topic>Case-Control Studies</topic><topic>Databases, Factual - statistics & numerical data</topic><topic>Delivery, Obstetric - statistics & numerical data</topic><topic>Enterocolitis, Necrotizing - epidemiology</topic><topic>Female</topic><topic>Gastroenterology. Liver. Pancreas. Abdomen</topic><topic>Gastroschisis - epidemiology</topic><topic>Gastroschisis - mortality</topic><topic>Humans</topic><topic>Infant, Newborn</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Morbidity</topic><topic>Other diseases. Semiology</topic><topic>Outcome Assessment (Health Care)</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Stomach, duodenum, intestine, rectum, anus</topic><topic>Stomach. Duodenum. Small intestine. Colon. Rectum. Anus</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the digestive system</topic><topic>Survival Analysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Snyder, Charles L</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of pediatric surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Snyder, Charles L</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcome analysis for gastroschisis</atitle><jtitle>Journal of pediatric surgery</jtitle><addtitle>J Pediatr Surg</addtitle><date>1999-08-01</date><risdate>1999</risdate><volume>34</volume><issue>8</issue><spage>1253</spage><epage>1256</epage><pages>1253-1256</pages><issn>0022-3468</issn><eissn>1531-5037</eissn><coden>JPDSA3</coden><abstract>Background/Purpose
: Several factors are reportedly associated with an adverse outcome in gastroschisis, including mode of delivery, in utero diagnosis, type of closure, concurrent anomalies, intestinal atresia, and necrotizing enterocolitis (NEC). Since 1969, the authors have treated 185 patients who had gastroschisis. The authors analyzed their database to identify variables associated with increased morbidity and mortality.
Methods
: A retrospective study of all patients with gastroschisis treated at our institution in the last 30 years was performed. The characteristics of survivors and nonsurvivors were compared. A logistic regression analysis was performed, with survival as the dependent variable, and the following parameters as independent variables: in utero diagnosis, mode of delivery, gestational age and birth weight, era of repair, type of closure, presence of other associated anomalies, intestinal atresia, and development of necrotizing enterocolitis. Further logistic regression analysis was performed, with various indicators of morbidity as dependent variables. These included development of sepsis, bowel obstruction, and complications related to the closure or to the silo. No attempt at long-term follow-up was made.
Results
: A total of 185 infants with gastroschisis were treated at our institution from 1969 to 1999. Mean gestational age was 36.6 weeks, and the mean birth weight was 2,501 g. A total of 21 infants had intestinal atresia. NEC developed in 8 infants. Six infants had other serious anomalies. The overall survival rate was 91%. Survival improved in last 2 decades (94%). There were no differences in gestational age, birth weight and mode of delivery, method of closure, or presence of intestinal atresia between survivors and nonsurvivors. Only the era of repair (
P = .002), presence of necrotizing enterocolitis (
P = .044), and presence of other major anomalies (
P < .001) correlated with mortality in the logistic regression analysis. Sepsis, bowel obstruction, and closure complications accounted for most of the morbidity. Analysis of these three morbidity factors identified low gestational age (
P = .038) and development of necrotizing enterocolitis (
P = .020) as independent predictors of sepsis. Closure complications were only associated with lower birth weight (
P = .006). No predictors of bowel obstruction were identified.
Conclusions
: Mode of delivery, method of closure, birth weight and gestational age, and the presence of intestinal atresia do not appear to correlate with survival in infants with gastroschisis. Only the presence of another major anomaly, the era of repair, and the development of necrotizing enterocolitis were associated with increased mortality. Degree of prematurity and development of enterocolitis were associated with an increased incidence of septic complications. Low birth weight was a marker for closure complications. Type of delivery (vaginal or cesarean section) had no influence on either morbidity or mortality.</abstract><cop>Philadelphia, PA</cop><pub>Elsevier Inc</pub><pmid>10466606</pmid><doi>10.1016/S0022-3468(99)90162-8</doi><tpages>4</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0022-3468 |
| ispartof | Journal of pediatric surgery, 1999-08, Vol.34 (8), p.1253-1256 |
| issn | 0022-3468 1531-5037 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_69999911 |
| source | MEDLINE; Elsevier ScienceDirect Journals Complete |
| subjects | Biological and medical sciences Birth Weight Case-Control Studies Databases, Factual - statistics & numerical data Delivery, Obstetric - statistics & numerical data Enterocolitis, Necrotizing - epidemiology Female Gastroenterology. Liver. Pancreas. Abdomen Gastroschisis - epidemiology Gastroschisis - mortality Humans Infant, Newborn Logistic Models Male Medical sciences Morbidity Other diseases. Semiology Outcome Assessment (Health Care) Retrospective Studies Risk Factors Stomach, duodenum, intestine, rectum, anus Stomach. Duodenum. Small intestine. Colon. Rectum. Anus Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the digestive system Survival Analysis |
| title | Outcome analysis for gastroschisis |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-14T15%3A46%3A35IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Outcome%20analysis%20for%20gastroschisis&rft.jtitle=Journal%20of%20pediatric%20surgery&rft.au=Snyder,%20Charles%20L&rft.date=1999-08-01&rft.volume=34&rft.issue=8&rft.spage=1253&rft.epage=1256&rft.pages=1253-1256&rft.issn=0022-3468&rft.eissn=1531-5037&rft.coden=JPDSA3&rft_id=info:doi/10.1016/S0022-3468(99)90162-8&rft_dat=%3Cproquest_cross%3E69999911%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=69999911&rft_id=info:pmid/10466606&rft_els_id=S0022346899901628&rfr_iscdi=true |