Clinical outcome of patients with gastroschisis: what are the differences from the past?

Objective: The aim of the present study was to review the experience in management of neonates with gastroschisis and analyze the differences in the clinical outcome during a 24-year period.

Material And Method: A retrospective study of patients with gastroschisis treated at Queen Sirikit National Institute of Child Health (QSNICH) between 1986 and 2009 was conducted. Patients' information was compared between the first period (1986-1997) and the second period (1998-2009) regarding demographic data, modes of operative procedures and results of the treatment. The statistical differences were analyzed by the Chi-square, Fisher exact and student t-test with a p-value less than 0.05 considered significant.

Results: During a 24-year period, 919 neonates with gastroschisis were treated at QSNICH; 342 cases (161 males and 181 females) in the first 12-year period and 577 cases (295 males and 282 females) in the second 12-year period. The incidence of gastroschisis at Rajavithi Hospital was 0.26: 1,000 live births in the first period and 1.03: 1,000 live births in the second period. Average birth weight of the patients and average maternal age in both periods were not significantly different (p > 0.05). Congenital anomalies were found in approximately 15% of the patients in each period. Regarding modes of the operative treatment, primary closure of the abdominal wall defect was attempted in 23.7% of the patients during the first period and increased to 44% in the second period. The overall survival rate in the second period was better than the first period with statistical significance (92.4% vs. 75.4%, p < 0.001). In addition, complications in the second period were less than those in the first period, except for necrotizing enterocolitis, which was more frequent in the second period.

Conclusion: The obvious differences in patients with gastroschisis during the 24-year period were the increased incidence, increased successful primary closure of the abdominal wall defect and increased overall survival rate between 1998-2009. Improvement of the clinical outcomes reflected improved neonatal care including surgical techniques, parenteral nutrition, respiratory care and anesthetic practice.