Prognosis of gastroschisis: Influence of perinatal management

Objectives: The aim of this study was to evaluate the impact of the findings of antenatal diagnosis, the mode of delivery and the associated congenital malformations on the postnatal course of neonates born with gastroschisis. Methods: A retrospective study was performed on 41 children born with gastroschisis and consecutively admitted to a perinatal center over a 12-year period. Results: Antenatal diagnosis was made in 66% of the cases. Dilatation of bowel loops was observed in ten cases (37%), including three (11%) showing clearly increased peristaltism. Cesarean section did not reduce significantly the number of infants requiring secondary surgical procedures after permanent closure of the abdominal wall and the number of central venous catheter infections. The time to surgery was significantly shortened, both by antenatal diagnosis and delivery in the perinatal center (p = 0.0001). Primary closure of the abdominal wall defect was performed in 85% of the neonates. The overall mortality was 12% (n = 5). Two surviving children had short bowel syndrome secondary to an associated intestinal atresia. Some parameters of postoperative outcome of the 34 other children were significantly influenced by the birth weight, the gestational age, the presence of an associated intrauterine growth retardation, and the type of surgical procedure. Conclusions: Interdisciplinary cooperation between obstetricians, pediatric surgeons and neonatologists optimizes the care given to these children. Planning of delivery and elective Cesarean section can reduce mortality and neonatal morbidity.