Journal
JOURNAL OF PEDIATRIC SURGERY
Volume 52, Issue 12, Pages 1962-1971Publisher
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1016/j.jpedsurg.2017.08.068
Keywords
Gastroschisis; Delivery; Elective; Feeding; Preterm; Outcome
Categories
Ask authors/readers for more resources
Background/purpose: Elective preterm delivery (EPD) of a fetus with gastroschisis may prevent demise and ameliorate intestinal injury. While the literature on optimal timing of delivery varies, we hypothesize that a potential benefit may be found with EPD. Methods: A meta-analysis of publications describing timing of delivery in gastroschisis from 1/1990 to 8/2016 was performed, including studies where either elective preterm delivery (group 1, G1) or preterm gestational age (GA) (group 2, G2) were evaluated against respective comparators. The following outcomes were analyzed: total parenteral nutrition (TPN), first enteral feeding (FF), length of stay, ventilator days, fetal demise, complex gastroschisis, sepsis, and death. Results: Eighteen studies describing 1430 gastroschisis patients were identified. G1 studies found less sepsis (p < 0.01), fewer days to FF (p = 0.03), and 11 days less of TPN (p = 0.07) in the preterm cohort. Comparatively, G2 studies showed less days to FF in term GA (p = 0.02). Whereas G1 BWs were similar, G2 preterm had a significantly lower BW compared to controls (p = 0.001). Conclusions: Elective preterm delivery appears favorable with respect to feeding and sepsis. However, benefits are lost when age is used as a surrogate of EPD. A randomized, prospective, multi-institutional trial is necessary to delineate whether EPD is advantageous to neonates with gastroschisis. (C) 2017 Elsevier Inc. All rights reserved.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available