Does Delivery Location Really Impact Gastroschisis Outcomes?
Dalton et al. (Journal of Pediatric Surgery, 2017) examined whether patients had improved outcomes based on whether they were treated at the delivery hospital (inborn) or transferred elsewhere for definitive treatment (outborn)
Single Center Retrospective Chart Review
Pediatric tertiary care center from 2010 to 2015
Pooled data from all patients with uncomplicated gastroschisis
Patients were categorized as:
Patients delivered within center (inborn)
Patients delivered outside of center (outborn)
63 patients with uncomplicated gastroschisis were included for analysis
Inborn characteristics, compared to outborn:
Shorter length of stay (30 vs 40 days; P=0.03)
Fewer TPN days (23 vs 32 days; P=0.03)
Lower 90-day readmission % rate (11 vs 22%; P=0.02)
Fewer total hospital days (31 vs 43 days; P=0.01)
Time to definitive closure was similar between groups
Mortality was 0% for both inborn and outborn patients
The authors recommend that since most infants with gastroschisis are diagnosed prenatally, delivery should be arranged in a center that can provide complete care for the mother but also has definitive treatment capabilities for the newborn
This paper confirms other studies that delivery outside a perinatal center is a significant independent predictor of poorer outcomes in uncomplicated gastroschisis (Nasr et al., Journal of Pediatric Surgery, 2012)
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