1. Epidemiology and outcome of Gastroschisis in Tasmania
Dr. Gopakumar Hariharan
Advanced trainee in Neonatology and Paediatrics
Royal Hobart Hospital

2. Gastroschisis Serious congenital defect- surgery soon after birth
Intestines herniation through a defect in the abdominal wall – right of umbilicus
Cause – unknown- suspected vascular accident Antenatally.
Predisposing factors from previous studies – young maternal age, low socio-economic class, maternal smoking and substance abuse.
Fetus usually genetically normal.
Has increased risk of morbidities

3. Objective To describe Prevalence and trend Antenatal risk factors and
Outcome of neonates born with Gastroschisis.

4. Methods
Retrospective analysis of all Gastroschisis cases in Tasmania between 1996 to 2015 (20 years)
Data - Paper records from 1996 to 2005 and Digital medical records from 2006.
Antenatal, natal and postnatal factors.
Maternal characteristics, medical and surgical outcomes.
The prevalence of gastroschisis was compared between two 10-year periods, January December 2005(epoch 1)* and January 2006 to December 2015(epoch 2).
Further analysis was done on the data collected for epoch 2.
*Walwyn T, Morris P, Fenton E, Cartledge J, Parsons SJ,Dargaville PA. Epidemiology of gastroschisis and exomphalos in Tasmania 1990–2005. J. Paediatr. Child Health 2009; 45 (Suppl. 1): A63.

5. Statistical analysis
Descriptive statistics – Median, Interquartile range
Prevalence – calculated per 10,000 live births.( population data obtained from Australian Bureau of Statistics and Council of Obstetric and Paediatric Mortality and Morbidity). Confidence interval –calculated for proportions.
Non parametric analysis ( Mann Whitney U test) - Comparison of medians
Chi square test/Fischer exact test for categorical variables.

6. Results – Prevalence
58 cases of Gastroschisis during the 20-year period
Epoch 1 ( 29 live births + 1 still birth = 30 cases)
Epoch 2( 25 livebirths + 3 still birth = 28 cases)
Overall prevalence over 20 years – 4.5/10000 live births
The prevalence of gastroschisis was
Epoch 1 : 4.7 per 10000( 95% CI ; 2.7 , 6.7)
Epoch 2 : 4.06 per ( 95% CI ; 2.0 ,6.0)
Slight decreasing trend but not significant

7. Tasmanian regions – Medicare local ( regional offices- encompass 29 local government areas of Tasmania)
COPMM

8. Regional prevalence of Gastroschisis
Prevalence( cases/10000)
South
4.2 ( 95% CI; 2.2, 6.2)
North
4.5 ( 95% CI; 2.5, 6.5)
North west
4.3 ( 95% CI; 1.3, 6.3)

9. Incidence Plot

10. Results in context – Prevalence
Northern Queensland( 3.2 / livebirths) – Review of cases from 1988 to 2007 ( 59 cases)
(Whitehall et al, Journal of paediatrics and child health, 2010)
Victoria ( 3.42/10000 livebirths)
Increasing prevalence
Northern Queensland – increasing prevalence ( 0.7 to 4.8)
Western Australia – 1.53 to 4.30
Victoria – 0.71 to 2.44
CDC report( 14 states) – increasing prevalence
1995 to 2005 – 3.6/10000 live births
2006 to 2012 – 4.9/10000 live births

11. Epoch 2 analysis- Baseline data
Gestational age (median;IQR)
37 weeks( )
Range: 34 to 40 weeks
Birth weight (median;IQR)
2585 grams(2267 – 2878)
Range: 1805 to 3740
M:F
1:1
LSCS
10 (38%)
Polyhydramnios
None
Oligohydramnios
3 cases
Maternal smoking
28%

12. Epoch 2( Baseline data) TPN duration( median; IQR)
21 days(15.5 – 35.5)
Range : 10 to 131 days
Time to start oral intake (median;IQR)
5 days( 4.5 – 7.0)
Range – 2.0 to 13 days
Time to full feeds(median;IQR)
16 days( 12 – 27.5)
Range: 6.0 to 138 days
Hospital stay(median;range)
31 days ( days)
Intensive care days(median;range)
20 days ( 3 – 38 days)

13. Results – Maternal age
Majority of gastroschisis cases were diagnosed in mothers who were </=25 years
Epoch 1: 72%
Epoch 2 : 69%
2013 COPPM data –
maternal age distribution
Epoch 1
Epoch 2
Median (IQR)
22( )
24 ( )
P = 0.93
Range
16-39
16 – 37
</=25 years
21(72%)
18(69%)
P=0.8
</= 20 years
11(38%)
11(42%)

14. Prevalence according to maternal age
Prevalence ( per 10,000)
Less than 20 years
18.7
20 to 24 years
6.2
>/= 25 years 3
Increased prevalence in young maternal age ( <20 years) – statistically significant ( P – )

15. Maternal smoking ( age less than 20 years)
Percentage
1982
55.2
2009 43
2010
46.8
2011
35.7
2012
35.6
2013
33.4
Less than 20 years – 50% smoked during pregnancy
Council of obstetric &paediatric morbidity and mortality report

16. Epoch 2 analysis 84.6% of neonates were born to primi gravidas.
Adhesive intestinal obstruction – 4 cases ( day of presentation – 32 days to 3 years)
23% of cases had a postoperative period complicated by feed intolerance – hydrolysed or elemental formula.
There were four postnatal deaths in epoch 1 and none in epoch 2.
No concerns with regard to development.

17. Conclusions
The prevalence of the condition has remained similar for the two epochs.
Young primi mothers appears to be a predisposing factor for Gastroschisis although causality could not be established.
Babies born with gastroschisis can expect a normal outcome with current standard of care.
Long term follow up is essential as late complications are possible.

18. Limitations
Details on still births and neonatal deaths not available for this study.
Retrospective nature of the study.
Small population

19. Relevance of study results
1) Better understanding of predisposing factors - better parental counselling
2) Need for long term follow up- complications as late as 3 years.
3) Public health research – to identify etiological factors
4) Education – teenage pregnancy, maternal smoking.
4) Quality of care- benchmarking with other centres.

20. Acknowledgment Dr. Tony De Paoli ( Director, Neonatology)
Mr. Michael EE ( Staff specialist, Paediatric surgeon)
Prof. Peter Dargaville(Staff specialist, Neonatologist)
Dr. Thomas Walwyn
Dr.Reeshma Pattan

21. Thank you