1. Universtity of Texas Medical Branch, Department of Pediatrics PGY-III
Prenatal Bowel Dilation Is Associated With Longer Hospital Stay In Patients With Gastroschisis
Geetha L. Radhakrishnan MD, Alexandria J. Hill MD, Mary B. Munn MD, Ravi S. Radhakrishnan MD, Rafael A. Fonseca MD
Universtity of Texas Medical Branch, Department of Pediatrics PGY-III
Introduction
Results
Although infants with gastroschisis typically fare well, their length of hospital stay and likelihood of complications are difficult to predict. Prenatal and postnatal parameters that are used to predict the outcomes in patients with gastroschisis remain controversial. This makes it difficult to provide reliable prenatal parental counseling. Currently, there are few prenatal variables that can reliably predict their postnatal course. Antenatal bowel dilation has been used as one of the indicators of prognosis. Serial measurements taken on antenatal ultrasound beginning at 20 weeks gestation may aid in deciding on the time of delivery as well the postnatal management of these patients. Currently, the degree of prenatal bowel dilation that predicts patient outcome remains controversial.
Bowel dilation greater than 1.6cm indicated as long as a 2 month hospital admission. In contrast, dilation less than 1.6cm showed about a 1 month hospital course (p<0.05). The length of time on TPN and time to full enteral feedings, however, were not significantly different between the two groups. In addition, there was no difference in maternal age, birth weight, or discharge weight.
Table 1. Comparison of Gastroschisis Patients with Dilated and Non-dilated Bowel
Maternal Age (yrs)
LOS (days)
Birth GA
Birth Weight (g)
Discharge Weight (g)
Total TPN days
Days to full feeds
Non-Dilated
20.42
38.42
35.83
20.90
12.46
Dilated
20.00
52.50
36.92
23.45
9.56
p-value
0.306
0.044
0.124
0.048
0.131
0.300
0.180
Method
After obtaining IRB approval, we performed a chart review of all patients born at the University of Texas Medical Branch in Galveston, TX from with the diagnosis of gastroschisis. We then collected serial prenatal ultrasound bowel diameter measurements, patient birth weight and discharge weight, mother’s age, length of stay, days to full feeds, length of TPN administration, as well as demographic information.
Figure 1. Prenatal Ultrasound Image of Dilated Bowel
Description of study
From 2005 to 2011, a total of 45 patients born with gastroschisis at the University of Texas Medical Branch were reviewed. By working with physicians in maternal-fetal medicine, we obtained serial measurements of bowel dilation and bowel wall thickness in utero. The patients were then divided into two groups: those with bowel diameter of less than 1.6 cm and those with bowel diameter greater than 1.6 cm. Patient outcomes such as length of stay (LOS), total number of days on TPN (TPN days), time to reach full feeds, and other data such as gestational age, birth weight and complications of gastroschisis which include intestinal atresia, necrotizing enterocolitis and sepsis were examined. These data were analyzed by utilizing Student’s t-test.
Conclusions
Patients with gastroschisis have highly unpredictable hospital stays. Antenatal bowel dilation, as seen on prenatal ultrasound may represent a useful tool during prenatal parental counseling to help predict patient’s length of hospital stay.
References
Kuleva M, Khen-Dunlop N, Dumez Y, et al. Is Complex Gastroschisis Predictable by Prenatal Ultrasound? BJOG Jan; 119(1)
Long AM, Court J, Morabito A, et al. Antenatal Diagnosis of Bowel Dilatation in Gastroschisis is Predictive of Poor Postnatal Outcome. J Ped Surg Jun; 46(6)
Garcia L, Brizot M, Liao A, et al. Bowel Dilation as a Predictor of Adverse Outcome in Isolated Fetal Gastroschisis. Prenat Diag Oct; 30(10)
Davis RP, Treadwell MC, Drongowski RA, et al. Risk Stratification in Gastroschisis: Can Prenatal Evaluation or Early Postnatal Factors Predict Outcome? Ped Surg Int Apr; 25(4):
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