Journal of Pregnancy / 2014 / Article / Tab 1

Review Article

Gastroschisis: Antenatal Sonographic Predictors of Adverse Neonatal Outcome

Table 1

Summary of prenatal ultrasound markers predictive of adverse outcome in the included studies.

StudyStudy characteristics Sample size []MethodsPrenatal UM evaluatedAdverse outcome Prenatal UM predictive of outcomeOR (95% CI) value

Puligandla et al., 2004 [16]Retrospective analysis. Infants born with GS between 1990 and 2000 113Analysis of variance (ANOVA), Student’s -test, and Fisher’s exact tests and linear and logistic regression used for statistical analysis; = significantIUGR Number of surgeries
Days on TPN
Days to full PO
Days NPO
Length of stay (days)
NoneNRNS

Nick et al., 2006 [10]Retrospective review from January 1998 to August 2004. All neonates delivered with GS and admitted to Vanderbilt University Medical Centre 72Binary variables analyzed with Fisher’s exact test; continuous variables analyzed by logistic regression; Wilcoxon’s rank sum test determined if the number of days to complete closure and LOS was different between neonates with and without atresia; = significantIABD (no threshold)
Oligohydramnios
IUGR <10th percentile
Abnormal umbilical artery Doppler velocimetry
Small-bowel atresia

LOS in NICU
LOS in hospital
Time to complete closure
Discharge status of infant
IABD
IUGR
IABD
None

NR<0.0001
0.0199
0.0052
NS
NS
NS

Davis et al., 2009 [9]Retrospective analysis of neonates with GS at a single institution between June 1998 and March 2007 46Comparisons made using Fisher’s exact test, Pearson’s test, Student’s -test for continuous variables, or ANOVA; = significantBowel dilatation (>10, >17, >20 mm)
Bowel wall thickness (>3, >4 mm)
AFI
Bowel atresia
Necrotic bowel
Bowel stenosis
In utero volvulus
∗∗Other outcomes explored but all NS
NoneNRNS

Houben et al., 2009 [13]Retrospective review of all infants born with GS at King’s College Hospital (UK) from August 1994 to December 2007 46Data quoted as median (range)IABD > 10 mm
Growth restrictions
Hyperperistalsis
Closing gastroschisis (defined as circumferential or partial closure of the ring around protruding bowel associated with intestinal atresia, bowel ischemia, bowel necrosis, or viable intestine) IABDNRNR

Payne et al., 2009 [22]Retrospective analysis of all GS patients born between January 1990 and December 2007 admitted at NICU of the Children’s Hospitals and Clinics of Minnesota, Minneapolis Campus 155Normality of data examined using Shapiro-Wilk test; nonnormal distributed variables were summarized as median and range; univariate analyses performed using Wilcoxon’s rank-sum or Fisher’s exact tests; linear regression used to determine association between parenteral nutrition and LOS; variables associated with LOS at were included in multiple regression; = significantAFI <5th percentile
AC <5th percentile
Dilated intestine (>10 mm, >18 mm)
GI complication

Requiring a silo
Primary repair
Dilated intestine >10 mm
Dilated intestine >18 mm
None
NR0.01
0.003
NS
NS

Nicholas et al., 2009 [17]Retrospective cohort study at Washington University Medical Center from 1991 to 2006 80Univariable and multivariable statistical analysis; backward stepwise logistic regression used to identify variables in final prediction model; = significant in univariate analysis; predictive effectiveness of final model evaluated using area under receiver operating characteristic curve (AUC-ROC)Dilated bowel >10 mm
Dilated stomach
IUGR
Hyperperistalsis
AFI anomalies
Composite: death, prolonged hospital stay, >2 surgeries, feeding difficulties, sepsis, atresia IUGR2.7 (1.0–7.3)0.05

Ajayi et al., 2011 [18]Retrospective review of pregnancies complicated by GS between 2000 and 2008 74Categorical data analyzed with Fisher’s exact test; statistical normality evaluated using Shapiro-Wilk statistic; continuous variables that were normally distributed compared using Student’s -test and continuous variables not normally distributed compared using Wilcoxon rank sum; = significantAC <2.5th percentileMortality
Primary closure
Necrotizing enterocolitis
Short gut syndrome
LOS
Days intubated
Days until room air oxygen
Days until full enteral feeding
Days on TPN
∗∗Other outcomes examined but all found to be NS
NoneNRNS

Alfaraj et al., 2011 [23]Retrospective study of singleton neonates with GS delivered at Mount Sinai Hospital with postnatal care at the Hospital for Sick Kids in Toronto, Canada, from January 2001 to February 201098Chi-square or Fisher’s exact test used for categorical data; continuous variables presented as mean SD; continuous variables compared used Student’s -test or Mann-Whitney test; conventional values corrected for multiple comparisons using Bonferroni method; = significantGastric dilatation >2 SD above normal value
SGA <5th percentile
Polyhydramnios (>25 cm)
Meconium stained amniotic fluid
Intestinal atresia, necrosis, or perforation
Need for intestinal resection
Age at full enteral feeding (days)
LOS (days)
Short bowel syndrome
Neonatal death
∗∗Other outcomes noted at but NS
Gastric dilatation
None
NR0.017
NS
NS
NS
NS
NS
NS

Contro et al., 2010 [12]Retrospective study of all GS cases between November 1998 and September 200848Categorical data compared with Fisher’s exact test; normality of continuous data tested using Kolmogorov-Smirnoff test; comparisons carried out using Student’s -test or Mann-Whitney test; = significantIABD > 6 mm
EABD > 6 mm
Bowel obstruction
Bowel resection
Second laparotomy
Time in NICU (days)
∗∗Other outcomes looked at but no value reported as they were NS
IABD

None
4.05
(1.12–14.7)
NR
0.037
0.045
0.021
0.062
Garcia et al., 2010 [4] Retrospective study of singletons with a prenatal diagnosis of GS at a tertiary center for fetal medicine in Brazil from January 1997 to August 2009 94Cut-off value for prediction determined in ROC curve; cases grouped according to bowel dilatation and compared with chi-square and Fisher’s exact test and Mann-Whitney testBowel dilatation >25 mmIntrauterine fetal death (IUD)
Neonatal death (NND)
Volvulus
Perforation
Any bowel complications
Atresia
Necrosis
Time to oral feeding (days)
LOS (days)
None

Bowel dilatation
NRNS
NS
NS
NS
0.003
0.007
0.03
0.02
0.04

Mears et al., 2010 [24] Retrospective study of all cases of isolated GS diagnosed antenatally from 2004 to 2008 47 Spearman correlations used to explore relationships between antenatal findings and outcome measurements. Differences between groups examined with Kruskal-Wallis and Mann-Whitney tests; -value <0.05 = significantIABD > 10 mm
EABD > 10 mm
Both IABD and EABD
Type of surgical repair (primary, silo, patch, or stoma)
Days on TPN
Complications
Death
EABD predicted primary closure

None
NR0.03

NS
NS
NS

Kuleva et al., 2012 [11] Retrospective case-control study of all antenatal diagnoses of isolated GS from 1999 to 2010 105Normality of continuous data tested using Kolmogorov-Smirnoff test; between-group comparisons using Fisher’s exact test, Mann-Whitney test, or Student’s -test; relationship between prenatal ultrasound markers, complex GS and adverse outcome tested by chi-square test and logistic univariate and multivariate regression; all values <0.05 = significantThickened intestinal wall
IABD > 6 mm
EABD > 6 mm
Dilated stomach
Stomach herniation
SGA
CGS
IUFD
ND
IABD
None
4.13 (1.32–12.90) 0.018
NS
NS

Long et al., 2011 [19] Cases of antenatally diagnosed GS were identified from an in-house database of antenatal ultrasound scans performed in the Fetal Management Unit at St Mary’s Hospital, Manchester, from January 1998 to December 2007 170Chi-square test used to compare categorical outcomes and Fisher exact test used where numbers of included individuals were <10; Mann-Whitney test used for nonparametric data; value <0.05 = significant Bowel dilatation >20 mm GA at delivery
Days on PN
Death
Surgery for IF
BW at delivery
Intestinal atresia
Bowel dilatation

None
NR0.02
0.03
0.01
NS
NS
0.07

McClellan et al., 2011 [20]Retrospective review of patients undergoing surgery for GS at the University of California Los Angeles Medical Center from 1995 to 2010 117Logistic regression used to compare association between mortality of gastroschisis patients with liver herniation with those without Liver herniationMortality Liver herniationNR

Mousty et al., 2012 [21] Retrospective cohort study of six singletons with GS associated with secondary fetal bladder herniation managed at a tertiary referral center between 2001 and 2010 6No statistics presentedBladder herniationMortalityBladder herniationNR

Wilson et al., 2012 [5] Retrospective review of all cases of GS evaluated prenatally at the Center for Advanced Maternal Fetal Care, September 2007–June 2010 89Categorical data compared with chi-square test, Student’s -test; < 0.05 = significant; linear regression used to estimate association between days in NICU and presence of any bowel dilatationBowel dilatation (IABD, EABD, or both) >10 mmGestational age at birth
Birth weight at delivery
Length of NICU admission
Number of surgeries
NoneNRNS

Janoo et al., 2013 [6] Retrospective cohort study, all cases of GS managed at West Virginia University Hospital Morgantown 1998–2002 19 value below 0.05 = significantBowel thickness
Final bowel dilatation
Delta dilatation
Time to feeding

Number of days on ventilator
Number of days in hospital
Final bowel dilatation
Delta dilatation
None
NR0.023
0.007
NS
NS

Goetzinger et al., 2014 [1]Retrospective cohort study, patients carrying singletons diagnosed with GS, at Washington University Medical Center Division of Ultrasound and Genetics from 2001 to 2010 94Normality tested using Kolmogorov-Smirnov test; Student’s -tests and Mann-Whitney tests used to compare continuous variables; chi-square and Fisher’s exact tests used to compare dichotomous categorical variablesIABD (<6, >10, >14, and >18 mm)
EABD
Bowel-wall thickening (>3 mm)
Bowel atresia
NICU length of stay (days)
Bowel atresia
NE
NICU length of stay (days)
Time to abdominal wall closure (days)
IABD > 14 mm

Thickened bowel wall
3.1 (1.2–8.2) 0.01
0.02
0.04
0.03
0.03
0.02

GS: gastroschisis; IUGR: intrauterine growth restriction; TPN: total parenteral nutrition; PO: time to full enteral feedings; NPO: total number of days feeding was held; IABD: intra-abdominal bowel dilatation; NICU: neonatal intensive care unit; AFI: amniotic fluid index; AC: abdominal circumference; GI: gastrointestinal; LOS: length of stay; SGA: small for gestational age; EABD: extra-abdominal bowel dilatation; CGS: complex gastroschisis; IUFD: intrauterine fetal demise; ND: neonatal death; GA: gestational age; IF: intestinal failure; BW: birth weight; NE: necrotizing enterocolitis.
∗∗Denotes explanation that follows.

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