Incidence and Predictors of Mortality in Gastroschisis: A Population-Based Study of 4, 803 Cases in the United States [35K]. (May 2018)

• Record Type: Journal Article
• Authors: Brebner, Alison; Czuzoj-Shulman, Nicholas; Abenhaim, Haim Arie
• Is Part Of: Obstetrics and gynecology. Volume 131(2018)Supplement 1
• Publication Date: 2018-05
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1097/01.AOG.0000533537.44035.d4
• Languages: English
• ISSNs: 0029-7844

Abstract

Abstract : INTRODUCTION: Gastroschisis is a rare congenital anomaly consisting of a full-thickness abdominal wall defect, with survival normally exceeding 90%. Few large-scale studies have examined the predictors of mortality for these infants. Our objective was to use a large database to determine predictors of mortality in gastroschisis, its incidence and mortality rate over time. METHODS: Using the "Period linked Birth-Infant Death" database (CDC) from 2009 to 2013, we collected all infants coded as having gastroschisis. Using multivariable linear regression for various maternal and infant characteristics, we calculated predictors of mortality. We also determined the incidence, death rate and age of death for our cohort. RESULTS: There were 4, 803 cases of gastroschisis, with 287 deaths. The incidence of gastroschisis increased from 2.04 to 2.49/10, 000 births. The rate of death stayed constant around 5.9%. 38.1% of these infants died on day 0 of life. Statistically significant predictors of mortality were paying out of pocket for healthcare, maternal obesity, pre-pregnancy diabetes, birth weight <2, 500 g, gestational age <34 weeks and the presence of an additional congenital anomaly (46.2% mortality, OR 13.91). CONCLUSION: The incidence of gastroschisis in the United States increased, yet mortality rate remained stable. Mothers with DM1 or 2 should be counselled on the significantly higher risk of mortality, and be encouraged to diligently control their glycemias. The infants born preterm <34 weeks, or with birth weights <2, 500 g were at the highest risk. The presence of an additional congenital anomaly is an important prognostic factor, with a high associated mortality. This information can be used in prenatal counselling.