Clinical features and practice patterns of gastroschisis: a retrospective analysis using a Japanese national inpatient database

  • Michimasa Fujiogi
  • Nobuaki Michihata
  • Hiroki Matsui
  • Kiyohide Fushimi
  • Hideo Yasunaga
  • Jun Fujishiro
Original Article

Abstract

Purpose

The number of infants with gastroschisis is increasing worldwide, but advances in neonatal intensive care and parenteral nutrition have reduced gastroschisis mortality. Recent clinical data on gastroschisis are often from Western nations. This study aimed to examine clinical features and practice patterns of gastroschisis in Japan.

Methods

We examined treatment options, outcomes, and discharge status among inpatients with simple gastroschisis (SG) and complex gastroschisis (CG), 2010–2016, using a national inpatient database in Japan.

Results

The 247 eligible patients (222 with SG) had average birth weight of 2102 g and average gestational age of 34 weeks; 30% had other congenital anomalies. Digestive anomalies were most common, followed by circulatory anomalies. In-hospital mortality was 8.1%. The median age at start of full enteral feeding was 30 days. The median length of stay was 46 days. There were no significant differences in outcomes except for length of stay, starting full enteral feeding and total hospitalization costs between the SG and CG groups. About 80% of patients were discharged to home without home medical care. The readmission rate was 28%.

Conclusion

This study’s findings on the clinical characteristics and outcomes of gastroschisis are useful for the clinical management of gastroschisis.

Keywords

Pediatric surgery Neonatal Gastroschisis Complex gastroschisis Abdominal wall defect 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Study approval was obtained from the Institutional Review Board at the University of Tokyo.

Informed consent

The requirement for informed consent was waived for this study because of the anonymous nature of the data.

References

  1. 1.
    Gamba P, Midrio P (2014) Abdominal wall defects: prenatal diagnosis, newborn management, and long-term outcomes. Semin Pediatr Surg 23:283–290.  https://doi.org/10.1053/j.sempedsurg.2014.09.009 CrossRefPubMedGoogle Scholar
  2. 2.
    Fillingham A, Rankin J (2008) Prevalence, prenatal diagnosis and survival of gastroschisis. Prenat Diagn 28:1232–1237.  https://doi.org/10.1002/pd.2153 CrossRefPubMedGoogle Scholar
  3. 3.
    Wilson RD, Johnson MP (2004) Congenital abdominal wall defects: an update. Fetal Diagn Ther 19:385–398.  https://doi.org/10.1159/000078990 CrossRefPubMedGoogle Scholar
  4. 4.
    Mastroiacovo P, Lisi A, Castilla EE (2006) The incidence of gastroschisis: research urgently needs resources. BMJ 332:423–424CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Alvarez SM, Burd RS (2007) Increasing prevalence of gastroschisis repairs in the United States: 1996–2003. J Pediatr Surg 42:943–946.  https://doi.org/10.1016/j.jpedsurg.2007.01.026 CrossRefPubMedGoogle Scholar
  6. 6.
    Bradnock TJ, Marven S (2011) Gastroschisis: one year outcomes from national cohort. BMJ 6749:1–9.  https://doi.org/10.1136/bmj.d6749 Google Scholar
  7. 7.
    Gupta R, Cabacungan ET (2018) Outcome of neonates with gastroschisis at different gestational ages using a national database. J Pediatr Surg 53:661–665.  https://doi.org/10.1016/j.jpedsurg.2017.07.015 CrossRefPubMedGoogle Scholar
  8. 8.
    Fullerton BS, Velazco CS, Sparks EA et al (2017) Contemporary outcomes of infants with gastroschisis in North America: a multicenter cohort study. J Pediatr 188:192–197.e6.  https://doi.org/10.1016/j.jpeds.2017.06.013 CrossRefPubMedGoogle Scholar
  9. 9.
    Owen A, Marven S, Johnson P et al (2010) Gastroschisis: a national cohort study to describe contemporary surgical strategies and outcomes. J Pediatr Surg 45:1808–1816.  https://doi.org/10.1016/j.jpedsurg.2010.01.036 CrossRefPubMedGoogle Scholar
  10. 10.
    Dingemann C, Dietrich J, Zeidler J et al (2017) Surgical management of congenital abdominal wall defects in Germany: a population-based study and comparison with literature reports. Eur J Pediatr Surg 27:516–525.  https://doi.org/10.1055/s-0037-1598250 CrossRefPubMedGoogle Scholar
  11. 11.
    Kong JY, Yeo KT, Abdel-Latif ME et al (2016) Outcomes of infants with abdominal wall defects over 18 years. J Pediatr Surg 51:1644–1649.  https://doi.org/10.1016/j.jpedsurg.2016.06.003 CrossRefPubMedGoogle Scholar
  12. 12.
    Salihu HM, Aliyu ZY, Pierre-Louis BJ et al (2004) Omphalocele and gastroschisis: black–white disparity in infant survival. Birth Defects Res Part A -. Clin Mol Teratol 70:586–591.  https://doi.org/10.1002/bdra.20067 CrossRefGoogle Scholar
  13. 13.
    Stone ML, Lapar DJ, Kane BJ et al (2013) The effect of race and gender on pediatric surgical outcomes within the United States. J Pediatr Surg 48:1650–1656.  https://doi.org/10.1016/j.jpedsurg.2013.01.043 CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Mohamed MA, Aly H (2012) Birth region, race and sex may affect the prevalence of congenital diaphragmatic hernia, abdominal wall and neural tube defects among US newborns. J Perinatol 32:861–868.  https://doi.org/10.1038/jp.2011.184 CrossRefPubMedGoogle Scholar
  15. 15.
    Yamana H, Moriwaki M, Horiguchi H et al (2017) Validity of diagnoses, procedures, and laboratory data in Japanese administrative data. J Epidemiol 27:476–482.  https://doi.org/10.1016/j.je.2016.09.009 CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Ishitsuka K, Matsui H, Michihata N et al (2015) Medical procedures and outcomes of Japanese patients with trisomy 18 or trisomy 13: analysis of a nationwide administrative database of hospitalized patients. Am J Med Genet Part A 167:1816–1821.  https://doi.org/10.1002/ajmg.a.37104 CrossRefGoogle Scholar
  17. 17.
    WHO (2018) WHO international classification of diseases. http://www.who.int/classifications/icd/en/. Accessed 13 Feb 2018
  18. 18.
    Molik KA, Gingalewski CA, West KW et al (2001) Gastroschisis: a plea for risk categorization. J Pediatr Surg 36:51–55.  https://doi.org/10.1053/jpsu.2001.20004 CrossRefPubMedGoogle Scholar
  19. 19.
    Suita S, Okamatsu T, Yamamoto T et al (2000) Changing profile of abdominal wall defects in Japan: results of a national survey. J Pediatr Surg 35:66–71CrossRefPubMedGoogle Scholar
  20. 20.
    Corey KM, Hornik CP, Laughon MM et al (2011) Frequency of anomalies and hospital outcomes in infants with gastroschisis and omphalocele. Early Hum Dev 193:118–125.  https://doi.org/10.1016/j.earlhumdev.2014.05.006 Google Scholar
  21. 21.
    Lao OB, Larison C, Garrison MM et al (2010) Outcomes in neonates with gastroschisis in U.S. children’s hospitals. Am J Perinatol 27:97–101.  https://doi.org/10.1055/s-0029-1241729 CrossRefPubMedGoogle Scholar
  22. 22.
    Morisaki N, Urayama KY, Yoshii K et al (2017) Ecological analysis of secular trends in low birth weight births and adult height in Japan. J Epidemiol Community Health 71:1014–1018CrossRefPubMedGoogle Scholar
  23. 23.
    Takimoto H, Yokoyama T, Yoshiike N, Fukuoka H (2005) Increase in low-birth-weight infants in Japan and associated risk factors, 1980–2000. J Obstet Gynaecol Res 31:314–322CrossRefPubMedGoogle Scholar
  24. 24.
    Barrett MJ, Kozdoba O, Al Assaf N et al (2014) The national incidence and outcomes of gastroschisis repairs. Ir Med J 107:83–85PubMedGoogle Scholar
  25. 25.
    Benjamin B, Wilson GN (2014) Anomalies associated with gastroschisis and omphalocele: analysis of 2825 cases from the Texas Birth Defects Registry. J Pediatr Surg 49:514–519.  https://doi.org/10.1016/j.jpedsurg.2013.11.052 CrossRefPubMedGoogle Scholar
  26. 26.
    Kuleva M, Khen-Dunlop N, Dumez Y et al (2012) Is complex gastroschisis predictable by prenatal ultrasound? BJOG Int J Obstet Gynaecol 119:102–109.  https://doi.org/10.1111/j.1471-0528.2011.03183.x CrossRefGoogle Scholar
  27. 27.
    Weinsheimer RL, Yanchar NL, Bouchard SB et al (2008) Gastroschisis closure-does method really matter? J Pediatr Surg 43:874–878.  https://doi.org/10.1016/j.jpedsurg.2007.12.030 CrossRefPubMedGoogle Scholar
  28. 28.
    Bergholz R, Boettcher M, Reinshagen K, Wenke K (2014) Complex gastroschisis is a different entity to simple gastroschisis affecting morbidity and mortality—a systematic review and meta-analysis. J Pediatr Surg 49:1527–1532.  https://doi.org/10.1016/j.jpedsurg.2014.08.001 CrossRefPubMedGoogle Scholar
  29. 29.
    Zamakhshary M, Yanchar NL (2007) Complicated gastroschisis and maternal smoking: a causal association? Pediatr Surg Int 23:841–844.  https://doi.org/10.1007/s00383-007-1926-6 CrossRefPubMedGoogle Scholar
  30. 30.
    Habiba M, Da Frè M, Taylor DJ et al (2009) Late termination of pregnancy: a comparison of obstetricians’ experience in eight European countries. BJOG An Int J Obstet Gynaecol 116:1340–1349.  https://doi.org/10.1111/j.1471-0528.2009.02228.x CrossRefGoogle Scholar
  31. 31.
    Hostalery L, Tosello B (2017) Outcomes in continuing pregnancies diagnosed with a severe fetal abnormality and implication of antenatal neonatology consultation: a 10-year retrospective study. Fetal Pediatr Pathol 36:203–212.  https://doi.org/10.1080/15513815.2017.1296519 CrossRefPubMedGoogle Scholar
  32. 32.
    Breeze ACG, Lees CC, Kumar A et al (2007) Palliative care for prenatally diagnosed lethal fetal abnormality. Arch Dis Child Fetal Neonatal Ed 92:56–58.  https://doi.org/10.1136/adc.2005.092122 CrossRefGoogle Scholar
  33. 33.
    Balaguer A, Martín-Ancel A, Ortigoza-Escobar D et al (2012) The model of palliative care in the perinatal setting: a review of the literature. BMC Pediatr 12:25.  https://doi.org/10.1186/1471-2431-12-25 CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Courtwright AM, Laughon MM, Doron MW (2011) Length of life and treatment intensity in infants diagnosed prenatally or postnatally with congenital anomalies considered to be lethal. J Perinatol 31:387–391.  https://doi.org/10.1038/jp.2010.124 CrossRefPubMedGoogle Scholar
  35. 35.
    Boghossian NS, Hansen NI, Bell EF et al (2014) Mortality and morbidity of VLBW infants with trisomy 13 or trisomy 18. Pediatrics 133:226–235.  https://doi.org/10.1542/peds.2013-1702 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Michimasa Fujiogi
    • 1
    • 2
  • Nobuaki Michihata
    • 3
  • Hiroki Matsui
    • 2
  • Kiyohide Fushimi
    • 4
  • Hideo Yasunaga
    • 2
  • Jun Fujishiro
    • 1
  1. 1.Department of Pediatric Surgery, Graduate School of MedicineThe University of TokyoTokyoJapan
  2. 2.Department of Clinical Epidemiology and Health Economics, School of Public HealthThe University of TokyoTokyoJapan
  3. 3.Department of Health Services Research, Graduate School of MedicineThe University of TokyoTokyoJapan
  4. 4.Department of Health Policy and InformaticsGraduate School of Medicine, Tokyo Medical and Dental UniversityTokyoJapan

Personalised recommendations