NEONATOLOGY
Dilation Complication
Can abdominal dilation predict complex gastroschisis ?
Timing the delivery of a high-risk baby can be a delicate balance . That ’ s particularly true for gastroschisis , a congenital disorder in which some organs , most commonly the intestines , develop outside the abdominal wall .
In close to 90 % of cases , patients are born without complications and cured with a relatively low-risk surgery . The other 10 % of cases , however , can become life-threatening in the second trimester .
Fetal surgeon Kenneth Liechty , MD , and his team at the Colorado Fetal Care Center at Children ’ s Hospital Colorado , recently shed light on a predictive factor .
Dr . Liechty had speculated for some time that bowel dilation might correlate with complexity . If the opening in the abdominal wall constricted the intestines , he reasoned , the resulting blockage and buildup of fluid might lead to bowel dilation , either externally or internally . Previous studies , however , had not revealed such a correlation .
Identifying prenatal ultrasound findings associated with the risk of poor gastroschisis outcomes
Occurs in 4.9 of every 10,000 births
Gastroschisis is diagnosed as “ complex ” if the development of the intestines appears to be compromised .
Complex gastroschisis can result in increased infant morbidity and mortality and is often not diagnosed until after birth . Prenatal diagnosis could allow for perinatal management of these patients .
Complex gastroschisis costs $ 250,000 per patient per hospital stay
Can ultrasounds diagnose the risks of complex gastroschisis and poor outcomes ?
A retrospective review
Dr . Liechty and colleagues had three study objectives :
“ I think the difference between previous studies and this one is really the rigor involved ,” says Dr . Liechty . “ This wasn ’ t just one sampling . We followed 55 patients over time , looking at about a dozen different variables .”
1
Describe differences in ultrasonographic measures between complex and simple gastroschisis
One of those variables was distinguishing between extraabdominal and intra-abdominal intestinal diameter . That turned out to be key . An intra-abdominal diameter of more than 17 mm correctly identified 75 % of complex cases . The negative correlation was even stronger , with an intra-abdominal diameter of less than 17 mm identifying 92 % of “ simple ” cases .
“ There may be other factors involved ,” says Dr . Liechty . “ There may be inflammatory processes ; the bowel being exposed to amniotic fluid may lead to progressive bowel damage . So if these predictive factors are pointing to a poor outcome , it may be better to deliver earlier and decrease the duration of those insults .” •
2
3
Determine relationships between ultrasonography measures and patient outcomes
Identify a potential measure useful in predicting patient outcomes
Study criteria
• ICD diagnosis code of “ gastroschisis ”
• Admitted to a free-standing children ’ s hospital with a Level 3 NICU between 2007 and 2017
• No missing ultrasound report or images
4 | CHILDREN ’ S HOSPITAL COLORADO