GASTROSCHISIS - CAN THE MORBIDITY BE AVOIDED

Although the mortality associated with gastroschisis (GS) has fallen m arkedly over recent years, postoperative morbidity and the incidence o f complications remain high. Many different factors may contribute to this morbidity; the aim of this study was to determine which factors c ontributed most. Measures of morbidity used were time to full oral fee ding (FOF), time on parenteral nutrition (PN), age at discharge, and i ncidence of complications. Between 1969 and 1995, 44 neonates with GS were treated; there were 6 deaths, The average initial temperature of the patients who died was 34.6 degrees C compared with 36.0 degrees C for the rest of the group (P = 0.02). Staged repair and prematurity we re associated with increased time to FOF, time on PN, and age al disch arge (P < 0.001). When the corrected post-term age was used, the diffe rence between preterm and term babies was no longer significant. Mode of delivery did not influence any measure of morbidity. Seventeen pati ents (46%) had complications related to PN administration and 18 (43%) developed complications related to their surgery. There were no signi ficant differences in these measures of morbidity when comparing patie nts born in the first half of the study period with those born in the last half. Multivariate analysis revealed that time to FOF, time on PN , and age at discharge were all strongly independently associated with staged repair and with the presence of complications of PN (all F > 7 .2 and P < 0.01). Mode of delivery, gestational age, admission tempera ture, the need for postoperative ventilation, and complications of sur gery were not independently associated with ally of the measures of mo rbidity examined, Our data suggest that term delivery anti primary clo sure of the defect are likely to minimise the morbidity experienced by infants with GS.