Simple vs. Complex Gastroschisis Outcomes: 30-Year Multicenter Review

Background

Gastroschisis is a congenital abdominal wall defect that has increased in prevalence at birth globally over the past three decades. Despite advancements in neonatal care, gaps remain in understanding the long-term outcomes and factors driving differences between simple (SG) and complex gastroschisis (CG). Previous studies have highlighted disparities in morbidity and mortality between these two groups but lack consistent data over extended periods. This study aims to address these gaps by evaluating outcomes over a 30-year period, hypothesizing that differences in clinical outcomes exist between SG and CG.

Methods

A retrospective review of Cerner Real World Data (1998–2022) was conducted for neonates with gastroschisis. SG and CG were defined by operative procedures and comorbidities used in published studies and/or by author consensus. Outcomes were analyzed using descriptive statistics. Primary endpoints included mortality, length of stay (LOS), ventilator use, necrotizing enterocolitis (NEC), intestinal dysmotility, and gastroesophageal reflux disease (GERD).

Results

The study cohort comprised 331 neonates, with 255 categorized as simple gastroschisis and 76 as complex gastroschisis. Whites comprised 62 % of SG and 63 % of CG (p = 0.9). CG was associated with higher rates of prematurity (33 % vs. 22 %, p = 0.002), GERD (16 % vs. 11 %, p = 0.4), NEC (11 % vs. 0.4 %, p < 0.0001), and dysmotility (11 % vs. 0 %, p < 0.0001). CG was also associated with decreased routine discharge (80 % vs. 85 %, p < 0.0001) and increased LOS (median 75 days [IQR: 29–130] vs. 33 days [IQR: 23–53], p < 0.001). There was no significant difference in survival to discharge between the two groups.

Conclusion

This large, retrospective review demonstrates differences in outcomes between SG and CG. Fetal providers should counsel accordingly to optimally prepare families who are expecting a newborn with gastroschisis.

Level of Evidence

III.