Abstract 1378

Introduction: In the neonatal patient gastroschisis (GS) is associated with significant morbidity and less frequently with mortality. Objective: To objective of this study was to review the experience of management of gastroschisis and to determine the perinatal factors, which may have an impact on neonatal outcome. Study design: This was a retrospective study of infants with gastroschisis who were admitted to St. Joseph's Health Centre and Children's Hospital of Western Ontario, London, Ontario, Canada during the period of January 1, 1990 to December 31, 1997. Maternal, fetal, neonatal and surgical data were collected and correlated with outcome (mortality, days on ventilator, days to full feeds and total length of hospital stay). Results: Thirty-seven infants were identified during the study period. Thirty-two infants (86.5%) survived and five (13.5%) died. The factors which were significantly associated with mortality were lower birth weight (p value = 0.03), delivery by caesarean section (p value = 0.02), and the use of surfactant replacement therapy (p value = 0.01). The mean birth weight (±SD) was 2,544 g (±522) and the mean gestational age (± SD) was 36.6 weeks (±2.3) indicating that the infants were near term and appropriately grown. A primary surgical repair was performed on 29 infants (88%) and staged repair on 8 (22%) infants. Among the survivors, the mean (±SD) duration of hospital stay was 35.2 (±17.1) days, the mean time (±SD) to enteral feeds was 28.7 (±16.4) days and the mean (±SD) duration of ventilation was 5.6 (±3.1)days. Among the survivors, gestational age, mode of delivery, birth weight and interval from birth to surgery were not significantly associated with outcome, however, staged repair resulted in an increase in duration of ventilation, time to full feeds and length of hospital stay. There was a trend of a less favorable outcome in the presence of the liver outside the abdomen and small bowel stenosis/atresia. Conclusion: This study suggests that a staged repair is associated with a worse outcome although this likely reflects the larger size of the defect and the contents outside the abdomen. The identification of the predictors of outcomes antenatally is important when counselling parents of infants with known gastroschisis.