Prenatal Bowel Dilation Is Associated With Longer Hospital

Prenatal Bowel Dilation Is Associated With Longer Hospital Stay In Patients With Gastroschisis Geetha L. Radhakrishnan MD, Alexandria J. Hill MD, Mary B. Munn MD, Ravi S. Radhakrishnan MD, Rafael A. Fonseca MD Universtity of Texas Medical Branch, Department of Pediatrics PGY-III Introduction Results Although infants with gastroschisis typically fare well, their length of hospital stay and likelihood of complications are difficult to predict. Prenatal and postnatal parameters that are used to predict the outcomes in patients with gastroschisis remain controversial. This makes it difficult to provide reliable prenatal parental counseling. Currently, there are few prenatal variables that can reliably predict their postnatal course. Antenatal bowel dilation has been used as one of the indicators of prognosis. Serial measurements taken on antenatal ultrasound beginning at 20 weeks gestation may aid in deciding on the time of delivery as well the postnatal management of these patients. Currently, the degree of prenatal bowel dilation that predicts patient outcome remains controversial. Method After obtaining IRB approval, we performed a chart review of all patients born at the University of Texas Medical Branch in Galveston, TX from 2005 -2011 with the diagnosis of gastroschisis. We then collected serial prenatal ultrasound bowel diameter measurements, patient birth weight and discharge weight, mother’s age, length of stay, days to full feeds, length of TPN administration, as well as demographic information. Bowel dilation greater than 1. 6 cm indicated as long as a 2 month hospital admission. In contrast, dilation less than 1. 6 cm showed about a 1 month hospital course (p<0. 05). The length of time on TPN and time to full enteral feedings, however, were not significantly different between the two groups. In addition, there was no difference in maternal age, birth weight, or discharge weight. Table 1. Comparison of Gastroschisis Patients with Dilated and Non-dilated Bowel Maternal LOS Birth Age (yrs) (days) GA Birth Discharge Weight (g) Total Days to TPN full feeds days Non. Dilated 20. 42 38. 42 35. 83 2342. 00 3202. 14 20. 90 12. 46 Dilated 20. 00 52. 50 36. 92 2610. 00 3543. 50 23. 45 9. 56 pvalue 0. 306 0. 044 0. 124 0. 131 0. 300 0. 180 0. 048 Figure 1. Prenatal Ultrasound Image of Dilated Bowel Description of study From 2005 to 2011, a total of 45 patients born with gastroschisis at the University of Texas Medical Branch were reviewed. By working with physicians in maternal-fetal medicine, we obtained serial measurements of bowel dilation and bowel wall thickness in utero. The patients were then divided into two groups: those with bowel diameter of less than 1. 6 cm and those with bowel diameter greater than 1. 6 cm. Patient outcomes such as length of stay (LOS), total number of days on TPN (TPN days), time to reach full feeds, and other data such as gestational age, birth weight and complications of gastroschisis which include intestinal atresia, necrotizing enterocolitis and sepsis were examined. These data were analyzed by utilizing Student’s t-test. Conclusions Patients with gastroschisis have highly unpredictable hospital stays. Antenatal bowel dilation, as seen on prenatal ultrasound may represent a useful tool during prenatal parental counseling to help predict patient’s length of hospital stay. References 1. Kuleva M, Khen-Dunlop N, Dumez Y, et al. Is Complex Gastroschisis Predictable by Prenatal Ultrasound? BJOG. 2012 Jan; 119(1) 102 -109. 2. Long AM, Court J, Morabito A, et al. Antenatal Diagnosis of Bowel Dilatation in Gastroschisis is Predictive of Poor Postnatal Outcome. J Ped Surg. 2011 Jun; 46(6) 1070 -5. 3. Garcia L, Brizot M, Liao A, et al. Bowel Dilation as a Predictor of Adverse Outcome in Isolated Fetal Gastroschisis. Prenat Diag. 2010 Oct; 30(10) 9649. 4. Davis RP, Treadwell MC, Drongowski RA, et al. Risk Stratification in Gastroschisis: Can Prenatal Evaluation or Early Postnatal Factors Predict Outcome? Ped Surg Int. 2009 Apr; 25(4): 319 -25. Texas Pediatric Society Electronic Poster Contest