March/April - West Virginia State Medical Association

Scientific Article |
several “association” parameters.
We did not include cases beyond
2002 to increase the study “N” as the
team of physicians involved in the
care of these patients changed after
2002. Nonetheless the current study
has confirmed some of the findings
in the literature but refuted other
reports in the literature. Penman
et al 5 found that Gastrochisis was
more common in women younger
than 20 years of age. Our study
confirmed this with the mean
age of mothers being at 20 years.
We did not find any intrauterine
deaths, which is different than the
mortality rates of 5-12% noted in
the literature. 6-8 This difference may
be because of the small number
of cases in our population.
The primary outcome was
mortality. Although a trend was
noted of mortality with increasing
bowel thickness, survival was not
associated with bowel thickness even
after the data had been controlled
for gestational age as no statistical
significance was achieved probably
due to the small sample size.
There have been some reports
in the literature that IUGR has
been overestimated in this group
because of the smaller abdominal
circumference. We omitted this
measurement in our estimation and
found that a significant number
of babies were still born with
intrauterine growth restriction.
The current literature notes the
presence of growth restriction in
Gastrochisis babies as high as 24-
67%. 7,9 This has been hypothesized
to be secondary to protein loss from
the exposed bowel. 10 This ultimately
affects the outcome of these
neonates. Our numbers are similar
to those reported in the literature.
We also looked at secondary
outcomes (Table 2) as a marker for
morbidity. There was no difference
seen for bowel thickness to time
to feeding, the number of days on
the ventilator or the total hospital
length of stay. Piper et al 11 reported
that bowel thickness did affect
time to feeding but we did not
note that in our study. Similarly no
difference was seen in dilation or
delta dilation to number of days on
ventilator or length of hospital stay.
There was a significant association
between delta dilation (at 4 mm) to
time to feeding (Table 3) p < 0.007.
There was no association between
gestational age at birth or mode of
delivery to time to feeding, length
of hospital stay or number of days
on ventilator. An earlier diagnosis
did not affect outcome, nor did
the visual appearance of the bowel
at the time of birth. There was
however, a significant association
between the type of Gastrochisis
and the length of hospital stay
as well as the number of days on
ventilator and time to feeding.
Fetuses with complex Gastrochisis,
defined as those with this condition
in addition to bowel atresia, had
a longer hospital stay p