Antenatal corticosteroids and outcomes in gastroschisis: A multicenter retrospective cohort study |
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| Authors: | Helen Carnaghan Catherine P James Paul B Charlesworth Marco Ghionzoli Susana Pereira Mohamed Elkhouli David Baud Paolo De Coppi Greg Ryan Prakesh S Shah Mark Davenport Anna L David Agostino Pierro Simon Eaton Gastroschisis Study Group |
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| Institution: | 1. UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children, London, UK;2. Fetal Medicine Unit, University College London Hospital, London, UK;3. Paediatric Surgery Unit, King's College Hospital, London, UK;4. Departamento de Obstetrícia e Ginecologia, Centro Hospitalar Tondela-Viseu, Viseu, Portugal;5. Fetal Medicine Unit, Mount Sinai Hospital, University of Toronto, Ontario, Canada;6. Division of Neonatology, Mount Sinai Hospital, University of Toronto, Ontario, Canada;7. Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Ontario, Canada |
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| Abstract: | Objective In gastroschisis, there is evidence to suggest that gut dysfunction develops secondary to bowel inflammation; we aimed to evaluate the effect of maternal antenatal corticosteroids administered for obstetric reasons on time to full enteral feeds in a multicenter cohort study of gastroschisis infants. Methods A three center, retrospective cohort study (1992-2013) with linked fetal/neonatal gastroschisis data was conducted. The primary outcome measure was time to full enteral feeds (a surrogate measure for bowel function) and secondary outcome measure was length of hospital stay. Analysis included Mann-Whitney and Cox regression. Results Of 500 patients included in the study, 69 (GA at birth 34 25-38] weeks) received antenatal corticosteroids and 431 (GA at birth 37 31-41] weeks) did not. Antenatal corticosteroids had no effect on the rate of reaching full feeds (Hazard ratio HR 1.0 95% CI: 0.8-1.4]). However, complex gastroschisis (HR 0.3 95% CI: 0.2-0.4]) was associated with an increased time to reach full feeds and later GA at birth (HR 1.1 per week increase in GA 95% CI: 1.1-1.2]) was associated with a decreased time to reach full feeds. Conclusion Maternal antenatal corticosteroids use, under current antenatal steroid protocols, in gastroschisis is not associated with an improvement in neonatal outcomes such as time to full enteral feeds or length of hospital stay. |
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