October 1st, 2014

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Title:
Neonatal Outcomes by Mode of Delivery in Infants with Abdominal Wall Defects
Authors:  Heidi Leftwich, D.O., James F. X. Egan, M.D., Victor Herson, M.D., and Adam Borgida, M.D.
  OBJECTIVE: To compare neonatal outcomes for fetuses with gastroschisis and omphalocele by mode of delivery.

STUDY DESIGN: A retrospective review of maternal and neonatal charts from January 1999 to January 2009 was conducted, comparing multiple short-term neonatal outcomes. A multiple regression analysis was then employed to evaluate whether independent variables affected length of stay or length of mechanical ventilation.

RESULTS: A total of 75 fetuses with gastroschisis or omphalocele were reviewed. Decreased length of stay, length of ventilation, and episodes of neonatal sepsis were observed for fetuses with gastroschisis who were delivered via cesarean delivery. For omphalocele, a decreased length of stay, length of ventilation, episodes of obstruction, ischemia and rupture were observed with vaginal delivery. A multiple regression analysis showed gestational age to be a statistically significant variable for length of stay (p=0.0032). When comparing length of mechanical ventilation, only betamethasone therapy was statistically significant (p=0.0114).

CONCLUSION: When compared separately, though not statistically significant, fetuses with gastroschisis may have improved short-term outcomes with delivery by cesarean section. Vaginal delivery appears to have improved short-term outcomes for fetuses with omphalocele. When combined for analysis, the variables affecting these short-term outcomes appear to be gestational age and betamethasone therapy.
Keywords:  gastroschisis, obstetric delivery, omphalocele, umbilical hernia
   
   
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