Outcome of isolated gastroschisis; an international study, systematic review and meta-analysis

Objective: To determine outcome of children born with isolated gastroschisis (no extra-gastrointestinal congenital abnormalities). Study design: International cohort study and meta -analysis. Primary outcome: time to full enteral feeding (TFEF); secondary outcomes; Duration of mechanical ventilation, length of stay (LOS), mortality and differences in outcome between simple and complex gastroschisis (complex; born with bowel atresia, volvulus, perforation or necrosis). To compare the cohort study results with literature three databases were searched. Studies were eligible for inclusion if cases were born in developed countries with isolated gastroschisis after 1990, number of cases >20 and TFEF was reported. Results: The cohort study included 204 liveborn cases of isolated gastroschisis. The TFEF, median duration of ventilation and LOS was, 26 days (range 6-515), 2 days (range 0-90) and 33 days (range 11-515), respectively. Overall mortality was 10.8%. TFEF and LOS were significantly longer (P <0.0001) and mortality was fourfold higher in the complex group. Seventeen studies, amongst the current study, were included for further meta analysis comprising a total of 1652 patients. Mean TFEF was 35.3 +/- 4.4 days, length of ventilation was 5.5 +/- 2.0 days, LOS was 46.4 +/- 52 days and mortality risk was 0.06 [0.04-0.07 95%CI]. Outcome of simple and complex gastroschisis was described in five studies. TFEF, ventilation time, LOS were significant longer and mortality rate was 3.64 [1.95-6.83 95%CI] times higher in complex cases. Conclusions: These results give a good indication of the expected TFEF, ventilation time and LOS and mortality risk in children born with isolated gastroschisis, although ranges remain wide. This study shows the importance of dividing gastroschisis into simple and complex for the prediction of outcome