TY  - JOUR
A1  - Timothy J Bradnock
A1  - Sean Marven
A1  - Anthony Owen
A1  - Paul Johnson
A1  - Jennifer J Kurinczuk
A1  - Patsy Spark
A1  - Elizabeth S Draper
A1  - Marian Knight
T1  - Gastroschisis: one year outcomes from national cohort study
JF  - BMJ
Y1  - 2011/11/15
VL  - 343
N1  - 10.1136/bmj.d6749
UL  - http://www.bmj.com/content/343/bmj.d6749
N2  - Timothy J Bradnock, specialty registrar in paediatric surgery1, Sean Marven, consultant paediatric surgeon2, Anthony Owen, specialty registrar in paediatric surgery2, Paul Johnson, professor of paediatric surgery3, Jennifer J Kurinczuk, professor of perinatal epidemiology4, Patsy Spark, programmer4, Elizabeth S Draper, professor of perinatal and paediatric epidemiology5, Marian Knight, senior clinical research fellow4 on behalf of BAPS-CASS1Department of Paediatric Surgery, Royal Hospital for Sick Children, Glasgow, Scotland, UK2Paediatric Surgical Unit, Sheffield Children’s Hospital NHS Foundation Trust, Sheffield, UK3Department of Paediatric Surgery, University of Oxford, Oxford, UK4National Perinatal Epidemiology Unit, University of Oxford, Oxford OX3 7LF5Department of Health Sciences, University of Leicester, Leicester, UKCorrespondence to: M Knight marian.knight{at}npeu.ox.ac.ukAccepted 23 September 2011AbstractObjective To describe one year outcomes for a national cohort of infants with gastroschisis.Design Population based cohort study of all liveborn infants with gastroschisis born in the United Kingdom and Ireland from October 2006 to March 2008. Setting All 28 paediatric surgical centres in the UK and Ireland.Participants 301 infants (77%) from an original cohort of 393.Main outcome measures Duration of parenteral nutrition and stay in hospital; time to establish full enteral feeding; rates of intestinal failure, liver disease associated with intestinal failure, unplanned reoperation; case fatality.Results Compared with infants with simple gastroschisis (intact, uncompromised, continuous bowel), those with complex gastroschisis (bowel perforation, necrosis, or atresia) took longer to reach full enteral feeding (median difference 21 days, 95% confidence interval 9 to 39 days); required a longer duration of parenteral nutrition (median difference 25 days, 9 to 46 days) and a longer stay in hospital (median difference 57 days, 29 to 95 days); were more likely to develop intestinal failure (81% (25 infants) v 41% (102); relative risk 1.96, 1.56 to 2.46) and liver disease associated with intestinal failure (23% (7) v 4% (11); 5.13, 2.15 to 12.3); and were more likely to require unplanned reoperation (42% (13) v 10% (24); 4.39, 2.50 to 7.70). Compared with infants managed with primary fascial closure, those managed with preformed silos took longer to reach full enteral feeding (median difference 5 days, 1 to 9) and had an increased risk of intestinal failure (52% (50) v 32% (38); 1.61, 1.17 to 2.24). Event rates for the other outcomes were low, and there were no other significant differences between these management groups. Twelve infants died (4%).Conclusions This nationally representative study provides a benchmark against which individual centres can measure outcome and performance. Stratifying neonates with gastroschisis into simple and complex groups reliably predicts outcome at one year. There is sufficient clinical equipoise concerning the initial management strategy to embark on a multicentre randomised controlled trial comparing primary fascial closure with preformed silos in infants suitable at presentation for either treatment to determine the optimal initial management strategy and define algorithms of care.FootnotesThis study would not have been possible without the collaboration of BAPS-CASS reporting clinicians throughout the UK and Ireland: Addenbrooke’s Hospital (Adil Aslam, Christopher Parsons, Marcin Kamierski), Birmingham Children’s Hospital (Anthony Lander, Andrew Robb, Humza Malik), Bristol Royal Hospital For Children (Eleri Cusick, Evelyn Ong), Chelsea and Westminster Healthcare Trust (Nicholas Madden, Clare Skerritt, Anindya Niyogi), Edinburgh Royal Hospital for Sick Children (Gordon MacKinlay, Boma Adikibi), Glasgow Royal Hospital for Sick Children (Atul Sabharwal), Great Ormond Street Hospital for Sick Children (Joe Curry), Hull Royal Infirmary (Sanja Besarovic), John Radcliffe Hospital (Paul Johnson, Javaid Sadiq), King’s College Hospital (Mark Davenport), Leeds General Infirmary (Ian Sugarman, Anthony Owen), Leicester Royal Infirmary (Shawqui Nour), Norfolk and Norwich University Hospital (Thomas Tsang), Nottingham University Hospitals NHS Trust (Brian Davies, Richard Stewart), Our Lady’s Hospital for Sick Children (Prem Puri, Farhan Tareen), Queen Charlotte’s and Chelsea Hospital (Robin Abel), Royal Aberdeen Children’s Hospital (Christopher Driver), Royal Alexandra Children’s Hospital (Anies Mahomed, Rebecca Lisle), Royal Belfast Hospital for Sick Children (William A McCallion, Suzanne Lawther), Royal Liverpool Children’s Hospital (Paul Losty, David Wilkinson), Royal London Hospital (Catherine Cord-Udy, Simon Phelps), Royal Manchester Children’s Hospital (Antonino Morabito, Anju Goyal), Royal Victoria Infirmary (Gareth Hosie), Sheffield Children’s Hospital (Sean Marven, Karen Lloyd), Southampton General (David Burge, Melanie Drewett), St George’s Hospital (Bruce Okoye), University Hospital Lewisham (Catherine Richards), University Hospital of Wales (Simon Huddart, Daniela Vieten, Ram Shrestha).We also thank Judith Budd, Mary Bythell, Catherine Rounding, Rosie Thompson, Ann Tonks, David Tucker, and Diana Wellesley from the British Isles Network of Congenital Anomalies Registers and clinicians reporting cases to the UK Obstetric Surveillance System (UKOSS), who helped with additional case ascertainment. The support of the British Association of Paediatric Surgeons contributed greatly to the success of the study.Contributors: TJB carried out the analysis and wrote the first draft of the paper. SM assisted with the design of the study, provided clinical input, and contributed to the analysis and writing the paper. AO assisted with the design of the study. PJ provided clinical input to the study and contributed to the analysis and writing of the paper. JJK assisted with the design of the study and contributed to the analysis and writing of the paper. PS assisted with data coding and conducted validation of the data and some analysis. MK designed the study, coordinated data collection, coded the data, supervised the analysis, and contributed to the writing and editing of the paper. All authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. MK is guarantor.Funding: This study was funded by the charity BDF Newlife and the British Association of Paediatric Surgeons. The study funders played no part in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication. All authors are independent of the funders.Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.Ethical approval: This study was approved by the London multicentre research ethics committee (reference 05/MRE02/82).Data sharing: Data sharing is governed by the National Perinatal Epidemiology Unit Data Sharing Policy, which can be obtained from the corresponding author.This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/  and  http://creativecommons.org/licenses/by-nc/2.0/legalcode.
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