GASTROSCHISIS: A PROSPECTIVE COHORT OUTCOME STUDY

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Gastroschisis occurs in approximately 1 in 5000 live births. The defect is is characterized by a smooth-edged opening located to the right of the umbilical cord, probably caused by abnormal involution of the right umbilical vein in utero. Most commonly the stomach, small intestine and colon are herniated through the defect. Gastroschisis is incompatible with life if left untreated. All infants with gastroschisis require reduction of the herniated intestine and closure of the adominal wall defect. Traditional treatment of the infant with gastroschisis consists of wrapping the eviscerated bowel in sterile gauze in the delivery room, transferring the baby to a neonatal intensive care unit, and performing emergent surgery. Using this approach, the bowel is reduced into the abdomen and the abdominal wall defect closed in the operating room. The abdominal cavity in infants with gastroschisis is occasionally too small to accommodate the return of herniated viscera because the bowel has lost its "right of domain" during fetal development. Complete return of herniated viscera and primary closure of the abdominal wall can lead to excessive intra-abdominal pressure and decreased pulmonary excursion. When complete reduction of the eviscerated contents is not possible, which occurs 20-25% of the time, a silastic "silo" is used to cover the eviscerated bowel. With gravity, time, and gentle pressure, the eviscerated bowel is returned to the abdomen, a process that usually takes 3-10 days. Once reduction is obtained, the silo is removed and the abdominal defect is closed in a second operation. Regardless of how the bowel is reduced, infants with gastroschisis are at risk for a number of poor outcomes including necrotizing enterocolitis (NEC), bowel ischemia, prolonged ileus, sepsis, liver injury, prolonged intubation, and death. pardThe purpose of this study is to prospectively review the outcome of all children with gastroschisis at Texas Children's Hospital or Ben Taub General Hospital. Specific outcomes that will be evaluated will include total time in the hospital, time until feedings are tolerated, need for additional surgery , and development of complications such as necrotizing enterocolitis or central line infections. A secondary purpose will be to collect pilot data on whether there is a correlation between low serum albumin levels and/or high CRP (C-reactive protein) levels and poor outcome.