Hospital readmission among infants with gastroschisis.
ABSTRACT Infants with gastroschisis have significant perinatal morbidity including long hospitalizations and feeding intolerance. Two thirds are premature and 20% are growth restricted. Despite these known risk factors for post-natal complications, little is known about readmission for infants with gastroschisis. Our objective was to determine the frequency and indication for hospital readmission after initial discharge among infants with gastroschisis.
Retrospective cohort study. All surviving infants treated for gastroschisis at Cincinnati Children's Hospital Medical Center, born between January 2006 and December 2008 were included. Main outcome measures included the frequency and indication for readmission. Associated neonatal risk factors also were assessed.
Fifty-eight patients were analyzed. Twenty-three (40%) subjects were readmitted (five with multiple readmissions); 65% of readmissions occurred in the first year and 70% involved complications directly related to gastroschisis. The most common reasons for readmission were bowel obstruction and abdominal distention/pain. Median time to readmission directly related to gastroschisis was 23 weeks (range 5 to 92). All three infants with home parenteral nutrition were readmitted. Readmission was not associated with gestational age, birth weight or length of initial hospitalization.
Readmission after initial hospitalization is common in gastroschisis patients. Parental counseling should include education regarding the possibility of complications requiring readmission. Determinants of readmission require further study.
- SourceAvailable from: Jan E Dickinson
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- "Gastroschisis is also increasingly recognized prior to birth , thereby facilitating delivery in institutions capable of providing definitive neonatal medical and surgical care. The immediate survival of infants born with gastroschisis has steadily improved with most series now reporting rates of over 90%    ; however, there still remains a significant risk of short and long-term adverse outcomes     . "
ABSTRACT: Purpose To determine the progress, physical and metabolic outcomes of gastroschisis survivors. Methods Fifty children born with gastroschisis were assessed with a health questionnaire, physical assessment, bone density and nutritional blood parameters at a median age of 9 years (range 5–17). Results After initial abdominal closure, 27/50 (54%) required additional surgical interventions. Ten (20%) children had complex gastroschisis (CG). Abdominal pain was common: weekly in 41%; and requiring hospitalization in 30%. The weight, length and head circumference z-scores improved by a median 0.88 (p = 0.001), 0.56 (p = 0.006) and 0.74 (p = 0.018) of a standard deviation (SD) respectively from birth; 24% were overweight or obese at follow up. However, those with CG had significantly lower median weight z-scores (− 0.43 v 0.49, p = 0.0004) and body mass index (BMI) (− 0.48 v 0.42, p = 0.001) at follow up compared to children with simple gastroschisis. Cholesterol levels were elevated in 24% of children. Bone mineral density was reassuring. There were 15 instances of low blood vitamin and mineral levels. Conclusions Although gastroschisis survival levels are high, many children have significant ongoing morbidity. Children with simple gastroschisis showed significant catch up growth and a quarter had become overweight.Journal of Pediatric Surgery 10/2014; 49(10):1466–1470. DOI:10.1016/j.jpedsurg.2014.03.008 · 1.31 Impact Factor
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ABSTRACT: The embryology, epidemiology, associated anomalies, prenatal course and the neonatal and surgical care of newborns with gastroschisis and omphalocele are reviewed. For gastroschisis temporary intestinal coverage is often done before a more definitive operative closure that may be immediate or delayed. Outcomes in gastroschisis are determined by associated bowel injury. For omphalocele small defects are closed primarily while large defects are treated topically to allow initial skin coverage before a later definitive closure. Outcomes for omphalocele are determined mainly by the presence of associated anomalies.Surgical Clinics of North America 06/2012; 92(3):713-27, x. DOI:10.1016/j.suc.2012.03.010 · 1.93 Impact Factor
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ABSTRACT: Our world is shrinking due to computerized linkages and the mobility of society. Information is shared rapidly around the world. Issues surrounding newborn and infant nursing are global. In efforts to acknowledge the international community, each Newborn and Infant Nursing Review issue will feature a column that highlights care-related issues from a featured country or region of the world. To review issues occurring in different areas of the world, a different area of the global will be featured that addresses the Newborn and Infant Nursing Review's theme-oriented topic. This month the column presents a global view including the United States on the topic of transition from the neonatal intensive care unit (NICU) to home and the postdischarge needs of the infant and family. Our guest author is Ms Marina Boykova, PhD(c), MSc, RN, doctoral student from the University of Oklahoma College of Nursing, Oklahoma City, OK, and a neonatal nurse from Saint Petersburg, Russia.Newborn and Infant Nursing Reviews 12/2012; 12(4):184–186. DOI:10.1053/j.nainr.2012.09.004