The long term physical consequences of gastroschisis ☆ Emma L. Harris a, b , Corrado Minutillo b, c, ⁎, Susannah Hart d , Teresa M. Warner a , Madhur Ravikumara c , Elizabeth A. Nathan e , Jan E. Dickinson d a King Edward Memorial Hospital for Women, Perth, Western Australia, Australia b Centre for Newborn Research and Education, The University of Western Australia, Perth, Western Australia, Australia c Princess Margaret Hospital for Children, Perth, Western Australia, Australia d School of Women’s and Infants’ Health, The University of Western Australia, Perth, Western Australia, Australia e Women and Infants Research Foundation, Perth, Western Australia, Australia abstract article info Article history: Received 8 November 2013 Received in revised form 4 March 2014 Accepted 11 March 2014 Key words: Gastroschisis Abdominal wall defect Growth Long term outcome Surgical complications Metabolic syndrome 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. © 2014 Published by Elsevier Inc. Gastroschisis is a serious congenital anterior abdominal wall defect with an increasing birth prevalence internationally [1–5]. Gastro- schisis is also increasingly recognized prior to birth [6], 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% [7–10]; however, there still remains a significant risk of short and long-term adverse outcomes [11–15]. The short and medium-term outcomes of congenital gastroschisis have been well documented in several studies [8–13,16–18]. The majority of infants born with gastroschisis experience bowel- associated complications and in a study by Durfee et al. only 11% of infants had an entirely uncomplicated post-surgical course [9].A review of outcomes at one-year of age from the United Kingdom demonstrated that infants with complex gastroschisis experience a longer duration of parenteral feeding and hospitalization compared with simple gastroschisis cases [11]. The long term outcomes of gastroschisis have been less well studied [13,14,19,20]. In a 30-year follow up study, van Eijck et al. found complications such as abdominal pain (30%) and constipation (20%) were common. This study did not distinguish gastroschisis from exomphalos, however they did specifically report a small bowel obstruction rate of 25% in gastroschisis [14]. Vitamin and mineral deficiencies can have serious implications for general well-being and development; these deficiencies are well documented in children recovering from neonatal intestinal failure [21]. However, we are not aware of any long-term data on micronutrient status in survivors of less complicated forms of neonatal intestinal diseases. Because adult bone health is linked to childhood growth and health [22], both of which can be suboptimal in gastroschisis, we evaluated bone status with a bone mineral density scan. Therefore, this study was designed to assess a well defined population-based cohort of children born with gastroschisis with the following aims: firstly, to document the surgical progress of children Journal of Pediatric Surgery 49 (2014) 1466–1470 Abbreviations: BMD, Bone mineral density; IQR, Interquartile range; R, Range; CG, Complicated Gastroschisis group; BMI, Body mass index; BP, Blood pressure. ☆ Disclosure: The study was funded by a research grant obtained from Channel 7 Telethon, Western Australia.The authors declare NO conflict of interest, real or perceived by the study sponsor or authors in: (1) study design; (2) the collection, analysis, and interpretation of data; (3) the writing of the report; and (4) the decision to submit the paper for publication. Dr Emma Harris wrote the first draft of the manuscript. No honorarium, grant, or other form of payment was given to anyone to produce the manuscript. ⁎ Corresponding author at: Princess Margaret Hospital for Children, GPO Box D184, Perth, Western Australia, Australia, 6840. Tel.: +61 8 93408672; fax: +61 8 93. E-mail address: corrado.minutillo@health.wa.gov.au (C. Minutillo). http://dx.doi.org/10.1016/j.jpedsurg.2014.03.008 0022-3468/© 2014 Published by Elsevier Inc. Contents lists available at ScienceDirect Journal of Pediatric Surgery journal homepage: www.elsevier.com/locate/jpedsurg