ORIGINAL ARTICLE S.J. Singh Æ A. Fraser Æ J.F. Leditschke Æ K. Spence R. Kimble Æ J. Dalby-Payne Æ S. Baskaranathan P. Barr Æ R. Halliday Æ N. Badawi Æ J.K. Peat M. Glasson Æ D. Cass Gastroschisis: determinants of neonatal outcome Accepted: 16 January 2002 / Published online: 3 April 2003 Ó Springer-Verlag 2003 Abstract This retrospective study elicits information regarding the dependence of neonatal outcome in gas- troschisis upon: (1) the mode of delivery, (2) place of birth, (3) time for birth to surgery, (4) method of closure, (5) time from operation to commencement of first enteral feeds. The neonatal intensive care database from five major tertiary centres was used to identify 181 neonates with gastroschisis from 1990 to 2000. There were 8 deaths. There were no significant differences in outcome for infants delivered vaginally (102) versus Caesarean section (79), those born near the tertiary centre (133) as compared to infants born away (48), ones operated within 7 hours (125) compared with those operated after 7 hours (56), with delayed closure (30) versus primary closure (151). Neonates fed within 10 days of operation (85) had significantly lower incidence of sepsis, duration of TPN and hospital stay when compared to those fed after 10 days (96). Early commencement of feeds decreases the incidence of sepsis, duration of total parenteral nutrition (TPN) and hospital stay. Place of delivery, mode of delivery, time to surgery and type of closure do not influence neonatal outcome. Keywords Gastroschisis Æ Mortality Æ Enteral feeding Æ Total Parenteral nutrition Æ Sepsis Introduction Gastroschisis is a small, full thickness abdominal wall defect that is almost always located to the right of the umbilicus. The herniated bowel may be shortened, thickened and covered in a fibrous peel. The prevalence of gastroschisis in Australia is 0.8 to 2.0 per 10000 births [1]. There are a few issues in the management of gastro- schisis that continue to be debated in the literature [2–15]. These issues relate to; (1) the ideal mode of delivery of infants with gastroschisis, (2) the ideal place of delivery, (3) method of closure and (4) time form birth to initial surgery. This retrospective study was imple- mented to address the above state 4 issues on the basis of a multi-institutional study. The fifth variable to be dis- cussed, that does not seem to have been studied at all in relationship to gastroschisis, is the role of early com- mencement of trophic feeds. Methods A retrospective review from the case notes of 181 consecutive neonates treated for gastroschisis between 1990 and 2000. This study involved 5 tertiary centres; Royal Alexandra Hospital for Children at Camperdown (Sydney), Westmead Hospital (Sydney), The Children’s Hospital and Westmead (Sydney), Royal Children’s Hospital (Brisbane) and Mater Misericordiae Hospital (Brisbane). The medical records were reviewed retrospectively and demo- graphic information collected including maternal age, gestational age and birth weight. In addition, data regarding mode of delivery, place of delivery, age at the time of surgery, type of closure, time to commencement of trophic feeds, duration of total parenteral nutrition (TPN), mechanical ventilation and hospital stay were Pediatr Surg Int (2003) 19: 260–265 DOI 10.1007/s00383-002-0886-0 S.J. Singh (&) Consultant Paediatric Surgeon, Department of Paediatric Surgery, University Hospital, Queen’s Medical Centre, Nottingham, NG7 2UH, UK E-mail: shailinder@aol.com Tel.: ++44-115-9249924 ex +43779 Fax: ++44-115-9709929 A. Fraser Æ S. Baskaranathan Æ M. Glasson Æ D. Cass Department of Surgery, The Royal Alexandra Hospital for Children, Weatmead, Sydney, Australia K. Spence Æ J. Dalby-Payne Æ P. Barr Æ R. Halliday Æ N. Badawi Department of Neonatology, The Royal Alexandra Hospital for Children, Weatmead, Sydney, Australia J.F. Leditschke Department of Pediatric Surgery, Royal Children’s Hospital and Mater Misericordiae Hospital, Brisbane, Australia R. Kimble Department of Pediatric Surgery, Royal Children’s Hospital, Brisbane, Australia J.K. Peat Department of Pediatric and Child Health, University of Sydney, Sydney, Australia