ORIGINAL ARTICLE Peripartum and neonatal outcomes of small-for-gestational-age infants with gastroschisis Anna I. Girsen 1 *, Samantha Do 1 , Alexis S. Davis 3,6 , Susan R. Hintz 2,6 , Arti K. Desai 4 , Trina Mansour 4 , T. Allen Merritt 5 , Bryan T. Oshiro 4 , Yasser Y. El-Sayed 1,6 and Yair J. Blumenfeld 1,6 1 Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA 2 Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA 3 Pediatrix Medical Group, San Jose, CA, USA 4 Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA, USA 5 Division of Neonatology, Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, CA, USA 6 The Fetal and Pregnancy Health Program, Lucile Packard Children’s Hospital Stanford, Palo Alto, CA, USA *Correspondence to: Anna I. Girsen. E-mail: anna.girsen@gmail.com ABSTRACT Objectives Neonates with gastroschisis are often small for gestational age (SGA) based on population nomograms. Our objective was to evaluate the effect of SGA on perinatal and neonatal outcomes in cases of gastroschisis. Methods This is a retrospective study of neonates with prenatally diagnosed gastroschisis from two academic centers between 2008 and 13. Perinatal and neonatal outcomes of neonates with SGA at birth were compared with appropriate-for-gestational-age (AGA) neonates. The primary composite outcome was defined as any of the following: neonatal sepsis, short bowel syndrome at discharge, prolonged mechanical ventilation (upper quartile for the cohort), bowel atresia or death. Results We identified 112 cases of gastroschisis, 25 of whom (22%) were SGA at birth. There were no differences in adverse peripartum outcomes between SGA and AGA infants. No difference was found in the primary composite neonatal outcome (52% vs 36%, p = 0.21), but SGA infants were more likely to have prolonged mechanical ventilation (44% vs 22%, p = 0.04) and prolonged length of stay (LOS) (52% vs 22%, p = 0.007). After adjusting for GA at delivery, SGA remained associated with prolonged LOS (OR = 4.3, CI: 1.6–11.8). Conclusion Among infants with gastroschisis, SGA at birth is associated with a fourfold increase in odds for prolonged LOS, independent of GA. © 2015 John Wiley & Sons, Ltd. Funding sources: None Conflicts of interest: None declared INTRODUCTION Gastroschisis is a severe paraumbilical defect of the fetal abdominal wall that occurs in approximately one to five cases per 10 000 live births. 1 Fetal gastroschisis is commonly diagnosed in utero by routine ultrasound that identifies the defect with high sensitivity and specificity starting as early as the first trimester. 2,3 Although the overall neonatal mortality among gastroschisis cases is low, 4 pregnancies with gastroschisis are at increased risk for severe peripartum complications including meconium staining, intrauterine growth restriction (IUGR) and stillbirth, as well as neonatal gastrointestinal morbidities including bowel dysfunction, bowel atresia, bowel necrosis and short-bowel syndrome. 5 Prior studies have identified the association between gas- troschisis and prenatally suspected IUGR and small for gestational age (SGA) at delivery. 6,7 It has been reported that pregnancies complicated by IUGR are more likely to result in increased neonatal morbidity, including increased surgical complications, longer hospital stay, delay in establishment of full enteral feeds and impaired long-term growth. 8–11 However, because of the underestimation of the fetal abdominal circumference by prenatal ultrasound using most estimated fetal weight formulas, 12 the false positive rates for suspected IUGR diagnosis may be high and a misdiagnosis may lead to unnecessary iatrogenic preterm delivery and related morbidities. Moreover, prenatal prediction of SGA is erroneous even in non-gastroschisis cases. 13,14 Therefore, understanding the association between ‘true SGA’ at birth and perinatal and neonatal outcomes in cases of gastroschisis is warranted. Our aim was to evaluate the association between SGA and perinatal and neonatal outcomes in cases of prenatally diagnosed gastroschisis. Prenatal Diagnosis 2015, 35, 477–482 © 2015 John Wiley & Sons, Ltd. DOI: 10.1002/pd.4562