NEW YORK (Reuters Health) - Intra-abdominal bowel dilatation on prenatal ultrasound strongly predicts complex gastroschisis, researchers from France report.
Gastroschisis, a congenital abdominal wall defect, complicates one to five in 10,000 births. Complex gastroschisis, which includes coexisting intestinal anomalies, often requires prolonged parenteral nutrition and affects survival.
As reported online 21 October in BJOG, Dr. Laurent J. Salomon from Hopital Necker Enfants Malades in Paris and colleagues analyzed prenatal ultrasound findings from 105 fetuses with gastroschisis.
The condition was diagnosed at a mean gestational age of 16.0 weeks, and the mean gestational age at delivery was 35.7 weeks.
One infant died at age 40 days, from septic complications and subsequent multisystem organ failure. Another infant died, on the seventh day of life, following an iatrogenic central venous catheter displacement. Two deaths occurred in utero at weeks 34 and 36 with bowel strangulation.
Eighty-nine neonates (86.4%) were classified as having simple gastroschisis, and 14 (14.6%) were classified as having complex gastroschisis.
Ultrasound findings of small-for-gestational age (SGA) fetuses, extra-abdominal bowel dilatation, thickened intestinal wall, stomach dilatation, and stomach herniation occurred with similar frequency in the simplex and complex gastroschisis cases.
The only predictive marker of complex gastroschisis was intra-abdominal bowel dilatation, which occurred four times more often and nearly four weeks earlier in the complex gastroschisis group than in the simple gastroschisis group.
Each additional millimeter of dilatation was associated with a 10% increase in risk of complex gastroschisis.
A cutoff value of 6 for the ratio of observed/expected bowel diameter (which corresponds to 9 mm of bowel dilatation at 22 weeks, 11 mm at 28 weeks, and 17 mm at 32 weeks) yielded 54% sensitivity, 88% specificity, 41% positive predictive value, and 92% negative predictive value for complex gastroschisis.
"Gastroschisis is generally considered a fetal anomaly that can be completely cured postnatally," the researchers note. "However, some infants have serious complications and predicting such cases is essential for adequate prenatal counseling."
"The results of the study may be helpful for prenatal counseling," the investigators conclude, "specifically preparing parents for the outcomes including short- and medium-term morbidity associated with the subset of complex gastroschisis."
Source: http://bit.ly/tVGGSW
BJOG 2011.
Last Updated: 2011-11-29 19:03:07 -0400 (Reuters Health)
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