335355
Delayed closure increases the risk of sepsis and length of stay in neonates with gastroschisis
Tuesday, November 3, 2015
Arti Desai, MPH, PhD(s),
Department of Earth and Biological Sciences, Basic Sciences, School of Medicine Loma Linda University, Loma Linda, CA
Tara Billings, D.O.,
The Perinatal Institute, Loma Linda University Medical Center, Loma Linda, CA
Background: Neonates with gastroschisis undergo primary or delayed closure. We sought to determine whether there was any difference in neonatal sepsis based upon the closure strategy. Additionally, we investigated the effect of sepsis and type of closure on length of stay (LOS). Methods: The records of neonates with gastroschisis managed in two academic medical centers from February 1999 to December 2012 were reviewed (n=152). The closure type was classified as: primary fascial closure (P/F) and initial silo closure with staged fascial closure (S). Primary outcome was culture proven sepsis and secondary outcome was LOS. Sepsis rates by type of closure were assessed. Crude log-binomial risk ratios (RR) and 95% confidence intervals (CI) were reported for the presence of chlamydia, gonorrhea, genital herpes, urinary tract infections, preterm premature rupture of membranes, preterm delivery, meconium staining, Hispanic ethnicity and abuse of any of the following substances: tobacco, illicit drugs and alcohol. The effects of sepsis and type of closure on LOS were assessed using multiple linear regression. Results: The distribution of closure strategies was as follows: P/F=44 and S=108. Sepsis incidence was 83% higher in S compared to P/F, RR=1.83 (1.02-3.30). The risk of sepsis was doubled among neonates delivered to mothers with chlamydia RR=2.07 (1.30-3.30). None of the other covariates showed a significant effect on neonatal sepsis. An increase of 26 (11.89, 39.99) days was observed for neonates with S compared to P/F, while sepsis increased LOS by 45 (31.55, 58.07) days. Conclusion: There is a significant increase in both the risk of sepsis and LOS associated with S compared to P/F, but further investigations are warranted to elucidate these effects. This study and information can aid the development of neonatal and pediatric policies to support high-risk deliveries.
Learning Areas:
Administer health education strategies, interventions and programs
Advocacy for health and health education
Basic medical science applied in public health
Clinical medicine applied in public health
Provision of health care to the public
Public health biology
Learning Objectives:
Discuss the importance of identifying high risk factors that can contribute to adverse effects in neonates with gastroschisis.
Explain the significance of educating and increasing awareness and knowledge in the population locally and globally about birth outcome in neonates with gastroschisis.
Keyword(s): Birth Defects, Birth Outcomes
Presenting author's disclosure statement:Qualified on the content I am responsible for because: I am a PhD student in Biology focusing on Perinatal Biology and investing the temporal, spatial, environmental, biological, social, epidemiological, and obstetric factors contributing to gastroschisis and negative pregnancy outcomes. I have my MPH with a concentration in Global Health with work related to community and minority health, cultural sensitivity and cross- cultural interactions.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines,
and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed
in my presentation.
