Cesarean sections and delayed closure increase the risk of sepsis and length of stay in neonates with gastroschisis

Background: Neonates with gastroschisis, a congenital birth defect of the abdominal wall, undergo primary or delayed closure following birth. To optimize management of neonates with gastroschisis we evaluated the risk of culture proven sepsis based upon the mode of delivery and 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 and their mothers managed in two academic medical centers from 1999 to 2012 were reviewed (n=152). The mode of delivery was defined as: vaginally(V), cesarean section with labor(CS&L), and cesarean section(CS) without labor. 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 mode of delivery and 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, and urinary tract infections. The effects of sepsis and mode of delivery and type of closure on LOS were assessed using multiple linear regression. Results: The mode of delivery was distributed as: 51.8%V, 25.6%CS&L, and 22.6%CS. The distribution of closure strategies was as follows: P/F=44 and S=108. Sepsis incidence was 2.5 times more likely in CS&L compared to V, RR=2.51(1.55-4.05). Sepsis rate in CS was not significantly increased compared to V, RR=1.50(0.82-2.77). 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). LOS in neonates delivered by CS&L and CS were 15(-31 to 0.55) days and 6(-22 to 9) days shorter, respectively, compared to V. Neonatal sepsis increased LOS by 50(35 to 63) days compared to neonates without 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: A significant increase in risk of sepsis was observed for neonates with gastroschisis delivered by CS&L and 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.