Poster Session 4
Category: Prematurity
Poster Session 4
Nikan Zargarzadeh, MD (she/her/hers)
Research Fellow
Boston Children's Hospital
Boston, Massachusetts, United States
Giulia Bonanni, MD
Postdoctoral Research Fellow
Division of Fetal Medicine and Surgery, Boston Children's Hospital Harvard Medical School
Boston, Massachusetts, United States
Enaja Sambatur, MD (she/her/hers)
Clinical Research Specialist
Southeast Health Medical Center
Southeast Health Medical Center, Alabama, United States
Kjersti M. Aagaard, MD, MSCI, PhD
Medical Director, HCA Healthcare and HCA Research Institute
HCA
Houston, Texas, United States
.jpg "Alireza A. Shamshirsaz, MD (he/him/his) photo")
Alireza A. Shamshirsaz, MD (he/him/his)
Department Director, Professor of Surgery
Boston Children's Hospital, Harvard Medical School
Boston, Massachusetts, United States
The optimal timing and indication for delivery in gastroschisis remain subjects of ongoing debate. This study evaluates clinical characteristics and postnatal outcomes associated with varying indications for preterm delivery in this population.
Study Design:
This IRB-approved retrospective cohort study included pregnancies with prenatally diagnosed gastroschisis delivered at 34–38⁶⁄₇ weeks at a single center (2000–2023). Deliveries were grouped by indication: (1) bowel concern (e.g., dilation, wall thickening, echogenicity), (2) non-reassuring fetal status defined by obstetric indications (NRFS), and (3) preterm labor (PTL). Neonatal outcomes—closure timing, surgical needs, hospital length of stay, sepsis, feeding initiation, and complex gastroschisis rate—were compared using Kruskal-Wallis and Fisher’s exact tests, with pairwise comparisons against the bowel concern group.
Results:
A total of n=83 infants met inclusion criteria: 22 delivered due to bowel concern, 36 for NRFS, and 25 for PTL. Age at abdominal wall closure was significantly earlier in the NRFS and PTL groups compared to the bowel concern group after adjusting for gestational age at delivery (adjusted p=0.013 for NRFS; p=0.025 for PTL). However, there were no significant differences across groups in number of surgical interventions, LOS, incidence of sepsis, timing to enteral feeding initiation, or type of surgical repair.
Conclusion:
Although bowel-related concerns prompted earlier delivery, this strategy did not translate into improvements in key clinical outcomes. In contrast, infants delivered for spontaneous or fetal-status-related reasons had comparable or even more favorable postnatal trajectories. These findings call into question the clinical utility and favorable prognostic value of bowel appearance alone as an indication for preterm delivery in gastroschisis and highlight the need for more evidence-based delivery criteria.