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Mode of Delivery and Neonatal Survival of Infants With Isolated Gastroschisis

Hamisu M. Salihu, MD, PhD^*, Donath Emusu, MD, MPH^*, Zakari Y. Aliyu, MD, MPH, Bosny J. Pierre-Louis, CRT, MPH, Charlotte M. Druschel, MD, MPH and Russell S. Kirby, PhD^*

From the *Department of Maternal and Child Health, University of Alabama at Birmingham; Congenital Malformations Registry, New York State Department of Health, Troy, New York; Department of Biostatistics and Epidemiology, University of South Florida, Tampa; and Department of Internal Medicine, Saint Agnes Hospital, Baltimore, Maryland.

Address reprint requests to: Hamisu Salihu, MD, PhD, Department of Maternal and Child Health, University of Alabama at Birmingham, 1665 University Boulevard, Room 320, Birmingham, AL 35294; e-mail: hsalihu{at}uab.edu.

OBJECTIVE: We sought to compare neonatal survival of infants with gastroschisis by mode of delivery.

METHODS: We conducted a retrospective cohort study on infants with gastroschisis who were delivered in New York State from 1983 through 1999. We compared neonatal mortality between infants born vaginally and those delivered by cesarean using adjusted hazard ratios derived from Cox proportional hazards regression models.

RESULTS: A total of 354 infants were found to have isolated gastroschisis. Of these, 174 were delivered vaginally, whereas 180 were delivered by cesarean. Neonatal mortality was registered among 18 infants (5.1%); 12 (6.9%) in the vaginal and 6 (3.3%) in the cesarean group. After controlling for potential confounders, the risk for neonatal demise was similar in both the vaginal and cesarean subcohorts (adjusted hazard ratio 0.84, 95% confidence interval [CI] 0.29–2.43). Preterm birth was the morbidity pathway that explained the early demise of infants with gastroschisis, irrespective of mode of delivery (adjusted hazard ratio 3.4, 95% CI 1.10–10.4) whereas small for gestational age did not predict mortality (adjusted hazard ratio 1.04, 95% CI 0.13–8.14).

CONCLUSION: In this study the mode of delivery was not found to be associated with neonatal survival of infants with gastroschisis. Preterm birth rather than small for gestational age was the predictor of neonatal death among gastroschisis infants.

LEVEL OF EVIDENCE: III

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