404: The impact of delivery timing on neonatal outcomes of infants with gastroschisis

404 The impact of delivery timing on neonatal outcomes of infants with gastroschisis Anna Palatnik, Matthew Loichinger, Tana Kim, Randall Kuhlmann, Erica Peterson Medical College of Wisconsin, Department of Obstetrics and Gynecology, Milwaukee, WI OBJECTIVE: To assess whether earlier delivery of infants with gastroschisis minimizes intestinal damage or improves neonatal outcomes STUDY DESIGN: A retrospective study of 143 newborns born with gastroschisis between 2000-2011 in a single tertiary center was performed. They were divided in two groups: those delivered ‘’early’’ (before 36 weeks) and those delivered “late” (after 36 weeks). These groups were compared in terms of neonatal outcomes, including weight at the time of delivery, rate of primary closure, bowel atresia, necrotizing enterocolitis (NEC), respiratory distress syndrome (RDS), length of total parenteral nutrition (TPN), length of ventilation and length of neonatal intensive care unit (NICU) stay. RESULTS: 73 neonates were in the early delivery group with mean gestational age (GA) of 34.3 weeks, and 70 were in the late with mean GA of 36.4 weeks. Mean weight of the early group was 2112g and for the late group 2436g (p 0.0001). The rate of primary closure was not significantly different between the two groups (72.8% in late group vs. 67.1% in early group (p 0.54)). Bowel atresia was more frequent in the early group (10.96% vs 7.1%) as well as NEC (5.5% vs 2.9%) but that difference wasn’t significant (p 0.42, and p 0.43 ). The percentage of RDS and mean length of ventilation wasn’t significantly different between groups (p 0.19, and p 0.2). The length of TPN and NICU stay were longer in the early group (37.6 vs 29.1 days and 45.7 vs 34.3 days respectively) and both were statistically significant (p 0.01). Based on the two variables that were significantly different between the groups (length of stay and TPN), we performed survival analysis to include 3 stillbirth cases. It predicted higher probability of discharge and discontinuation of TPN for the late delivery group. CONCLUSION: Delivery before 36weeks is associated with longer NICU stay and longer time of TPN feeding. At the same time there was no significant difference in rates of primary closure or intestinal complications among the two groups of gestation.