366 - Admissions and early transfers of infants with gastroschisis in England and Wales: a retrospective cohort study

Publication Number: 366.3871

Behrouz Nezafat Maldonado, Imperial College London, London, England, United Kingdom; Cheryl Battersby, Imperial College London, London, England, United Kingdom

Background: Infants with gastroschisis require neonatal intensive care and specialist surgical care. Care pathways vary across the UK, with infants with gastroschisis born in one of three types of units: (1) tertiary neonatal unit (NICU) with co-located surgical services, (2) tertiary NICU, or (3) non-tertiary unit. The latter two require postnatal transfer for surgery to a NICU with surgical facilities or a standalone paediatric surgical centre. The impact of place of birth and transfers on outcomes is unclear.

Objective: To examine birth prevalence, admissions characteristics, transfers, and survival by place of birth for infants with gastroschisis.

Design/Methods: We analyzed data from the National Neonatal Research Database (NNRD) of babies born with gastroschisis admitted to neonatal units in England and Wales (01/01/2012–31/12/2020). The NNRD includes neonatal units but not the four standalone surgical units.

Results: Our study cohort included 1832 babies with gastroschisis, an estimated birth prevalence of 3.0 (95% CI 2.5-3.5) per 10 000 live births. Of these, 1103/1832 (60%) were born in units with co-located surgical services, while 729/1832 (40%) required postnatal transfer. Of those requiring postnatal transfer, 564/729 (77%) were born in tertiary NICUs (Table 1). We found that prevalence of gastroschisis decreased over time whilst the proportion of infants born in co-located neonatal surgical services increased (Figure 1). The majority of infants requiring transfer, were transferred within 48 hours (542/729(74%)). Early transfers occurred more frequently for those infants born in non-tertiary units. Of those born in tertiary NICU, 305/564 (54%) had planned delivery at the admitting hospital, suggesting that these were intended regional pathways. Babies from non-tertiary units tended to be more premature. Survival and NICU length of stay prior to discharge home were similar across groups (median 30 days). Across all groups, 782/1832 (43%) were transferred to other healthcare settings from NICU.

Conclusion(s): 4 in 10 infants with gastroschisis are born in centres without surgical services, requiring postnatal transfer within 48 hours. Our results suggest these are planned pathways of care. This variation in access to neonatal surgical services and potential impact of separating mother and baby and early postnatal transfer warrants further study. We also show that over 4 in 10 infants require ongoing specialist care and are discharge to other services rather than home. These findings are useful for counselling purposes and help inform the design of care pathways.

Number of babies admitted with gastroschisis per year and neonatal unit type (bars) and birth prevalence per 10 000 live births (line, y-2 axis)


Table 1. Infant characteristics and outcomes
**Adjusted denominator for complete-case only. Co-located neonatal surgical services n=794, Tertiary neonatal unit (no surgical services) n=204, Non-tertiary unit n=84