CÁC YẾU TỐ LIÊN QUAN ĐẾN KẾT QUẢ ĐIỀU TRỊ HỞ THÀNH BỤNG Ở TRẺ SƠ SINH TẠI BỆNH VIỆN NHI ĐỒNG 1

Abstract

Background: Gastroschisis is a congenital abdominal wall defect, typically located to the right of the midline, resulting from abnormal fetal development in which abdominal organs fail to return to the abdominal cavity. On prenatal ultrasound, it is identified by freely floating herniated viscera in the amniotic fluid without a covering membrane; the herniated structures mainly include the small intestine, but may also involve the stomach, colon, and, in rare cases, the gonads ^[4,5]. Globally, a 2023 study reported an incidence of gastroschisis of 3.3 per 10,000 live births ^[3]. In Vietnam, epidemiological data remain limited; however, a population-based study by Hoang Truong et al. estimated an incidence of approximately 1.43 per 10,000 live births during 2007–2010 ^[6]. This study was conducted to identify factors associated with treatment outcomes in neonates with gastroschisis.

Objectives: To identify factors associated with treatment outcomes of neonatal gastroschisis at Children’s Hospital No. 1.

Methods: A case series study was conducted from January 1, 2020, to June 30, 2025, at Children’s Hospital 1.

Results: There were 61 cases of gastroschisis in newborns during the study period. The male-to-female ratio was 1.1:1. The median gestational age was 36.3 weeks (35.0–37.5), and the median birth weight was 2,140 g (1,900–2,400). Cesarean delivery accounted for 50.8% of cases. Prenatal diagnosis was achieved in 85.2%, and the median maternal age was 21.0 years (19.0–24.0). The severity of bowel injury was classified as grade I in 86.9%, grade II in 9.8%, and grade III in 3.3%. Associated congenital anomalies included congenital heart disease (1.7%) and small intestinal atresia (1.7%). Regarding clinical characteristics on admission and transport safety, respiratory distress was observed in 77.0% of neonates, shock in 14.6%, hypothermia in 85.2%, and intestinal perforation in 8.2%. During transport, sterile plastic bag coverage was used in 50.8% of cases, sterile moist gauze dressing in 42.6%, and no fluid resuscitation in 4.9%. In terms of surgical management, the median duration of silo placement was 5.0 days (4.0–5.0), and 3.3% of patients underwent silo placement without definitive surgical closure. Postoperative clinical characteristics and complications included surgical site infection (21.3%), meningitis (21.3%), pneumonia (9.8%), intestinal obstruction (9.8%), necrotizing enterocolitis (9.8%), and short bowel syndrome (3.3%). The median duration of invasive mechanical ventilation was 5.0 days (4.0–8.0). Enteral feeding was initiated at a median of 7.0 postoperative days (6.0–10.0), full enteral nutrition was achieved at 15.0 days (10.0–18.5), and the median duration of parenteral nutrition was 18.5 days (15.0–25.0). The median length of hospital stay was 30.0 days (23.0–40.0). The overall mortality rate was 3.3%, with causes of death including respiratory distress syndrome (1.6%) and septic shock (1.6%). Prolonged hospital stay (>30 days) was the most significant outcome. Univariate analysis identified prematurity, small for gestational age, prolonged severe metabolic acidosis, silo placement >5 days, invasive mechanical ventilation >5 days, initiation of enteral feeding >7 days postoperatively, and parenteral nutrition duration >18.5 days as factors associated with prolonged hospital stay (>30 days).

Conclusion: Multivariate logistic regression analysis demonstrated that prematurity, small for gestational age, and prolonged severe metabolic acidosis were independently associated with prolonged hospital stay. Early identification of these risk factors is crucial for risk stratification, optimization of management strategies, and reduction of hospital stay, thereby improving treatment outcomes in neonates with abdominal wall defects.