Survival of newborns with abdominal holes differs according to hospital

Oct 28 2007

A newborn's chance for surviving a low-risk version of a condition called gastroschisis varies greatly by hospital, according to a study by Johns Hopkins surgeons. Babies with the condition have a hole in their abdomen near the umbilical cord.

The uncomplicated variant of the condition, where the hole is the only abdominal anomaly, is fairly easy to repair, and 97 percent of babies survive it. However the Hopkins findings suggest that in some hospitals, far fewer babies who should survive the condition after treatment actually do. Some hospitals had death rates three to five times the national average.

The findings of the study are being presented at the American Academy of Pediatrics Conference Oct. 26 through Oct. 30 in San Francisco.

Researchers compared mortality rates among 1,775 infants born with uncomplicated gastroschisis in 40 U.S hospitals. Only hospitals that had treated at least 25 newborns with gastroschisis were included. Of the 40 hospitals, one-fourth (10) had death rates higher than 2.9 percent, which is the national average for the low-risk variant of the condition. Of the 10, two hospitals had very poor death rates—8.6 percent and 14.3 percent.

“We went into this prepared to see some differences, but we didn't expect to see these striking variations from hospital to hospital in these fairly uncomplicated cases,” says investigator Meghan Arnold, M.D., a surgical resident at the Johns Hopkins Children's Center.

Because surgical techniques to repair gastroschisis are uniform across hospitals, researchers say the next step should be finding whether the difference in survival could be due to factors such as different nurse-to-patient ratios, variations in medication and nursing protocols and the availability of pediatric subspecialists.