Online Program

Cesarean sections increase the risk of sepsis in neonates with gastroschisis

Tuesday, November 3, 2015

Arti Desai, MPH, PhD(s), Department of Earth and Biological Sciences, Basic Sciences, School of Medicine Loma Linda University, Loma Linda, CA
Bryan Oshiro, M.D., Loma Linda University Medical Center, Loma Linda, CA
Trina Mansour, MD(c), Perinatal Research, Loma Linda University, Loma Linda, CA
Tara Billings, D.O., The Perinatal Institute, Loma Linda University Medical Center, Loma Linda, CA
Background: To optimize management of neonates with gastroschisis we evaluated the risk of sepsis based upon the mode of delivery and length of stay (LOS). Methods: Records of neonates with gastroschisis and their mothers from 1999 to 2012 were reviewed. The mode of delivery was defined as: vaginally(V), cesarean section with labor(CS&L), and cesarean section(CS) without labor. Sepsis rates by mode of delivery were assessed. Log-binomial risk ratios(RR) and 95% confidence intervals(CI) were reported after adjustment for the presence of chlamydia, genital herpes and urinary tract infections(UTI); the effects of sepsis and mode of delivery on LOS were assessed using multiple linear regression. Results: Among 164 neonates, the mode of delivery was distributed as: 85 V(51.8%), 42 CS&L(25.6%), and 37 CS(22.6%). Sepsis incidence was 2.5 times more likely in CS&L compared to V, RR=2.51(1.55-4.05). Sepsis rate in CS was not significantly increased compared to V, RR=1.50(0.82-2.77). Neonates delivered to mothers with chlamydia, genital herpes or UTI had RR=1.58(1.04-2.41), RR= 1.85(1.35-2.52) and RR=1.85(1.35-2.52) of sepsis, respectively. LOS in neonates delivered by CS&L and CS were 15(-31 to 0.55) days and 6(-22 to 9) days shorter, respectively, compared to V. Neonatal sepsis increased LOS by 50(35 to 63) days compared to neonates without sepsis. Conclusions: A significant increase in risk of sepsis was observed for neonates with gastroschisis delivered by CS&L, and mother with chlamydia, genital herpes or UTIs, however their LOS was shorter compared to V. This study can aid the development of neonatal and pediatric policies to support high-risk deliveries.

Learning Areas:

Administer health education strategies, interventions and programs
Advocacy for health and health education
Basic medical science applied in public health
Clinical medicine applied in public health
Public health biology

Learning Objectives:
Discuss the importance of identifying high risk factors that can contribute to adverse effects in neonates with gastroschisis. Explain the significance of educating and increasing awareness and knowledge in the population locally and globally about birth outcome in neonates with gastroschisis.

Keyword(s): Birth Defects, Child Health Promotion

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a PhD student in Biology focusing on Perinatal Biology and investing the temporal, spatial, environmental, biological, social, epidemiological, and obstetric factors contributing to gastroschisis and negative pregnancy outcomes. I have my MPH with a concentration in Global Health with work related to community and minority health, cultural sensitivity and cross- cultural interactions.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.