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Inter-center variations in inpatient outcomes for infants with gastroschisis from the Children’s Hospitals Neonatal Consortium

Journal of Perinatology volume 45, pages 1105–1113 (2025)Cite this article

Subjects

Abstract

Objective

To estimate inter-center variation (ICV) in hospital length of stay (LOS) and oral feeding at discharge among infants with gastroschisis.

Study design

The Children’s Hospitals Neonatal Consortium’s (CHNC) database was used to identify hospitalized survivors with gastroschisis. Two outcomes were evaluated: LOS and discharge without tube feedings. Hospital outcomes were evaluated in unadjusted and adjusted analyses. Generalized linear models with log link for gamma distribution were used to model LOS and logistic regression for discharge without tube feeds.

Results

For 3987 surviving infants with gastroschisis, LOS and discharge within 70 days with exclusively oral feeding both exhibited significant ICV. Differences persisted in multivariable analyses. Risk-adjusted LOS (68% difference) and oral feeding at discharge (6.4-fold difference) varied significantly between centers.

Conclusion

Hospital of care was independently associated with LOS and exclusive oral feeding at discharge rates for infants with gastroschisis. Management differences, potentially influenced by parental preferences, contributed to variation.

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Fig. 1: Inter-center variation of risk-adjusted outcomes of surviving infants with gastroschisis.

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Data availability

CHNC is a consortium of multiple hospitals, each with a formal legal agreement between the hospital and the CHNC organization. Because the data registry collects multiple elements of protected health information (PHI), the legal agreements strictly prohibit the sharing of data among member hospitals or outside the organization.

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Acknowledgements

Beverly Brozanski, Jacquelyn Evans, Theresa Grover, Karna Murthy, Michael Padula, Eugenia Pallotto, Anthony Piazza, Kristina Reber, Billie Short, and ex-officio David Durand, Francine Dyes, Jeanette Asselin, are executive members of the Children’s Hospitals Neonatal Consortium, Inc., who developed and managed the CHND (thechnc.org). For more information, please contact exec@thechnc. We appreciate Mr. John Mallett and Ms. Evelyn Werbaneth’s contribution to data collection, curation, and security for this analysis.

We are indebted to the following CHNC participating institutions that serve the infants and their families; these institutions (and their site sponsors) also have invested in and continue to participate in the CHND:

Children’s Healthcare of Atlanta – Egleston, Atlanta, GA, USA (Anthony Piazza); Children’s Healthcare of Atlanta - Scottish Rite, Atlanta, GA, USA (Gregory Sysyn); Dell Children’s, Austin, TX, USA (Ashley Lucke, Molly Pont); Children’s of Alabama, Birmingham, AL, USA (Allison Black, Carl Coghill); Boston Children’s Hospital, Boston, MA, USA (Anne Hansen) Levine Children’s Hospital, Charlotte, NC, USA (Eugenia Pallotto); Ann & Robert H. Lurie Children’s Hospital, Chicago, IL, USA (Karna Murthy, Gustave Falciglia); Cincinnati, Children’s Hospital, Cincinnati, OH, USA (Beth Haberman); Cleveland Clinic, Cleveland, OH, USA (Tetyana Nesterenko); Nationwide Children’s Hospital, Columbus, OH, USA (Thomas Bartman); Children’s Medical Center Dallas, Dallas, TX, USA (Sushmita Yallapragada, Lina Chalak); Children’s Hospital Colorado, Denver, CO, USA (Danielle Smith, Stephanie Bourque); Children’s Hospital Michigan, Detroit, MI, USA (Girija Natarajann); Cook Children’s Healthcare System, Ft. Worth, TX, USA (Annie Chi, Yvette Johnson); Connecticut Children’s, Hartford, CT, USA (Annmarie Gotiolo); Texas Children’s Hospital, Houston, TX, USA (Lakshmi Katarkan, Kristina Reber); Riley Children’s Health, Indianapolis, TX, USA (Rebecca Rose); University of Iowa Stead Family Children’s Hospital, Iowa City, IA, USA (Julie Lindower); The Children’s Mercy Hospital, Kansas City, KS, USA (Julie Weiner); Arkansas Children’s, Little Rock, AR, USA (Laura Carroll); Children’s Hospital, Los Angeles, CA USA (Rachel Chapman); American Family Children’s Hospital, Madison, WI, USA (Nina Menda); Le Bonheur Children’s Hospital, Memphis, TN, USA (Mark Weems); Children’s Minnesota, Minneapolis, MN, USA (Ann Downey); Wisconsin Children’s Hospital, Milwaukee, WI, USA (Joanne Lagatta); UCSF Benioff Children’s Hospital, Oakland, CA, USA (Priscilla Joe); Oklahoma Children’s Hospital, Oklahoma, OK, USA (Trent Tipple, Patricia Williams); Children’s Nebraska, Omaha, NE, USA (Nicole Birge); Children’s Hospital of Orange County, Orange County, CA, USA (Michel Mikhael); Advent Health for Children, Orlando, FL, USA (Narendra Dereddy, Rajan Wadhawan); Nemours Children’s Hospital, Orlando, FL, USA (Aaron Weiss); Children’s Hospital of Philadelphia, Philadelphia, PA, USA (Michael Padula); St. Christopher’s Hospital for Children, Philadelphia, PA, USA (Vilarmis Quinones); Phoenix Children’s Hospital, Phoenix, AZ, USA (Pam Griffiths); Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA (Toby Yanowitz); Mayo Clinic Children’s, Rochester, MN, USA (Ellen Bendel-Stenzel); Intermountain Primary Children’s Hospital, Salt Lake City, UT, USA (Con Yee Ling); Rady Children’s Hospital, San Diego, CA, USA (Mark Speziale); Seattle Children’s Hospital, Seattle, WA, USA (Robert DiGeronimo, Elizabeth Jacobson); St. Louis Children’s Hospital, St Louis, MO, USA (Beverly Brozanski, Rakesh Rao); Children’s Minnesota, St Paul, MN, USA (Ann Downey); All Children’s Hospital, St. Petersburg, FL, USA (Linda Van Marter); The Hospital for Sick Children, Toronto, Ontario, Canada (Kyong-Soon Lee); Children’s National Hospital, Washington, DC, USA (Billie Lou Short); Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE, USA (Kevin Sullivan); Brenner Children’s Hospital, Winston-Salem, NC, USA (Cherrie Welch).

Funding

CHNC funded the analytic support for this project and supported a portion of Dr. Murthy’s faculty effort from 2023 to 2024 to complete this work.

Author information

Authors and Affiliations

  1. Division of Neonatology, University of Utah School of Medicine, Salt Lake City, UT, USA

    Con Yee Ling

  2. Children’s Hospitals Neonatal Consortium, Dover, DE, USA

    Isabella Zaniletti

  3. Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, OH, USA

    Stefanie Riddle

  4. University of Washington, Seattle, WA, USA

    Jacobson Elizabeth

  5. Division of Neonatology, Cook Children’s Medical Center, Fort Worth, TX, USA

    Stephanie G. Korff

  6. University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Angela L. Chandler

  7. Wake Forest University School of Medicine, Winston-Salem, NC, USA

    L. Corbin Downey

  8. University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Michael A. Padula

  9. University of Colorado School of Medicine, Aurora, CO, USA

    Jacquelyn R. Evans

  10. Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Theresa R. Grover

  11. Children’s Healthcare of Atlanta – Egleston, Atlanta, GA, USA

    Karna Murthy

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Consortia

On behalf of Children’s Hospitals Neonatal Consortium Gastroschisis Focus Group

Contributions

Theresa Grover, Mike Padula, Karna Murthy, Jackie Evans, Stephanie Riddle, and Elizabeth Jacobsen contributed to data acquisition and curation, formulating the analytic question and data interpretations. Isabella Zaniletti completed statistical analyses and interpretations. Con Yee Ling and Karna Marthy drafted the first version of the manuscript. Stephanie Korff, Angela Chandler, and Corbin Downey participated in the data interpretation and editing of the manuscript.

Corresponding author

Correspondence to Con Yee Ling.

Ethics declarations

Competing interests

Authors affiliated with CHNC serve as executive directors of CHNC and members of the CHNC board.

Ethics approval and consent to participate

Each participating CHNC hospital retains IRB and administrative oversight for participation in the work and all associated studies. Subsequent secondary analyses were reviewed and exempted as non-human subject research by the Stanley Manne Research Institute (Chicago, IL: 2009-14982) Institutional Review Board.

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Supplementary information

Supplementary Table 1: Comorbidity Definitions

41372_2024_2160_MOESM2_ESM.docx

Supplementary Table 2: Unadjusted Characteristics of Infants with Gastroschisis by Hospital of Care Considered for Analysis

The Children’s Hospital Neonatal Consortium Gastroschisis Focus Group includes the following members:

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Ling, C.Y., Zaniletti, I., Riddle, S. et al. Inter-center variations in inpatient outcomes for infants with gastroschisis from the Children’s Hospitals Neonatal Consortium. J Perinatol 45, 1105–1113 (2025). https://doi.org/10.1038/s41372-024-02160-6

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