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We appreciate the comments by Salomon et al regarding our analysis of the association of prenatal intraabdominal bowel dilation (IBD) with postnatal bowel complications. It is agreed that prenatal IBD may prove to be a useful prognostic factor of outcomes for which its utility as a diagnostic marker has not yet been characterized fully. Our conclusions in our analysis highlight IBD—in particular, multiple loops of IBD—as a potential important diagnostic marker that should be investigated in future, prospective, larger cohort studies. Our analysis suggests an association between these variables but does not imply a pathophysiologic relationship nor infer a causational relationship between IBD and bowel complications.

In our large, retrospective study of consecutive fetuses with gastroschisis, our analysis suggests that IBD is associated with postnatal gastrointestinal complications in fetuses with gastroschisis. One of the points that Salomon et al raises is that IBD was detected in both the second or third trimester. Because this was a retrospective review, time-dependent and actuarial data after the progression or resolution of IBD could not be evaluated in a retrospective manner. Hence, we analyzed all fetuses that demonstrated any IBD at any time point and reported on their clinical outcomes.

Our analysis highlights IBD as an important prognostic factor that needs further investigation in prospective, large cohort studies. Retrospective analysis identifies important variables that can be studied in blinded prospective studies. Because of the rare nature of gastroschisis, a metaanalysis may be required to aggregate the statistical power to make critical insights to this disease. The most important finding in our analysis was the potential association of multiple loops of IBD with postnatal complications. In our analysis, which compared fetuses with multiple loops of IBD with a single loop, multiple loops of IBD were associated significantly with an increased rate of complications. This potential prognostic factor of multiple IBD loops has not been investigated previously in a large, consecutive series of fetuses, such as we investigated in our study.

Last, we agree with Salomon et al that IBD, as suggested in our analysis, may be associated with worse outcomes and may require that fetuses be observed in a closer manner, with possible intensive care, and that these interventions with these findings may ultimately improve care for fetuses with IBD and gastroschisis. We thank our colleagues for their comment and hope that our contribution highlights in this retrospective, consecutive, large cohort study an association of IBD with bowel complications and demonstrates the further need to evaluate IBD and gastroschisis in prospective, large cohort studies.