Perinatal management of gastroschisis: analysis of a newly established clinical pathway.

Abstract:

PURPOSE:The authors developed a clinical pathway for optimal management after antenatal diagnosis of gastroschisis. This is the outcomes analysis of our first 30 consecutive patients. METHOD:Antenatal counseling was provided for all families with in-utero diagnosis of gastroschisis. Bowel dilatation, thickness, motility, amniotic fluid volume, and fetal development were followed by ultrasonography every 4 weeks. Babies were delivered by cesarean section between 36 and 38 weeks gestation if the lungs were mature or earlier for bowel complications. Gastroschisis repair was scheduled 90 minutes after birth. Primary repair was attempted in all through the abdominal wall defect without an additional incision, resulting in an umbilicus with no abdominal scar. RESULTS:Primary repair was achieved in 83%. Babies needed assisted ventilation for 3 days, reached full feeds by 19 days, and were discharged by 24 days (all medians). There were 3 (10%) deaths, all after staged repair. CONCLUSIONS:Our new protocol of both scheduled elective cesarean section and early gastroschisis repair resulted in a higher proportion of primary repair, shorter duration of mechanical ventilation, earlier full feeds, and shorter length of stay. There was no increase in mortality or morbidity. The primary-repair babies had no mortality and had excellent cosmesis.

journal_name

J Pediatr Surg

authors

Vegunta RK,Wallace LJ,Leonardi MR,Gross TL,Renfroe Y,Marshall JS,Cohen HS,Hocker JR,Macwan KS,Clark SE,Ramiro S,Pearl RH

doi

10.1016/j.jpedsurg.2004.11.037

subject

Has Abstract

pub_date

2005-03-01 00:00:00

pages

528-34

issue

3

eissn

0022-3468

issn

1531-5037

pii

S0022346804008085

journal_volume

40

pub_type

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