Gastroschisis: ward reduction compared with traditional reduction under general anesthesia.
OBJECTIVE
In gastroschisis it is proposed that gut reduction may be achieved without intubation or general anesthesia (GA) through ward reduction. The authors aimed to determine if ward reduction decreased morbidity and duration of treatment.


METHODS
Infants born from January 1, 1995, to December 31, 2001, with gastroschisis were managed with either reduction under GA in the operating theatre (OT group)--up to September 1999, or ward reduction (when eligible) in the neonatal unit without GA/ventilation (ward reduction [WR] group)--from September 1999.


RESULTS
Of the 37 infants, 31 were eligible for ward reduction-15 from the OT group, 16 from the WR group. All infants in the OT group had at least 1 episode of ventilation and 1 GA: 62% of infants in the WR group avoided ventilation (P = .0002) and 81% avoided GA (P < .0001). Infants who had ward reduction had significantly shorter durations of ventilation and oxygen therapy. Septicemia occurred in 31% of the WR group and 7% of the OT group (P = .17). Infants who had ward reduction left intensive care 16 days earlier (P = .02) and tended to reach full enteral feeds 8 days sooner (P = .06) and be discharged from hospital 15 days earlier (P = .05).


CONCLUSIONS
Infants who had ward reduction do better in terms of avoiding GA/ventilation, establishing feeds, and going home earlier. A randomized, controlled trial comparing the 2 approaches is feasible, safe, and worthwhile.
Davies
Mark W
MW
Grantley Stable Neonatal Unit, Royal Women's Hospital, Brisbane, Queensland, 4029, Australia. Mark_Davies@health.qld.gov.au
Kimble
Roy M
RM
Cartwright
David W
DW
D034861:Abdominal Wall / Q000601:surgery; D000082:Acetaminophen / Q000627:therapeutic use; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000768:Anesthesia, General; D019072:Antibiotic Prophylaxis; D002405:Catheterization, Central Venous; D015331:Cohort Studies; D003243:Consciousness; D004750:Enteral Nutrition / Q000009:adverse effects; D005260:Female; D020139:Gastroschisis / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D007441:Intubation, Gastrointestinal; D007902:Length of Stay; D008297:Male; D008991:Monitoring, Physiologic; D009779:Occlusive Dressings; D010288:Parenteral Nutrition / Q000295:instrumentation; D012121:Respiration, Artificial; D012189:Retrospective Studies; D018805:Sepsis / Q000150:complications; D016037:Single-Blind Method; D016896:Treatment Outcome
D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen