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


METHODS
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.
Vegunta
Ravindra K
RK
Department of Surgery, University of Illinois College of Medicine, Peoria, IL 61603, USA. vegunta@uic.edu
Wallace
Lizabeth J
LJ
Leonardi
Michael R
MR
Gross
Tom L
TL
Renfroe
Yolanda
Y
Marshall
J Stephen
JS
Cohen
Howard S
HS
Hocker
James R
JR
Macwan
Kamlesh S
KS
Clark
Sue E
SE
Ramiro
Susan
S
Pearl
Richard H
RH
D000015:Abnormalities, Multiple / Q000401:mortality; D000328:Adult; D019090:Case Management; D002585:Cesarean Section; D017558:Elective Surgical Procedures; D004750:Enteral Nutrition; D004954:Esthetics; D005260:Female; D005325:Fetal Organ Maturity; D020139:Gastroschisis / Q000000981:diagnostic imaging / Q000196:embryology / Q000401:mortality / Q000601:surgery*; D005865:Gestational Age; D017052:Hospital Mortality; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000601:surgery*; D007902:Length of Stay; D008168:Lung / Q000196:embryology; D008297:Male; D010288:Parenteral Nutrition; D011183:Postoperative Complications / Q000401:mortality; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D012121:Respiration, Artificial; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal