[Impact in our environment of a gastroschisis therapeutic management protocol].
BACKGROUND
Continuous exposure to amniotic in fetus with gastroschisis, leads to inflammation and edema of intestinal loops, hindering intestinal return to abdomen and making staged repair necessary in many cases. Furthermore, intestinal loops are hipoperistaltic, which leads to oral toleration difficulties, large periods of parenteral nutrition and an increase of hospital stay. The objective of this study is to evaluate the results in our environment, of a new multidisciplinary management protocol in patients with a prenatal diagnosis of gastroschisis.


METHODS
Between January 2003 and May 2006, six cases of prenatal diagnosis of gastroschisis were included in the protocol. This consisted in a weekly ultrasound monitorization of the gestants which showed prenatal diagnosis of gastroschisis and elective delivery by caesarean section on the 39th week and if early signs of intestinal suffering appear (bowel diameter > 17 mm or wall thickening > 3 mm), in order to prevent harm to intestinal loops and its consequences in the neonatal period. After birth, bowel reduction through the defect was performed under general anaesthesia in the operating room. Gestational age at delivery, bowel appearance, associated anomalies, incidence of sepsis and intestinal obstruction in the postoperative period, PN and hospital stay are analyzed in a prospective descriptive study.


RESULTS
Mean gestational age at delivery was 36,3 weeks (range 35-38). In all the cases, except one, bowel loops presented a nearly normal appearance, without signs of chronic inflammation. As associated anomalies we found two cases of intraabdominal testis and one of hypertrophic pyloric stenosis. No evidence of intestinal atresia in any case. Mean time of PN was 28 days. Two patients developed sepsis with good outcome with intravenous antibiotics treatment. No cases of intestinal obstruction in the immediate or late postoperative period were observed. Mean time of hospital stay was 38,8 days, with mean stay in neonatal care unit of 4 days.


CONCLUSIONS
. Weekly ultrasound monitorization assessment in cases of prenatally-diagnosed gastroschisis allows early detection of bowel suffering signs, before chronic inflammatory damage of the herniated intestinal loops. The application of this prenatal gastroschisis management protocol permits normal gestation without having to anticipate delivery in practically all cases, minimizing consequences of prematurity.
Vila-Carbó
J J
JJ
Servicio de Cirugía Pediátrica, Hospital Universitario Infantil La Fe, Valencia. vila_jjo@gva.es
Hernández
E
E
Ayuso
L
L
Ibáñez
V
V
D002985:Clinical Protocols; D020139:Gastroschisis / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D011446:Prospective Studies; D016216:Ultrasonography, Prenatal