Prenatal and Postnatal Management of Gastroschisis in German-Speaking Countries: Is There a Standardized Management?
BACKGROUND
Evidence-based guidelines or protocols regarding the perinatal management of babies born with gastroschisis are lacking. The aim of this work is to evaluate the different current treatment modalities for newborns with gastroschisis during the perinatal period in the German-speaking countries Germany, Austria, and Switzerland. These data could serve as a starting point for the development of a multicenter randomized controlled trial.


METHODS
A questionnaire was developed with 30 questions divided into five sections: (1) prenatal diagnosis, (2) fetal therapy, (3) mode and timing of delivery, (4) operative management, and (5) postoperative management. All pediatric surgery institutions that treat newborns with gastroschisis were identified and asked to participate. Data were categorized by country and analyzed using descriptive statistics (frequency and percentage).


RESULTS
The return rate of the questionnaire was 95% (89 hospitals). A standard procedure was identified regarding prenatal ultrasound monitoring, interdisciplinary team approach, planned delivery through cesarean section, postnatal coverage of the intestine with a silastic bag, first intervention within the first 6 hours after birth, attempt of primary abdominal wall closure, and perioperative antibiotic treatment. For many crucial parameters, management was not standardized.


CONCLUSIONS
There is no gold standard in German-speaking countries on how to manage fetuses and babies with gastroschisis. Moreover, this report unveils some questionable elements of daily practice for which there is no evidence at all and which can jeopardize outcome and even prove fatal (fetal therapy, preterm delivery, lack of abdominal pressure monitoring). Prospective randomized-controlled multicenter studies are needed to set a standard.
Department of Pediatric Surgery, University Children's Hospital, Zurich, Switzerland.
Katharina
K
Schib
Department of Pediatrics, Triemli Municipal Hospital Zurich, Zurich, Switzerland.
Marc
M
Schumacher
Department of Pediatric Surgery, University Children's Hospital, Zurich, Switzerland.
Martin
M
Meuli
Department of Pediatric Surgery, University Children's Hospital, Zurich, Switzerland.
Sasha
S
Tharakan
Department of Pediatric Surgery, University Children's Hospital, Zurich, Switzerland.
Ulrike
U
Subotic
D001317:Austria; D003456:Cryptorchidism / Q000150:complications / Q000601:surgery; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005260:Female; D046128:Fetal Therapies; D020139:Gastroschisis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D005858:Germany; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007409:Intestinal Atresia / Q000150:complications / Q000601:surgery*; D007422:Intestines / Q000601:surgery*; D008297:Male; D011182:Postoperative Care; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011296:Prenatal Diagnosis; D011795:Surveys and Questionnaires; D013557:Switzerland