title: Outcomes of bedside sutureless umbilical closure without endotracheal intubation for gastroschisis repair in surgical infants.
abstract: BACKGROUND
  Newborns with gastroschisis have historically undergone surgical repair under general anesthesia. Our institution recently transitioned to the sutureless umbilical closure for gastroschisis. We sought to evaluate the feasibility of bedside gastroschisis repair without endotracheal intubation.
  
  
  METHODS
  A retrospective review was performed of neonates with gastroschisis who underwent sutureless umbilical closure from 2011 to 2015. Clinical characteristics and outcomes between groups were compared.
  
  
  RESULTS
  In total, 53 infants underwent sutureless umbilical closure. Closure without endotracheal intubation was attempted in 23 (43%) babies and was successful in 15 (65%) infants. Two of the 8 patients who required intubation needed a temporary silo. Neonates successfully repaired without intubation were more premature (p < 0.01), smaller at birth (p = 0.01), and repaired nearly an hour sooner (p < 0.01). There were no differences in time to full enteral nutrition, length of stay, bowel ischemia, or sepsis.
  
  
  CONCLUSIONS
  Bedside sutureless umbilical closure without intubation is feasible and effective in newborns with gastroschisis. The procedure decreases time to gastroschisis closure. Smaller and more premature neonates were more likely to be successfully closed without intubation.
authors.affiliation: Department of Pediatrics, University of Washington, School of Medicine, Seattle Children's Hospital, Seattle, WA, USA.
authors.forename: Gillian E
authors.initials: GE
authors.lastname: Pet
authors.affiliation: Department of Surgery, University of California-Davis, Davis, CA, USA.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Stark
authors.affiliation: Division of Pediatric General and Thoracic Surgery, University of Washington, School of Medicine, Seattle Children's Hospital, Seattle, WA, USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Meehan
authors.affiliation: Division of Pediatric General and Thoracic Surgery, University of Washington, School of Medicine, Seattle Children's Hospital, Seattle, WA, USA. Electronic address: patrick.javid@seattlechildrens.org.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Javid
mesh_terms: D058107:Abdominal Wound Closure Techniques; D005240:Feasibility Studies; D005260:Female; D020139:Gastroschisis / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D007442:Intubation, Intratracheal; D008297:Male; D019095:Point-of-Care Systems; D012189:Retrospective Studies; D016896:Treatment Outcome; D014472:Umbilicus / Q000601:surgery*