[Advances in treatment of congenital gastroschisis based on personal examinations]

The aim of the study was the definition of standard approach to a newborn with gastroschisis. The rules of treatment introduced in 1992 enabled the closure of the abdominal wall primarily in all newborns and made it possible to decrease the mortality considerably. This was achieved despite the fact that we usually did not have influence on time and method of delivery or quality of transportation to our department. In the Department of Pediatric Surgery of Institute Mother and Child, in the years 1992-1997, twenty three newborns with gastroschisis were admitted. The standard approach in all patients was the following: insertion of the catheters to the small bowel through the appenddicocaecostomy and to the large bowel through the rectum, intraoperative irrigation of the meconium (mucosolvan), forceful stretching of the abdominal wall, returning of extraabdominal viscera under control of central venous pressure or middle airway pressure (anesthesiologic control). In the postoperative period all patients routinely had controlled ventilation, administration of analgesic drugs, catecholamines, antibiotics and total parenteral nutrition. Intestinal catheters were gradually removed every day for irrigations of all levels. Oral nutrition was started after the return of effective peristalsis. From 23 treated newborns 16 are alive. 7 children died, 4 of them were resuscitated before operation because of severe general condition. Two patients died because of sepsis in the second month of life, one because of SIDS (sudden infant death syndrome) in the third week of life. Sixteen children are followed up. The development of all children is normal.