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Perinatal management of gastroschisis: analysis of a newly established clinical pathway
Ravindra K Vegunta1, Lizabeth J Wallace, Michael R Leonardi
1Department of Surgery, University of Illinois College of Medicine, Peoria, IL 61603, USA. vegunta@uic.edu
Insights
A new clinical pathway for gastroschisis management, including scheduled C-sections and early repair, improved primary repair rates and reduced recovery times. This approach ensured excellent cosmetic outcomes without increasing mortality.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Fetal Medicine
Background:
- Gastroschisis, a congenital abdominal wall defect, requires specialized management strategies.
- Antenatal diagnosis allows for proactive planning and intervention.
Purpose of the Study:
- To evaluate the outcomes of a novel clinical pathway for managing gastroschisis diagnosed antenatally.
- To assess the efficacy of a protocol involving scheduled cesarean delivery and early primary repair.
Main Methods:
- Families received antenatal counseling following in-utero gastroschisis diagnosis.
- Fetal development and gastrointestinal status were monitored via ultrasonography.
- Babies underwent primary gastroschisis repair within 90 minutes of birth via scheduled cesarean section.
Main Results:
- Primary repair was successful in 83% of cases.
- Median duration for assisted ventilation was 3 days, with full feeds by 19 days and discharge by 24 days.
- Mortality occurred in 10% of cases, exclusively in those requiring staged repair.
Conclusions:
- The implemented clinical pathway significantly increased primary repair rates for gastroschisis.
- This protocol led to shorter hospital stays, reduced ventilation needs, and earlier feeding.
- Primary repair resulted in no mortality and superior cosmetic outcomes.
Purpose:
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.
Method:
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.
