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Prenatal and Postnatal Management of Gastroschisis in German-Speaking Countries: Is There a Standardized Management?
Katharina Schib1, Marc Schumacher2, Martin Meuli1
1Department of Pediatric Surgery, University Children's Hospital, Zurich, Switzerland.
Insights
Management of gastroschisis in German-speaking countries lacks standardization, with no established gold standard for perinatal care. This study highlights variations in treatment and calls for multicenter trials to improve outcomes for newborns with gastroschisis.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Congenital Anomalies
Background:
- Lack of evidence-based guidelines for perinatal gastroschisis management.
- Variability in current treatment protocols across German-speaking countries.
- Need for data to inform multicenter randomized controlled trials.
Purpose of the Study:
- Evaluate current perinatal treatment modalities for gastroschisis in Germany, Austria, and Switzerland.
- Identify variations and potential areas for standardization in gastroschisis care.
- Provide a foundation for developing standardized treatment protocols.
Main Methods:
- Developed and distributed a 30-question survey to pediatric surgery institutions.
- Included sections on prenatal diagnosis, fetal therapy, delivery, operative, and postoperative management.
- Analyzed data from 89 participating hospitals using descriptive statistics.
Main Results:
- Achieved a 95% response rate from hospitals treating gastroschisis.
- Identified standardized practices in prenatal monitoring, team approach, C-section delivery, silastic bag coverage, early intervention, primary closure attempts, and antibiotic use.
- Revealed significant non-standardization in crucial management parameters.
Conclusions:
- No universally accepted gold standard exists for gastroschisis management in German-speaking regions.
- Identified potentially harmful practices lacking evidence, such as fetal therapy, preterm delivery, and inadequate pressure monitoring.
- Emphasized the necessity of prospective, randomized, multicenter studies to establish standardized care.
Introduction:
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.
Materials And 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.
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