[Management protocol in gastroschisis]

Area of Science:

• Neonatal surgery
• Pediatric surgery
• Congenital anomalies

Background:

• Gastroschisis management traditionally involves primary or delayed closure.
• A multidisciplinary protocol was implemented in 2007, featuring preterm delivery at 34-35 weeks gestation and primary closure to minimize abdominal wall peel injury.

Purpose of the Study:

• To evaluate the impact of a new multidisciplinary protocol for gastroschisis management.
• To compare outcomes before and after the implementation of the protocol.

Main Methods:

• Retrospective study comparing gastroschisis patients before (1978-2006) and after (2007-2016) protocol implementation.
• Key outcomes analyzed include complex gastroschisis frequency, peel presence, closure type, complications, re-interventions, NICU length of stay, enteral nutrition onset, total parenteral nutrition duration, and overall hospitalization length.

Main Results:

• The post-protocol group showed a significant decrease in complex gastroschisis (1 vs. 9, p=0.001), re-interventions (15.38% vs. 58.33%, p=0.025), and complications (23.07% vs. 66.67%, p=0.028).
• NICU length of stay reduced from 40 ± 32 to 17 ± 12 days (p=0.025).
• Enteral nutrition onset improved to 9 ± 5 days (p=0.004), and hospitalization length decreased to 35 ± 15 days (p=0.011).

Conclusions:

• Protocol implementation facilitated primary closure for gastroschisis.
• The new protocol significantly reduced hospitalization duration, complications, and mortality rates.
• This multidisciplinary approach represents an advancement in gastroschisis care.