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[Management protocol in gastroschisis].

V Villamil1, M J Aranda García1, J M Sánchez Morote1

  • 1Servicio de Cirugía Pediátrica. Hospital Clínico Universitario Virgen de la Arrixaca. Murcia.

Cirugia Pediatrica : Organo Oficial De La Sociedad Espanola De Cirugia Pediatrica
|June 7, 2017
PubMed
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A new protocol for gastroschisis management, involving preterm delivery and primary closure, significantly reduced complications and hospital stays. This approach improved outcomes for newborns with gastroschisis, decreasing re-interventions and length of neonatal intensive care unit (NICU) stay.

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.
Keywords:
GastroschisisPeelSilo

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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.