Single center protocol driven care in 150 patients with gastroschisis 1998-2017: collaboration improves results

Area of Science:

• Neonatal Surgery
• Pediatric Surgery
• Congenital Abnormalities

Background:

• Gastroschisis (GS) is a congenital defect requiring surgical intervention.
• Optimizing clinical pathways for GS repair is crucial for improving neonatal outcomes.
• Previous approaches lacked standardized protocols for immediate management.

Purpose of the Study:

• To review the effectiveness of a collaborative clinical pathway for gastroschisis (GS) repair.
• To evaluate the impact of immediate attempted abdominal closure and mucolytic bowel irrigation.
• To assess the correlation between repair success and patient outcomes.

Main Methods:

• Retrospective review of 150 neonates with gastroschisis over 20 years.
• Analysis of a clinical pathway involving immediate defect reduction (within 2 hours) and bowel decompression with mucolytic irrigation.
• Assessment of outcomes including time to extubation, feeding initiation, and length of stay.

Main Results:

• Successful primary repair was achieved in 77% of cases.
• Primary repair success and time to closure significantly correlated with shorter extubation times, faster feeding initiation, and reduced hospital stays.
• Delayed closure cases were excluded from statistical analysis.

Conclusions:

• Early definitive abdominal closure combined with mucolytic bowel irrigation improves neonatal outcomes in gastroschisis.
• This pathway effectively reduces time to first feeds, total parenteral nutrition (TPN) use, extubation time, and length of hospital stay.
• The findings support the adoption of this standardized clinical pathway for gastroschisis management.