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Infectious Complications and Antibiotic Use in Gastroschisis
Marshall W Wallace1, Melissa E Danko2, Irving J Zamora2
1School of Medicine, Vanderbilt University, Nashville, Tennessee, USA.
Insights
Infection is a major risk in gastroschisis (a neonatal condition). Selective, short-term antibiotics are recommended for simple cases to improve outcomes.
Area of Science:
- Neonatal surgery
- Pediatric infectious diseases
Background:
- Gastroschisis is a complex congenital defect with high rates of infection, morbidity, and mortality.
- Infection affects up to two-thirds of gastroschisis patients, significantly increasing complications.
Purpose of the Study:
- To review infection risks and antibiotic management in gastroschisis.
- To provide evidence-based recommendations for antibiotic use in neonates with gastroschisis.
Main Methods:
- Literature review of studies on gastroschisis and infection.
- Analysis of factors associated with increased infection risk.
- Evaluation of current antibiotic usage patterns.
Main Results:
- Increased central venous catheter days, complex gastroschisis, and delayed closure correlate with higher infection rates.
- Sutureless gastroschisis closure is linked to reduced infection incidence.
- Antibiotic use in gastroschisis management is highly variable.
Conclusions:
- Selective, short-term antibiotic therapy is advised for simple gastroschisis, irrespective of closure method.
- Developing evidence-based guidelines is crucial to standardize care and improve outcomes.
- Reducing variability in care can enhance patient outcomes across institutions.
Abstract:
Gastroschisis is a challenging neonatal condition often with prolonged hospitalizations, need for parenteral nutrition, infectious complications, and can even result in death. Infection is reported to occur in up to two-thirds of patients with gastroschisis and is a strong risk factor for increased morbidity and mortality. Increased days with a central venous catheter, complex gastroschisis, and delayed abdominal wall closure have been consistently found to be associated with increased risk of infection, whereas sutureless gastroschisis closure has been associated with fewer infections. Although one of the most common complications of gastroschisis is infection, the use of antibiotic agents varies widely with variability in the literature to guide management. Antibiotic usage should be selective and short-term, especially in neonates with simple gastroschisis regardless of method for abdominal wall closure. Future initiatives should focus on development of evidence-based guidelines on the care of these patients with the goal of reducing variability and improve outcomes within and across institutions.
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