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Is 24 hours enough? Evaluating prophylactic antibiotic duration after abdominal wall closure in neonatal

Anna Zrinyi1, Anna Shawyer1, Richard Keijzer1

  • 1Division of Pediatric Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.

Journal of Pediatric Surgery
|February 8, 2026
PubMed

Insights

Discontinuing prophylactic antibiotics 24 hours after gastroschisis closure did not increase infection risk. This finding supports current guidelines for uncomplicated cases, suggesting shorter antibiotic courses are safe and effective.

Area of Science:

  • Pediatric Surgery
  • Neonatal Care
  • Infectious Disease Prevention

Background:

  • Current American Pediatric Surgical Association (APSA) guidelines recommend discontinuing prophylactic antibiotics 24 hours post-closure for gastroschisis patients managed with a silo.
  • Evidence supporting this limited antibiotic course recommendation is scarce.
  • This study evaluated infection rates based on antibiotic duration post-closure.

Purpose of the Study:

  • To determine if a short course (≤24 hours) of prophylactic antibiotics post-closure is associated with higher infection rates compared to longer courses in gastroschisis patients.
  • To provide evidence to support or refute the current APSA recommendation.

Main Methods:

  • Retrospective review of 53 neonates with gastroschisis managed with a silo (1991-2022).
  • Patients were categorized into short-course (≤24 hours) and prolonged-course (>24 hours) antibiotic groups.
  • Infection within 30 days of closure was the primary outcome, analyzed using logistic regression.

Main Results:

  • Infection occurred in 57% of the short-course group (16/28) and 44% of the prolonged-course group (11/25).
  • The adjusted odds ratio for infection with prolonged versus short-course antibiotics was 0.82 (95% CI=0.25-2.65, p=0.74).
  • No statistically significant difference in infection rates was observed between the two groups.

Conclusions:

  • Discontinuation of prophylactic antibiotics up to 24 hours after abdominal wall closure is not associated with an increased risk of infection in uncomplicated gastroschisis.
  • Findings support the current APSA recommendation for discontinuing prophylactic antibiotics 24 hours post-closure.
  • This supports a conservative approach to antibiotic use in gastroschisis management.
Abstract

Keywords:
Delayed closureGastroschisisProphylactic antibioticsSilo

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