Improving outcomes for uncomplicated gastroschisis: clinical practice guidelines from the American Pediatric Surgical Association Outcomes and Evidence-based Practice Committee
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In brief
In brief
The American Pediatric Surgical Association developed clinical practice guidelines for uncomplicated gastroschisis management based on systematic review of 33 studies. Evidence supports implementing standardized nutrition and postnatal care protocols to reduce TPN use, shorten hospital stays, and decrease complications like infections and mechanical ventilation requirements.
- Gastroschisis-specific nutrition protocols significantly reduce TPN administration and promote earlier intestinal feeding.
- Standardized postnatal management protocols are associated with shorter hospital stays, less mechanical ventilation, and fewer infections.
- Evidence quality is limited (Level 2-5, Grades B-D); high-quality comparative studies are needed to guide practice improvements.
- Implementation of structured feeding and clinical care protocols is recommended despite variable impact on length of stay.
Written by the GCMD Library team from the article.
Abstract
Background
The authors sought better outcomes for uncomplicated gastroschisis through development of clinical practice guidelines.
Methods
The authors and the American Pediatric Surgical Association Outcomes and Evidenced-based Practice Committee used an iterative process and chose two questions to develop clinical practice guidelines regarding (1) standardized nutrition protocols and (2) postnatal management strategies. An English language search of PubMed, MEDLINE, OVID, SCOPUS, and the Cochrane Library Database identified literature published between January 1, 1970, and December 31, 2019, with snowballing to 2022. The Appraisal of Guideline, Research and Evaluation reporting checklist was followed.
Results
Thirty-three studies were included with a Level of Evidence that ranged from 2 to 5 and recommendation Grades B–D. Nine evaluated standardized nutrition protocols and 24 examined postnatal management strategies. The adherence to gastroschisis-specific nutrition protocols promotes intestinal feeding and reduces TPN administration. The implementation of a standardized postnatal clinical management protocol is often significantly associated with shorter hospital stays, less mechanical ventilation use, and fewer infections.
Conclusions
There is a lack of comparative studies to guide practice changes that improve uncomplicated gastroschisis outcomes. The implementation of gastroschisis-specific feeding and clinical care protocols is recommended. Feeding protocols often significantly reduce TPN administration, although the length of hospital stay may not consistently decrease.