Management of Gastroschisis: Timing of Delivery, Antibiotic Usage & Closure | English-language publications | Systematic review by APSA | 1970-2019 | 92 manuscripts | 28 papers -> optimal timing of delivery | 5 papers -> antibiotic use | 59 papers -> closure considerations | Delivery after 37 weeks is optimal | Prophylactic antibiotics are adequate to reduce infection until definitive closure | Sutureless repair is safe, effective, and does NOT delay feeding or extend length of stay | Sedation and intubation are NOT routinely required for sutureless closure | Conclusion: There is a lot of variation gastroschisis management, so better research is needed to establish clear, evidence-based guidelines for treating these infants. | https://pubmed.ncbi.nlm.nih.gov/38796391/ | Source: Slidell MB et. al. | Division of Pediatric Surgery, Johns Hopkins Children's Center, Baltimore, MD, USA | @StayCurrentMD | @EmGootee MD | Cincinnati Children's | Journal of Pediatric Surgery
Management of Gastroschisis: Timing of Delivery, Antibiotic Usage, and Closure Considerations (A Systematic Review From the American Pediatric Surgical Association Outcomes & Evidence Based Practice Committee)
Infographic · Sep 2024 · 1 min read
In brief
In brief
This APSA systematic review of 92 studies found optimal gastroschisis management includes delivery after 37 weeks, prophylactic skin-flora antibiotics, and primary fascial closure when feasible. Sutureless repair is safe and effective without requiring intubation. Despite extensive literature, poor data quality necessitates high-quality RCTs.
- Delivery after 37 weeks gestational age is optimal for gastroschisis outcomes
- Prophylactic antibiotics covering skin flora are adequate until definitive closure
- Primary fascial repair is preferred when abdominal domain and hemodynamics permit
- Sutureless repair is safe, effective, and does not delay feeding or extend hospital stay
- High-quality RCTs needed due to poor data quality and wide practice variation in gastroschisis management
Written by the GCMD Library team from the infographic.
The infographic uses a teal and yellow color scheme with simple line illustrations including a calendar, stacked papers, a baby bottle, a healthcare worker holding an infant, and medical tubing. Key findings are presented in white and yellow text boxes against the teal background, with a yellow conclusion banner at the bottom. Social media handles and journal branding appear in the footer.
Mark B. Slidell, Jarod McAteer, Doug Miniati,Stig Sømme, Derek Wakeman, Kristy Rialon, Don Lucas, Alana Beres, Henry Chang, Brian Englum, Akemi Kawaguchi, Katherine Gonzalez, Elizabeth Speck, Gustavo Villalona, Afif Kulaylat, Rebecca Rentea, Yasmine Yousef, Aarkis Darderian, Shannon Acker, Shawn St Peter, Lorraine Kelley-Quon, Robert Baird, Joanne Baerg
Background: No consensus exists for the initial management of infants with gastroschisis.
Methods: The American Pediatric Surgical Association (APSA) Outcomes and Evidenced-based Practice Committee (OEBPC) developed three a priori questions about gastroschisis for a qualitative systematic review. We reviewed English-language publications between January 1, 1970, and December 31, 2019. This project describes the findings of a systematic review of the three questions regarding: 1) optimal delivery timing, 2) antibiotic use, and 3) closure considerations.
Results: 1339 articles were screened for eligibility; 92 manuscripts were selected and reviewed. The included studies had a Level of Evidence that ranged from 2 to 4 and recommendation Grades B-D. Twenty-eight addressed optimal timing of delivery, 5 pertained to antibiotic use, and 59 discussed closure considerations (Figure 1). Delivery after 37 weeks post-conceptual age is considered optimal. Prophylactic antibiotics covering skin flora are adequate to reduce infection risk until definitive closure. Studies support primary fascial repair, without staged silo reduction, when abdominal domain and hemodynamics permit. A sutureless repair is safe, effective, and does not delay feeding or extend length of stay. Sedation and intubation are not routinely required for a sutureless closure.
Conclusions: Despite the large number of studies addressing the above-mentioned facets of gastroschisis management, the data quality is poor. A wide variation in gastroschisis management was documented, indicating a need for high quality RCTs to provide an evidence-based approach when caring for these infants.