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)
Topic overview
APSA systematic review of 92 studies examining gastroschisis management finds optimal delivery after 37 weeks, prophylactic skin-flora antibiotics until closure, and primary fascial repair preferred when feasible. Sutureless closure is safe and effective without requiring routine intubation, though evidence quality remains poor across all management aspects.
Key takeaways
- Delivery after 37 weeks gestational age is optimal timing for infants with gastroschisis
- Prophylactic antibiotics covering skin flora are adequate until definitive closure to reduce infection risk
- Primary fascial repair is preferred over staged silo reduction when abdominal domain and hemodynamics allow
- Sutureless repair is safe and effective without delaying feeding or extending hospital stay
- Current evidence quality is poor; high-quality RCTs needed to establish evidence-based management protocols
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