Management of Gastroschisis: Timing of Delivery, Antibiotic Usage, and Closure Considerations
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Key Takeaways
- Deliver gastroschisis infants after 37 weeks gestation for optimal outcomes
- Prophylactic antibiotics covering skin flora are sufficient until closure—broader coverage not needed
- Primary fascial repair is preferred when hemodynamics and abdominal domain allow
- Sutureless repair is safe and does not delay feeding or increase length of stay
- High-quality RCTs are needed to establish evidence-based gastroschisis management protocols
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What is the optimal initial management of an infant with gastroschisis? I'm Alex Halpern, a research fellow from Children's National, and this is an article that you should know. The ABSA Outcomes and Evidence-based Practice Committee performed a systematic review to try and answer this question. They found that delivery after 37 weeks is optimal. Prophylactic antibiotics covering skin flora are adequate to reduce infection risk until closure. Studies support primary fascial repair as long as hemodynamics and abdominal domain permit, and sutureless repair is safe, effective. And does not delay feeding or increased length of stay. They concluded that there is a need for a high quality randomized controlled trials to help provide evidence-based care for these infants. Does this information change your practice at all? Let us know what you think in the comments below.