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)

Part of Pediatric Surgical Outcomes 11 items

Infographic · Sep 2024 · 1 min read

In brief

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.

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

Written by the GCMD Library team from the infographic.

A three-column comparison layout with medical illustrations of esophageal procedures. Each column contains anatomical diagrams in blue and pink tones showing the esophagus and surgical intervention points, accompanied by statistical data boxes below. The design uses a clean, clinical color palette with icons and percentage indicators for outcomes.

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.

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