Perinatal management of gastroschisis: analysis of a newly established clinical pathway |
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Authors: | Vegunta Ravindra K Wallace Lizabeth J Leonardi Michael R Gross Tom L Renfroe Yolanda Marshall J Stephen Cohen Howard S Hocker James R Macwan Kamlesh S Clark Sue E Ramiro Susan Pearl Richard H |
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Institution: | a Department of Surgery, University of Illinois College of Medicine at Peoria, IL 61603, USA b Department of Pediatrics, University of Illinois College of Medicine at Peoria, IL 61603, USA c Department of Obstetrics and Gynecology, University of Illinois College of Medicine at Peoria, IL 61603, USA d Section of Neonatology, Children's Hospital of Illinois, OSF St Francis Medical Center, Peoria, IL 61637, USA e The North Central Perinatal Region of Illinois, Peoria, IL 61614, USA |
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Abstract: | PurposeThe authors developed a clinical pathway for optimal management after antenatal diagnosis of gastroschisis. This is the outcomes analysis of our first 30 consecutive patients.MethodAntenatal counseling was provided for all families with in-utero diagnosis of gastroschisis. Bowel dilatation, thickness, motility, amniotic fluid volume, and fetal development were followed by ultrasonography every 4 weeks. Babies were delivered by cesarean section between 36 and 38 weeks gestation if the lungs were mature or earlier for bowel complications. Gastroschisis repair was scheduled 90 minutes after birth. Primary repair was attempted in all through the abdominal wall defect without an additional incision, resulting in an umbilicus with no abdominal scar.ResultsPrimary repair was achieved in 83%. Babies needed assisted ventilation for 3 days, reached full feeds by 19 days, and were discharged by 24 days (all medians). There were 3 (10%) deaths, all after staged repair.ConclusionsOur new protocol of both scheduled elective cesarean section and early gastroschisis repair resulted in a higher proportion of primary repair, shorter duration of mechanical ventilation, earlier full feeds, and shorter length of stay. There was no increase in mortality or morbidity. The primary-repair babies had no mortality and had excellent cosmesis. |
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Keywords: | Gastroschisis Clinical pathway Antenatal counseling Elective cesarean section Primary repair |
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