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
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.
Key takeaways
- 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
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