Journal article
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)
Journal of pediatric surgery, v 59(8), pp 1408-1417
01 Aug 2024
PMID: 38796391
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
No consensus exists for the initial management of infants with gastroschisis.
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.
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.
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.
Qualitative systematic review of Level 1–4 studies.
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Details
- Title
- 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)
- Creators
- Mark B. Slidell - Johns Hopkins Children's CenterJarod McAteer - Providence HospitalDoug Miniati - Kaiser Permanente Roseville Medical CenterStig Sømme - University of Colorado DenverDerek Wakeman - University of Rochester Medical CenterKristy Rialon - Texas Children's HospitalDon Lucas - Naval Medical Center San DiegoAlana Beres - St. Christopher's Hospital for ChildrenHenry Chang - Johns Hopkins All Children's HospitalBrian Englum - University of Maryland, BaltimoreAkemi Kawaguchi - The University of Texas Health Science Center at HoustonKatherine Gonzalez - St. Luke's ClinicElizabeth Speck - C. S. Mott Children's HospitalGustavo Villalona - ITERAfif Kulaylat - Penn State Milton S. Hershey Medical CenterRebecca Rentea - Children's Mercy HospitalYasmine Yousef - Montreal Children's HospitalSarkis Darderian - Children's Hospital ColoradoShannon Acker - University of Colorado DenverShawn St Peter - Children's Mercy HospitalLorraine Kelley-Quon - Children's Hospital of Los AngelesRobert Baird - University of British ColumbiaJoanne Baerg - Presbyterian Healthcare Services
- Publication Details
- Journal of pediatric surgery, v 59(8), pp 1408-1417
- Publisher
- Elsevier
- Number of pages
- 10
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Surgery
- Web of Science ID
- WOS:001272367300001
- Scopus ID
- 2-s2.0-85194058177
- Other Identifier
- 991021969474804721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Pediatrics
- Surgery