II. Definition
- Open peri-umbilical abdominal wall defect in newborns
III. Epidemiology
IV. Risk factors
- Intrauterine Growth Retardation
- Prematurity
- Young mother (under age 20)
V. Pathophysiology
- Abdominal wall defect lateral to Umbilicus
- Evisceration of Small Intestine and ascending colon
- Bowel abnormal - matted and thickened
VI. Associated Conditions (21% of cases)
- Intestinal Atresia
- Gallbladder agenesis
- Renal agenesis
VII. Diagnosis
- Usually diagnosed by prenatal Obstetric Ultrasound
VIII. Management
- Stabilization
- Apply warm fluid-impermeable dressing over defect
- Avoid excessively Wet Dressings (macerates bowel)
- Place lower half of baby in sterile bowel bag
- Orogastric Tube for decompression
- Fluid Resuscitation (high evaporative losses)
- Maintenance IV fluids: D10W or 1/4NS
- Start with 20 cc/kg bolus over 30 minutes
- Fluid requirements in Gastroschisis 2.5x normal
- Blood Culture
- Broad spectrum Antibiotic coverage
- Ampicillin 100 mg/kg/day and
- Gentamicin 5 mg/kg/day
- Apply warm fluid-impermeable dressing over defect
- Surgical repair on first day of life
- Parenteral Feeding
IX. Complications
- Necrotizing Enterocolitis
- Bowel perforation
X. Prognosis
- Mortality: 10%
XI. References
- Feldman (1998) Sleisenger Gastrointestinal, p. 1428
- Townsend (2001) Sabiston Surgery, Saunders, p. 1479-80
- Fuloria (2002) Am Fam Physician 65(2):265-70 [PubMed]