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Gastroschisis
Aka: Gastroschisis
- See Also
- Omphalocele
- Definition
- Open peri-umbilical abdominal wall defect in newborns
- Epidemiology
- Overall Incidence: 1 in 10,000 births
- Incidence in mothers under age 20: 7 in 10,000 births
- Risk factors
- Intrauterine Growth Retardation
- Prematurity
- Young mother (under age 20)
- Pathophysiology
- Abdominal wall defect lateral to Umbilicus
- Evisceration of Small Intestine and ascending colon
- Bowel abnormal - matted and thickened
- Associated Conditions (21% of cases)
- Intestinal atresia
- Gallbladder agenesis
- Renal agenesis
- Diagnosis
- Usually diagnosed by prenatal Obstetric Ultrasound
- 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
- Surgical repair on first day of life
- Parenteral Feeding
- Complications
- Necrotizing Enterocolitis
- Bowel perforation
- Prognosis
- Mortality: 10%
- 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]