Management of an Infant born with Gastroschisis

Antenatal Management:
Often young maternal age
Ultrasound:
o Usually identified as early as 12 weeks
o Defect lateral to umbilicus (usually to the right)
o Other abnormalities less likely
o Often have oligohydramnios. Polyhydramnios may indicate
intestinal atresia
o Note presence of any bowel dilatation
Counselling with Neonatal and Surgical team
Labour and Delivery:
Notify the Neonatal and Surgical team of impending delivery
Delivery may be vaginal or by Caesarian section
Anticipate associated problems (Prematurity, IUGR)
Prepare for specific management of the defect
Delivery Room Management:
ABC
If respiratory support is required, intubation and ventilation is preferable to
nCPAP to minimize gaseous distension of the gut
Stabilize the bowels in the midline with doughnut ring
Wrap the bowels with cling film
Pass a wide bore orogastric/nasogastric tube to decompress and aspirate
the gastric contents
Avoid unnecessary handling of the bowels
Pre-operative Management:
ABC
Assess perfusion and give fluid bolus if necessary
2 x large bore i.v. cannulae (Avoid veins suitable for long line)
Avoid unnecessary handling of the bowel
NG tube to low intermittent suction
Routine investigation including group and crossmatch
Vitamin K
I.V Augmentin, unless additional risk factors for sepsis present
(See separate guideline)

Fluid Management:
Fluid requirements may be greatly increased in the peri-operative
period due to evaporative loss from the exposed viscera and third
space loss into the abdominal cavity and tissues

10% Dextrose maintenance initially

Change to TPN when possible
Use normal saline or 4.5% HAS for fluid boluses
Replace NG losses with 0.45% saline with 1 mmol KCL per 50 ml
Ensure adequate hydration by monitoring perfusion, urine output and
blood pressure

Post-operative Management:
ABC
Review fluid management
Regularly assess hydration status
Aim for a urine output of at least 1 ml/kg/hr
Adequate pain relief (morphine, paracetamol)
Monitor NG losses and replace all losses
Continue antibiotics as per the Surgical team plan
Monitor serum electrolytes as necessary
Place a percutaneous central venous line
Nutritional support with TPN ( It may take ~4 weeks to establish full feeds)
Commence enteral feeding when NG aspirates less than 10 ml/kg
Use EBM for enteral feeding
Alert Surgeons if features of compartment syndrome:
Metabolic acidosis
Worsening ventilatory requirements
Lower limb oedema
Increasing abdominal distension
Decreased urine output despite adequate fluid management

Family Support:
Ensure parents are aware of management plans
Encourage mother to express breast milk
Orientate family to unit
References:
1.

M Drewett, GD Michailidis, D Burge. Perinatal Management of Gastroschisis, Early Human Development, 2006

Dr. Jenny Calvert/ Dr. Raju Narasimhan

To be re-evaluated June 2009