What are the considerations in the delivery and early perioperative care of neonates with abdominal wall defects?

Updated: Jul 23, 2019
  • Author: Assar A Rather, MBBS, MD, FACS; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Answer

The greatest loss of contractility and mucosal function of the bowel and the fibrous coating of the bowel in gastroschisis occurs late in gestation. Delivery of infants with prenatally diagnosed abdominal wall defects can be via vaginal or cesarean delivery; neither method has a clear advantage over the other.

Preterm induction after ensuring lung maturity may be advantageous in cases of gastroschisis where serial imaging of the bowel reveals increasing dilation suggestive of a restrictive defect. To avoid damage to the sac from labor and delivery, elective preterm cesarean section is no longer recommended for infants with large omphaloceles.

Placing the infant up to the axillae in a sterile plastic bag maintains sterility, prevents evaporative water loss, and decreases heat loss. Infants with gastroschisis can be placed on their right side until silo placement is complete to prevent vascular compromise from twisting or kinking of the fascial edge. Although recommendations in the literature vary, the trend is toward universal silo placement and gradual reduction. Broad-spectrum antibiotics should be given, most commonly ampicillin and gentamicin.

The inflamed peritoneal and intestinal capillary membranes stabilize in 12-18 hours after surgery, and the fluid requirements then markedly decrease. When the capillary membrane stabilizes, exogenous albumin may be administered to elevate serum levels to 2.5-3 g/dL. The testes may be extracorporeal and should be placed near the processus vaginalis, because testicular proximity is a critical factor in the formation of the gubernaculum.


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