How is pediatric gastroschisis treated?

Updated: Nov 05, 2019
  • Author: James G Glasser, MD, MA, FACS; Chief Editor: Dharmendra J Nimavat, MD, FAAP  more...
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Answer

If the stomach is distended (from swallowed air), an orogastric tube should be placed to evacuate the air and succus intericus ("intestinal juice").

The eviscerated intestine should be placed over the abdominal wall defect, covered by Saran Wrap, and wrapped with dry Kerlix; the infant's lower torso may then be placed in a bowel bag. The baby may be placed in an incubator or under a radiant warmer, as long as the bowel is protected.

Administer broad-spectrum antibiotics because of the exposed intestine and open peritoneal cavity.

Anticipate and correct fluid, electrolyte, and heat losses: Administer an IV fluid bolus (20 mL/kg lactated Ringer or normal saline), followed by 5% dextrose/0.45 normal saline with potassium chloride (after having established the infant's urine output). Usually the baby's fluid requirements are greater than maintenance because of evaporative and third-space losses (within the lumen of the gut and interstitial tissues). Clinicians must carefully balance intake (IV fluids) and output (urine and gastrointestinal losses).

Urine output provides the most accurate measure of the adequacy of fluid resuscitation. Blood gas analysis identifies hypoperfusion and/or inadequate ventilation. Reduction of the herniated viscera is facilitated by evacuating meconium from the sigmoid colon and rectum.

Place a central venous line to provide parenteral nutrition, thereby minimizing catabolic protein loss during the period of gastrointestinal dysfunction. [33, 34, 35]


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