Gastroschisis Anne Aspin 2010 Gastroschisis • Defect lies to right of umbilicus • Central abdominal wall defect • No sac Embryology • 6TH Week intestine grows rapidly • Rotates and inverts by 10th week • Liver, bladder, stomach • Caused by vascular accident. Incidence • Omphalocele 1 :4000 • Gastroschisis 1:6000 – 10,000 • Increasing over last 30 years • Common in young mums, <20yrs. Associated anomalies • Gastro-intestinal tract, atresia,stenosis • Duplication cysts. Delivery • Maintain clear airway • Large naso-gastric tube, at least size 8. • Wrap the defect in cling film, or plastic bag. • IVI. Cling film • Clear so you can see defect • Protection • Prevent drying out. • Encloses in own serous fluid. On the neonatal unit • IVI at unit protocol, at least 60-75 ml / kg • HAS at 10 ml/kg cont infusion • Ng tube asp half hourly, replacement fluid • Prepare for theatre / transfer. Post operation • TPN, • Ng aspirated hourly, 2hrly, 4hrly, spigot • EBM cont feeds / bolus feeds (2 week ) • Build up slowly • Reflux • Central line infection • NEC Feeding problems • Gastro-oesophageal reflux • Vomiting • Poor weight gain • Colic • Fractious, fussy, crying • Irregular bowel actions So what can we do • Nappy change prior to feeds • Nurse with mattress raised • Sit in a chair after feeds by day • Tummy massage • Warm bubbly baths, music, swing chairs Medications • Thick,n easy • Thix o d • Ranitidine • Omeprazole • Erythromycin • Domperidone Long term management • Adhesive bowel obstruction • Short bowel syndrome • Motility disorders • Bowel transplantation • Normal lives mostly. References • Bonnard A, Zamakhshary M, De Silva N et al (2008). Non-operative management of • • • • • • • • • • • • gastroschisis: a case matched study. Pediatric Surgery International. 24 (7) : 767 771. Case-control Study of a Gastroschisis Cluster in Nevada. Archives of Pediatric Adolescent Medicine 2009. 163 : 1000 Case-control study of a self reported genitourinary infections and risk of gastroschisis: findings from the national birth defects prevention study, 1997 - 2003. BMJ 2008. 336 : 1420 Castilla E, Mastroiacovo P, Oriolo I (2008). Gastroschisis: international epidemiology and public health persepctives. Am J Med Genet C Semin Med Genet. 148C (3) : 162 -179 Glasser J (2007). Omphalocoele and Gastroschisis. eMedicine. Golladay E, McCrudden K (2008). Abdominal Hernias. eMedicine Houben C, Patel S (2008). Gastroschisis closure: a technique for improved cosmetic repair. Paediatric Surgery International. 24 (9) : 1057 - 1060. Khalil B, Baath M, Baillie C et al (2008). Infections in gastroschisis: organisms and factors. Pediatric Surgery International. 24 (9) : 1031 - 1035. Khan A, Thomas N, MacDonald S, Chandramohan H. Omphalocoele. eMedicine. Mann S, Blinman T, Douglas Wilson R (2008). Prenatal and postnatal management of omphalocele. Prenatal Diagnosis. 28 (7) : 626 - 632. Prognosis in isolated gastroschisis with bowel dilatation: a systematic review. Archives of Disease in Childhood. Fetal Neonatal Edition 2009. 94 : F268 Rahn S, Bahr M, Schalamon J et al (2008). Single-center 10 year experience in the management of anterior abdominal wall defects. Hernia. 12 (4) : 345 - 350. Stoll C, Alembik Y, Dott B et al (2008). Omphalocoele and gastroschisis and associated malformations. Am J Med Genet A. 146A (10) : 1280 - 1285.