Transcript Gastroschisis - the Yorkshire Neonatal Network

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
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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.