Implementation of Standardized Institutional Guidelines for Patients with Gastroschisis in a Level 4 NICU: Adherence and Outcomes

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-9-2025

Abstract

Gastroschisis is a congenital abdominal wall defect that allows for herniation of abdominal content and its direct exposure to amniotic fluid with an incidence of 2 to 5 per 10,000 live births (D'Antonio, F, et al). Advances in prenatal evaluation and multidisciplinary fetal/neonatal management have contributed significantly to the improvement in outcomes of patients with gastroschisis. Helen DeVos Children's Hospital Neonatal Intensive Care Unit (HDVCH NICU) implemented a new management guideline for neonates with gastroschisis with the goal to standardize care and reduce morbidity.

This is a retrospective chart review of neonates with gastroschisis treated at HDVCH Level 4 NICU, between 2018 and 2023. Chi-squared and Fischer exact test were utilized to compare various outcomes regarding gastroschisis site care, medical management, and length of hospitalization.

Forty-two neonates were included in this study, twenty-eight participants pre-guideline implementation and fourteen participants post-implementation. During the pre-implementation period, 8 patients experienced thirteen silo pop-offs compared to 0 silo pop-offs post-implementation. Post-implementation, we observed reduced time between NICU admission and silo placement, days to gastroschisis repair, days with central line and TPN administration, and decreased length of stay. We also observed increased epidural use, more frequent breastmilk administration compared to formula, and elimination of unnecessary post-operative antibiotic use.

While this study is underpowered to detect small differences in patient outcomes, there were multiple clinically relevant differences in clinical outcomes that can guide the development of best practices for gastroschisis management.

Comments

2025 Research Day Corewell Health West, Grand Rapids, MI, May 9, 2025. Abstract 1667

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