Improving outcomes for uncomplicated gastroschisis: clinical practice guidelines from the American Pediatric Surgical Association Outcomes and Evidence-based Practice Committee

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发表日期：

2024年8月30日

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Joanne Baerg,
Jarod McAteer,
Doug Miniati,
Stig Somme,
Mark Slidell,
Afif N. Kulaylat,
Tamar L. Levene,
Donald J. Lucas,
Sara A. Mansfield,
Rebecca M Rentea,
Stephanie F. Polites,
Kristy L. Rialon,
Robert L. Ricca,
Katie W. Russell,
Jason P. Sulkowski,
Jun Tashiro,
Derek Wakeman,
Yasmine Yousef,
Henry Chang,
Brian Englum,
Katherine Gonzalez,
Elizabeth Speck,
Sarkis Darderian,
Shannon Acker,
Shawn St. Peter,
Lorraine Kelley-Quon,
Robert Baird,
Alana L. Beres,
Emily Christison-Lagay,
Diana Diesen,
P. Benson Ham III,
Carlos T. Huerta

摘要

Background

The authors sought better outcomes for uncomplicated gastroschisis through development of clinical practice guidelines.

Methods

The authors and the American Pediatric Surgical Association Outcomes and Evidenced-based Practice Committee used an iterative process and chose two questions to develop clinical practice guidelines regarding (1) standardized nutrition protocols and (2) postnatal management strategies. An English language search of PubMed, MEDLINE, OVID, SCOPUS, and the Cochrane Library Database identified literature published between January 1, 1970, and December 31, 2019, with snowballing to 2022. The Appraisal of Guideline, Research and Evaluation reporting checklist was followed.

Results

Thirty-three studies were included with a Level of Evidence that ranged from 2 to 5 and recommendation Grades B–D. Nine evaluated standardized nutrition protocols and 24 examined postnatal management strategies. The adherence to gastroschisis-specific nutrition protocols promotes intestinal feeding and reduces TPN administration. The implementation of a standardized postnatal clinical management protocol is often significantly associated with shorter hospital stays, less mechanical ventilation use, and fewer infections.

Conclusions

There is a lack of comparative studies to guide practice changes that improve uncomplicated gastroschisis outcomes. The implementation of gastroschisis-specific feeding and clinical care protocols is recommended. Feeding protocols often significantly reduce TPN administration, although the length of hospital stay may not consistently decrease.