GASTROSCHISIS CLINICAL PATHWAY

GASTROSCHISIS CLINICAL PATHWAY

A

Resuscitation
1. Provide Respiratory Support as indicated
2. Protect exposed viscera
a. Saran Wrap followed by Kerlix creating gauze silo
b. Lateral position to protect silo of wrapped bowel
c. Place OG (8-10 Fr), Aspirate Stomach
3. Place peripheral IV
4. Begin IV Glucose Infusion at 100 mL/kg/d
5. Fluid bolus-normal saline

NICU
1. Routine Admission Procedures
2. Blood work
a. CBC with differential
b. Blood Culture
c. Glucose
d. Type and screen
3. OG Tube to Low intermittent Suction , #8-#10 Fr.
4. Urinary catheter
5. Ampicillin and Gentamicin until 24 hrs after Abdominal Closure
6. PICC line attempt for all infants. Consider Broviac if unable to place PICC
7. Pediatric Surgery Consult for silo placement and decision about timing of closure .

Primary or Staged Surgical Intervention

1. If Intubated; Goal PIP <25 cm H2O (VT 4-6 ml/kg)
2. Measure intra-abdominal pressure (IAP)
a. Hourly until consistently <12 mm Hg. Then measure Q 4 hours.
3. If IAP >12 mm Hg notify Neonatologist or Nurse Practitioner & consider.
a. For IAP >20 Hg consider undoing silo reduction
b. Elevate HOB to 30 degrees (maximum)
c. Remove constricting dressings
d. Neuromuscular blockade
4. Call Surgery to assess for; IAP >20 mm Hg; (the definition of intra-abdominal
compartment syndrome). Urine output <1mg/kg/hr.
5. Morphine and Ativan as clinically indicated

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 GASTROSCHISIS CLINICAL PATHWAY
B

Post-Op. Abdominal Wall Closure Management

1. Morphine Q 2-4 hours PRN; change to drip if inadequate pain control , or if
needed more frequently than Q 2-4 hours.
2. Ativan 0.1 mg/kg IV agitation q4H PRN
3. OG to LIS
4. Monitor IAP via same pathway in previous box.

Attempt Feeding
1. Assess stooling, OG drainage and OG color.
2. ¼ Glycerin Suppository Q 12 hours PRN when showing signs of bowel activity.
3. Begin with bolus 20 mL/Kg/day offered by mouth divided Q3H or gtt feed based on
clinical exam.
4. Breast milk use encouraged.

Failure to Progress Successful Feeding

1. Reassess by 4 weeks Discharge
2. Consider GI patency studies

Post-Discharge Follow-Up
1. Recommend close monitoring of growth (at least 6, 12, 18 months) (2 X risk of poor
growth in first 3 years)
2. > 50% chance of re-hospitalization (especially in complicated cases- atresias and
bowel resections)
3. Slightly higher risk of delayed development (mostly in atresia/resection patients)
4. Follow up with primary surgeon 1-2 months after discharge

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GASTROSCHISIS V.8/05/15