Gastroschisis-Guidel..

10/13/10 Gastroschisis Guideline Page 2 /3Resuscitation1. Dry the infant2. Assess respiratory status3. Provide respiratory support4. Attach monitors5. Protect exposed visceraa. Saran wrap followed by Kerlix creating gauze silob. Lateral position to protect silo of wrapped bowel6. Place peripheral IV7. Begin IV glucose infusion – 120/kg8. Fluid bolus-normal saline – 10 ml/kg9. Nasogastric tube, aspirate stomach and low intermittentsuction10. Blood cx11. Temperature stabilizationNICU1. Infant is weighed2. Infants length is measured3. Attach monitors4. Respiratory support5. Call pediatric surgeonsa. Notify surgeon in advance (day/evening only)b. During Night only call when he/she should come tothe NICU6. Blood worka. CBC with differentialb. Glucosec. Type and screen7. Intubated and paralyzed, if clinically indicated8. OG Tube to LIS, #8-#10 Fr. Replogle9. Urinary catheter (Foley)10. Spring loaded silo placed if abd. Closure not possible11. Amp. and Gentamicin until 24 hrs after abd. closure12. PICC line for all infantsa. If PICC line not central Broviac may be placed atclosurePrimary Surgical Closure1) PIP 12 mm Hg. (16 cm H 2 O), notify doctor &consider:a) Elevate HOB to 30 degrees (maximum)b) Remove constricting dressingsc) Neuromuscular blockaded) Vasoactive meds to increase perfusion5) For IAP > 20 mm Hg (27 cm H 2 O), which is the officialdefinition of intra-abdominal compartment syndrome)&/or urine output < 1 ml/kg/hr, consider surgicalinterventionSilo followed by Surgical Closure1) Measure intra-abdominal pressure (IAP)a) Hourly X 1 days or until consistently < 12 mm Hg (16cm H 2 O)b) Hourly X 1 day after each silo reduction untilconsistently < 12 mm Hg (16 cm H 2 O)2) For IAP > 20 mm Hg (27 cm H 2 O) consider undoingsilo reduction3) Monitor SpO 2 on silo every hour (not continuously—can damage the bowel)a) Apply probe to the TOP of the silo outside thetopmost part of bowel.b) Do NOT remove plastic liner from the probe—inother words do not expose and do not apply stickypart of probe to silo (can damage silo). Use tape tokeep probe in place and move as silo is reduced.c) Notify neonatologist if SpO 2 on silo and hand is morethan 10% different