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Ward reduction without general anaesthesia versus reduction and repair under general anaesthesia for gastroschisis in newborn infantsDavies MW, Kimble RM, Woodgate PG
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SummaryWard reduction without general anaesthesia versus reduction and repair under general anaesthesia for gastroschisis in newborn infantsWard reduction for newborn infants with gastroschisis is not supported or refuted by evidence from randomised controlled trials. Newborn babies with gastroschisis are born with their gut hanging out of a hole in their belly. If the gut is not put back they could get sick from fluid and heat loss or part of the gut could die or they could get a life-threatening infection. Traditionally the gut is pushed back inside the belly under anaesthetic in the operating theatre but in some hopsitals they push the gut back without anaesthetic in the neonatal ward (i.e., ward reduction). It is not known which method gives better outcomes. The reviewers did not identify any randomised studies comparing the two approaches. They concluded that there is no evidence either supporting or refuting ward reduction of gastroschisis.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2010 Issue 1, Copyright © 2010 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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July 22. 2002 AbstractBackgroundGastroschisis is a congenital anterior abdominal wall defect with the abdominal contents protruding through the defect. Reduction of the abdominal contents is required within hours after birth as the infant is at risk not only of water and heat loss from the exposed bowel but also of compromised gut circulation with ischaemia and infarction. To avoid the complications of general anaesthetic and mechanical ventilation it has been proposed that the reduction of abdominal contents can be achieved without endotracheal intubation or anaesthesia. ObjectivesTo determine which approach to the immediate surgical treatment of gastroschisis has the better outcomes: ward reduction without general anaesthetic or reduction and repair of the abdominal wall defect under general anaesthesia. Search strategyThe standard search strategy of the Cochrane Neonatal Review Group was used. This included searches of electronic databases: Oxford Database of Perinatal Trials; Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2003); MEDLINE (1966 - July 2003); CINAHL (1982 - July 2003); and previous reviews including cross references, abstracts, conferences, symposia proceedings, expert informants and journal hand searching mainly in the English language. Selection criteriaRandomised, controlled trials (RCT) comparing ward reduction with reduction under general anaesthesia, for neonates with gastroschisis. Outcomes considered were: mortality, duration of total parenteral nutrition, time to full enteral feeds, need for a silo, infection, gastro-intestinal tract perforation, length of bowel lost/resected, need for a general anaesthesia, need for and duration of mechanical ventilation and respiratory support, duration of oxygen therapy, need for further operative procedure after initial reduction, duration of hospital stay, cosmetic outcome, nutritional status, and neurodevelopmental outcome. Data collection and analysisNo studies were found meeting the criteria for inclusion in this review. Main resultsNo studies were found meeting the criteria for inclusion in this review. Authors' conclusionsThere is no evidence from RCTs to support or refute the practice of ward reduction for the immediate management of gastroschisis. There is an urgent need for RCTs to compare ward reduction versus reduction under general anaesthesia in infants with gastroschisis. Initial trials would best be limited to those infants with uncomplicated gastroschisis (using pre-defined selection criteria excluding infants that are unstable, have gut perforation, necrosis or atresia, have other organs requiring reduction besides bowel, or are considered to need a silo prior to any reduction). Trials should use adequate pain relief and specify a pre-defined time period after which manual reduction is abandoned. |