The Experience of Gastroschisis Management from a Single National Medical Center in China

Background: Gastroschisis is a severe congenital anomaly, and there is no evidence-based guidelines or protocols on how to manage gastroschisis. The clinical pathway which was focused on the quality improvement to standardize care, was implemented in the gastroschisis and the outcomes were improved. Methods: Eleven cases of gastroschisis neonates hospitalized between 2015 and 2019 at the Children’s Hospital were enrolled retrospectively. Antenatal counseling, a warm transport, appropriate fluid resuscitation, early closure, measurements of BdP (bladder pressure), and postoperative management were assured in the perinatal management. Outcomes after the implement of the clinical pathway were studied and analyzed. Findings: Eleven patients with gastroschisis were treated of perinatal management, including standardization of care and emphasis on early and monitoring in surgical approach, the survival rate was 100%. When compared to the perinatal mortality rate of 74·69% in China, the overall survival of gastroschisis was significantly improved. In eight of eleven cases, the pediatric quality of life was followed, during which developed well. Interpretation: Through targeted interventions and standardized management, the outcomes of infants born with gastroschisis in developing countries can be significantly improved. Funding: This work was supported by National Natural Science Foundation of China (grant number 81901989) and Postdoctoral Research Foundation of China (grant number 2019M652108). Declaration of Interests: The authors report no potential conflicts of interest relevant to this article. Ethics Approval Statement: The study was approved by the Institutional Review Board of the Children’s Hospital, Zhejiang University School of Medicine (ethics approval number 2021-IRB-001). Patients’ guardian all gave written informed consent.