O2167: Evolution of Gastroschisis Treatment at a Major Academic Children’s Hospital and the Role of Clinical Care Guidelines in Improving Outcomes

Purpose/Objectives: Gastroschisis is an abdominal wall defect, occurring in an estimated 3 in 10,000 live births. The treatment for gastroschisis within our institution has been made more standardized by the implementation of clinical care guidelines in 2015 with an updated version in 2020. We reviewed our single institution outcomes data from 2010 until 2024 and present our findings.

Design/Methods: We conducted a retrospective review using the Children’s Hospitals Neonatal Database (CHND) and electronic medical records (EMR) of 127 patients treated for gastroschisis from 2010 – 2024 at Children’s Hospital Colorado (CHCO). We separated simple and complex gastroschisis, focusing our analysis on those with simple gastroschisis. Primary outcomes included location and type of initial repair, endotracheal intubation, mechanical ventilation, anesthesia, and the use of tunneled central lines.

Results: From 2010 – 2024, 127 patients with gastroschisis were treated at CHCO, 29 of which were complex. In 2010 – 2014 compared to 2016 – 2024, the percent of non-complex repairs performed in the operating room under general anesthesia decreased from a mean of 47.8% to 7.7%. In 2010 – 2014 compared to 2018 – 2024, the percent of patients undergoing mechanical ventilation for repair decreased from 92% to 45% and the percent of patients receiving tunneled lines decreased from 23% to 0%.

Conclusion/Discussion: The implementation of clinical care guidelines to guide treatment of gastroschisis in our institution has led to a more standardized treatment approach and significantly improved outcomes. Over the course of 15 years, we have changed our treatment practice from most infants undergoing surgical closure under general anesthesia in the operating room to mostly performing sutureless bedside closures under sedation. Additionally, we have transitioned from placement of tunneled central venous catheters in about one quarter of patients to exclusive placement of peripherally inserted central venous catheters.