Table 3 Recommendations

Module 1—Prenatal care

1.1 a

The panel suggests birth between 37⁺⁰ and 39⁺⁰ weeks in children with uncomplicated gastroschisis

1.1 b

The panel suggests vaginal birth in children with uncomplicated gastroschisis

1.1

The panel suggests vaginal birth between 37⁺⁰ and 39⁺⁰ in children with uncomplicated gastroschisis

1.2

The panel suggests interpreting Intra-Abdominal Bowel Dilatation and Extra-Abdominal Bowel Dilatation on follow up ultrasound as predictors for complex gastroschisis

The panel recommends evaluating the fetus with gastroschisis based on a complete image of different ultrasound parameters combined. It would, therefore, be useful to evaluate bowel thickness, gastric dilation, herniation of the stomach and/or bladder through the abdominal wall defect, presence of polyhydramnios, fetal growth parameters, fetal movement and size of the abdominal wall defect in addition to IABD and EABD

There is insufficient evidence or expert experience to suggest using altered mesenteric artery flow as a prognostic factor for a complex gastroschisis. The experts do not formulate any recommendation

Module 2—Management and closure of the abdominal wall defect

2.1

The panel suggests considering Bianchi’s approach as a possible option for treatment of neonates with simple gastroschisis and good bowel conditions

2.2

The panel suggests sutureless closure in neonates with gastroschisis and who undergo repair without general anesthesia (silo-staged or primary)

If primary closure under general anesthesia is performed, the panel suggests a sutured closure to avoid possible hernia development (and surgery) later in life

2.3

The panel suggests primary intestinal repair for complex gastroschisis patients with atresia if the general condition and bowel allow for primary intestinal repair

The panel suggests determining the treatment strategy for patients with complex gastroschisis based on the individual characteristics, general condition, and bowel condition of each patient

2.4

The panel suggests considering treatment without ventilation and general anesthesia as an option in case of patients with simple gastroschisis and a stable condition if staged closure is the treatment option of choice

The panel recommends close monitoring of comfort and pain using objective measurements in patients undergoing staged closure while breathing spontaneously

2.5

The panel suggests using either synthetic or biologic mesh in cases where fascial closure is not feasible after silo reduction

The final decision for the type of mesh should be based on inhouse expertis of the pediatric surgical team

Module 3—Feeding

3.1a

The panel suggests starting enteral feeding within the first 14 days post repair. If the neonate’s condition is favorable with low aspirates, starting enteral feeds before the 7th day can be considered

3.1b

The panel suggests the implementation of a feeding protocol in centers to start enteral feeding after gastroschisis correction in neonates

3.2

The panel suggests the upper extremity as first choice in case of placement of a peripherally-inserted central catheter

The risk difference is larger in patients with a SILO. Should lower extremity PICC line be the option of choice in a patient with a SILO, cautious surveillance for complications is warranted

Module 4—Organization of care

4.1

Most parents were satisfied with the quality of care but suggestions for improvement were to obtain psychological support at all time, to provide more information in written folders, parents support groups, in the NICU: to allow relatives, adjusted sedation/analgesia protocols during reduction of bowels and structured and early feeding protocols

4.2

Decisions regarding antenatal follow-up, the timing, place and mode of delivery, as well as the procedures to be performed during the neonatal period should be discussed by the medical team prior to consultation with the parents to ensure that the information given is consistent and that the dialogue is homogeneous

4.3

A multidisciplinary care team for gastroschisis should include a maternal–fetal specialist, obstetrician, neonatologist, pediatric surgeon, pediatric anesthetist, pediatric gastroenterologist, dietitian, social worker and/or psychologist and coordinating nurse

4.4

There are indications that higher volume centers have a significantly lower mortality rate compared to lower volume centers

4.5

Measurement of QoL using a validated instrument is important

The guideline development group endorses the recommendation by Allin et al.(2019), to use the PedsQL until a gastroschisis-specific QoL instrument is developed and validated