Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ACUTE

gastroschisis

1st line – fluid resuscitation and temperature maintenance

Back
ACUTE
|
gastroschisis
1st line – 

fluid resuscitation and temperature maintenance

Immediate postnatal management of gastroschisis involves fluid resuscitation and temperature maintenance.

The infant should then be urgently transferred to a neonatal intensive unit with specialised paediatric surgical capacity.[32]

Plus – bowel protection

Back
ACUTE
|
gastroschisis
Plus – 

bowel protection

Treatment recommended for ALL patients in selected patient group

A sterile covering or a clear bowel bag should be placed immediately over the herniated abdominal contents to prevent evaporation, heat loss, and infection.

The infant should then be urgently transferred to a neonatal intensive unit with specialised paediatric surgical capacity.[32][Figure caption and citation for the preceding image starts]: Immediately after delivery, an infant with gastroschisis is placed in a protective bowel bagFrom collection of J.J. Tepas III, MD, FACS, FAAP [Citation ends].com.bmj.content.model.Caption@25bddc0a

Plus – primary surgical repair

Back
ACUTE
|
gastroschisis
|
small defect
Plus – 

primary surgical repair

Treatment recommended for ALL patients in selected patient group

Small defects may be treated with primary surgical repair.[35]

Plus – postsurgical nasogastric tube and parenteral nutrition

Back
ACUTE
|
gastroschisis
|
small defect
Plus – 

postsurgical nasogastric tube and parenteral nutrition

Treatment recommended for ALL patients in selected patient group

Surgery is followed by a trial of a nasogastric tube for decompression of the bowel and total parenteral nutrition while the inflammatory peel resolves.

Plus – staged reduction and surgical repair

Back
ACUTE
|
gastroschisis
|
large defect and/or extensive herniation
Plus – 

staged reduction and surgical repair

Treatment recommended for ALL patients in selected patient group

Larger defects or those with extensive herniation of abdominal contents require a staged approach with placement of the abdominal contents into a suspended silo and gradual reduction into the abdominal cavity.[35] Ventilatory support is often required during this process. Once the abdominal contents have been fully reduced into the abdominal cavity, surgery is performed to close the fascia and skin.[Figure caption and citation for the preceding image starts]: A staged repair of gastroschisis involves the placement of a silo to reduce contents into the abdomenFrom collection of J.J. Tepas III, MD, FACS, FAAP [Citation ends].com.bmj.content.model.Caption@250244fb[Figure caption and citation for the preceding image starts]: Once intestinal contents are fully reduced into the abdomen, closure of the abdominal wall followsFrom collection of J.J. Tepas III, MD, FACS, FAAP [Citation ends].com.bmj.content.model.Caption@43c21838

Plus – postsurgical nasogastric tube and parenteral nutrition

Back
ACUTE
|
gastroschisis
|
large defect and/or extensive herniation
Plus – 

postsurgical nasogastric tube and parenteral nutrition

Treatment recommended for ALL patients in selected patient group

Surgery is followed by a trial of a nasogastric tube for decompression of the bowel and total parenteral nutrition while the inflammatory peel resolves.[33]

Consider – secondary surgery

Back
ACUTE
|
gastroschisis
|
large defect and/or extensive herniation
Consider – 

secondary surgery

Additional treatment recommended for SOME patients in selected patient group

If an atretic (ischaemic) segment is present, a small bowel obstruction may develop after enteral feeds, necessitating further surgery.

omphalocele

1st line – fluid resuscitation and temperature maintenance

Back
ACUTE
|
omphalocele
1st line – 

fluid resuscitation and temperature maintenance

After delivery, infants with omphalocele should receive appropriate fluid resuscitation with temperature maintenance.[34]

The infant should then be urgently transferred to a neonatal intensive unit with specialised paediatric surgical capacity.

Plus – nasogastric tube

Back
ACUTE
|
omphalocele
|
intact membranous sac
Plus – 

nasogastric tube

Treatment recommended for ALL patients in selected patient group

A nasogastric tube should be inserted to decompress the bowel.

Consider – surgical repair

Back
ACUTE
|
omphalocele
|
intact membranous sac
Consider – 

surgical repair

Additional treatment recommended for SOME patients in selected patient group

Surgical repair of omphalocele is elective (non-urgent), unless the membranous sac is ruptured.

Defects without rupture of the membranous sac may be allowed to epithelialise, especially if associated anomalies render immediate surgical intervention inappropriately risky. The resultant ventral hernia can be repaired at a later date.[Figure caption and citation for the preceding image starts]: This ruptured omphalocele is similar in appearance to gastroschisisFrom collection of J.J. Tepas III, MD, FACS, FAAP [Citation ends].com.bmj.content.model.Caption@215006ff[Figure caption and citation for the preceding image starts]: A ventral hernia results from synthetic wall closure of the omphaloceleFrom collection of J.J. Tepas III, MD, FACS, FAAP [Citation ends].com.bmj.content.model.Caption@11e94454[Figure caption and citation for the preceding image starts]: The ventral hernia is repaired in a 6-year-old girl born with omphaloceleFrom collection of J.J. Tepas III, MD, FACS, FAAP [Citation ends].com.bmj.content.model.Caption@4fdafe9c

Plus – bowel protection

Back
ACUTE
|
omphalocele
|
ruptured membranous sac: small defect
Plus – 

bowel protection

Treatment recommended for ALL patients in selected patient group

If the membranous sac is not intact, a sterile covering or a clear bowel bag must be placed over the herniated abdominal contents to prevent evaporation, heat loss, and infection.[34][Figure caption and citation for the preceding image starts]: The abdominal wall defect in omphalocele is covered with a synthetic membraneFrom collection of J.J. Tepas III, MD, FACS, FAAP [Citation ends].com.bmj.content.model.Caption@1147aece

Plus – primary surgical repair

Back
ACUTE
|
omphalocele
|
ruptured membranous sac: small defect
Plus – 

primary surgical repair

Treatment recommended for ALL patients in selected patient group

Small defects may be treated with primary surgical repair.[35]

Plus – postsurgical nasogastric tube and parenteral nutrition

Back
ACUTE
|
omphalocele
|
ruptured membranous sac: small defect
Plus – 

postsurgical nasogastric tube and parenteral nutrition

Treatment recommended for ALL patients in selected patient group

Surgery is followed by a trial of a nasogastric tube for decompression of the bowel and total parenteral nutrition while the inflammatory peel resolves.

Plus – staged reduction and surgical repair

Back
ACUTE
|
omphalocele
|
ruptured membranous sac: large defect and/or extensive herniation
Plus – 

staged reduction and surgical repair

Treatment recommended for ALL patients in selected patient group

Larger defects or those with extensive herniation of abdominal contents require a staged approach with placement of the abdominal contents into a suspended silo and gradual reduction into the abdominal cavity.[35] Ventilatory support is often required during this process. Once the abdominal contents have been fully reduced into the abdominal cavity, the fascia and skin are surgically closed.

Plus – post-surgical nasogastric tube and parenteral nutrition

Back
ACUTE
|
omphalocele
|
ruptured membranous sac: large defect and/or extensive herniation
Plus – 

post-surgical nasogastric tube and parenteral nutrition

Treatment recommended for ALL patients in selected patient group

Surgery is followed by a trial of a nasogastric tube for decompression of the bowel and total parenteral nutrition while the inflammatory peel resolves.

back arrow

Choose a patient group to see our recommendations

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

Use of this content is subject to our disclaimer