Abstract：
BACKGROUND: No consensus exists for the initial management of infants with gastroschisis.
METHODS: The American Pediatric Surgical Association (APSA) Outcomes and Evidenced-based Practice Committee (OEBPC) developed three a priori questions about gastroschisis for a qualitative systematic review. We reviewed English-language publications between January 1, 1970, and December 31, 2019. This project describes the findings of a systematic review of the three questions regarding: 1) optimal delivery timing, 2) antibiotic use, and 3) closure considerations.
RESULTS: 1339 articles were screened for eligibility; 92 manuscripts were selected and reviewed. The included studies had a Level of Evidence that ranged from 2 to 4 and recommendation Grades B-D. Twenty-eight addressed optimal timing of delivery, 5 pertained to antibiotic use, and 59 discussed closure considerations (Figure 1). Delivery after 37 weeks post-conceptual age is considered optimal. Prophylactic antibiotics covering skin flora are adequate to reduce infection risk until definitive closure. Studies support primary fascial repair, without staged silo reduction, when abdominal domain and hemodynamics permit. A sutureless repair is safe, effective, and does not delay feeding or extend length of stay. Sedation and intubation are not routinely required for a sutureless closure.
CONCLUSIONS: Despite the large number of studies addressing the above-mentioned facets of gastroschisis management, the data quality is poor. A wide variation in gastroschisis management was documented, indicating a need for high quality RCTs to provide an evidence-based approach when caring for these infants.
METHODS: Qualitative systematic review of Level 1-4 studies.
METHODS: The American Pediatric Surgical Association (APSA) Outcomes and Evidenced-based Practice Committee (OEBPC) developed three a priori questions about gastroschisis for a qualitative systematic review. We reviewed English-language publications between January 1, 1970, and December 31, 2019. This project describes the findings of a systematic review of the three questions regarding: 1) optimal delivery timing, 2) antibiotic use, and 3) closure considerations.
RESULTS: 1339 articles were screened for eligibility; 92 manuscripts were selected and reviewed. The included studies had a Level of Evidence that ranged from 2 to 4 and recommendation Grades B-D. Twenty-eight addressed optimal timing of delivery, 5 pertained to antibiotic use, and 59 discussed closure considerations (Figure 1). Delivery after 37 weeks post-conceptual age is considered optimal. Prophylactic antibiotics covering skin flora are adequate to reduce infection risk until definitive closure. Studies support primary fascial repair, without staged silo reduction, when abdominal domain and hemodynamics permit. A sutureless repair is safe, effective, and does not delay feeding or extend length of stay. Sedation and intubation are not routinely required for a sutureless closure.
CONCLUSIONS: Despite the large number of studies addressing the above-mentioned facets of gastroschisis management, the data quality is poor. A wide variation in gastroschisis management was documented, indicating a need for high quality RCTs to provide an evidence-based approach when caring for these infants.
METHODS: Qualitative systematic review of Level 1-4 studies.
摘要：
背景：对于胃裂婴儿的初始治疗尚无共识。
方法：美国儿科外科协会（APSA）成果和循证实践委员会（OEBPC）提出了三个关于胃裂的先验问题，以进行定性系统评价。我们审查了1970年1月1日至2019年12月31日之间的英语出版物。本项目描述了对以下三个问题进行系统审查的结果：1)最佳交付时间，2）抗生素使用，和3)关闭考虑。
结果：对1339篇文章进行了资格筛选；选择和审查了92篇手稿。纳入的研究的证据水平为2至4级，建议为B-D级。二十八个解决了最佳交付时间，5与抗生素使用有关，和59讨论了闭包注意事项(图1)。概念年龄后37周后的分娩被认为是最佳的。覆盖皮肤菌群的预防性抗生素足以降低感染风险，直到最终关闭。研究支持原发性筋膜修复，没有分阶段的筒仓减少，当腹部和血流动力学允许时。不小心修理是安全的，有效,并且不会延迟进食或延长逗留时间。无缝合闭合通常不需要镇静和插管。
结论：尽管有大量研究涉及上述胃裂管理方面，数据质量差。记录了腹裂管理的广泛差异，这表明在照顾这些婴儿时需要高质量的随机对照试验以提供循证方法。
方法：1-4级研究的定性系统评价。
方法：美国儿科外科协会（APSA）成果和循证实践委员会（OEBPC）提出了三个关于胃裂的先验问题，以进行定性系统评价。我们审查了1970年1月1日至2019年12月31日之间的英语出版物。本项目描述了对以下三个问题进行系统审查的结果：1)最佳交付时间，2）抗生素使用，和3)关闭考虑。
结果：对1339篇文章进行了资格筛选；选择和审查了92篇手稿。纳入的研究的证据水平为2至4级，建议为B-D级。二十八个解决了最佳交付时间，5与抗生素使用有关，和59讨论了闭包注意事项(图1)。概念年龄后37周后的分娩被认为是最佳的。覆盖皮肤菌群的预防性抗生素足以降低感染风险，直到最终关闭。研究支持原发性筋膜修复，没有分阶段的筒仓减少，当腹部和血流动力学允许时。不小心修理是安全的，有效,并且不会延迟进食或延长逗留时间。无缝合闭合通常不需要镇静和插管。
结论：尽管有大量研究涉及上述胃裂管理方面，数据质量差。记录了腹裂管理的广泛差异，这表明在照顾这些婴儿时需要高质量的随机对照试验以提供循证方法。
方法：1-4级研究的定性系统评价。
