It is now common for these two abnormalities to be detected in the antenatal period; delivery in a specialist center with pediatric surgical facilities is recommended. There is no consensus concerning the timing or mode of delivery of these babies and there is no convincing evidence to suggest that preterm or Cesarean section delivery confer any distinct advantage.49-51 In gastroschisis, however, delivery is commonly induced at 37 weeks' gestation to avoid late-gestation fetal death. What is of paramount importance is protection of the intestine and prevention of fluid loss in cases of gastroschisis from the moment of delivery. In exomphalos the hernial sac confers a degree of protection to the intestine. In cases of gastroschisis the eviscerated intestine should be wrapped in clingfilm and adequate support provided to prevent fluid loss and ischemic damage to the bowel. Cases of exomphalos in which the hernial sac ruptures during delivery should subsequently be treated as for gastroschisis. Surgery and attempted closure should take place as

Figure 2.9 Clinical appearance of an infant with gastroschisis. There is no sac enclosing the herniated intestine, which is thickened and inflamed.

soon as possible following stabilization of the infant to prevent dehydration. Recent evidence suggests that a staged repair may result in favorable outcome when compared with primary closure.52-54 Intestinal dysmotility is always present in neonates with gastroschisis requiring parenteral nutrition for a period of usually 2-3 weeks. Parenteral nutrition has significantly improved the survival of neonates with gastroschisis.

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