available, the bowel should be carefully wrapped in warm saline-soaked gauze. An OG
tube for gastric decompression should be placed.
Management in the NICU
If the baby is transferred to the NICU and not directl to the OR, vascular access
should be established. Gastroschisis babies tend to lose a lot of fluid. Therefore, a 20
cc/kg NS bolus; 1.5 maintenance D10W. Intravenous antibiotics such as ampicillin and
gentamicin are given. The baby’s position should be optimize position of baby (see
above)
Operative Decision Making
In some institutions, the decision whether a primary fascial closure versus a silo
closure is performed is determined the in the operating room. In this case, the baby
should be brought to the OR ASAP: the longer the bowel is out, the more edematous it
gets and more difficult to achieve primary abdominal wall closure.
In the OR, the baby is anesthetized. The intestines are cleaned and slowly
replaced in the peritoneal cavity. The decision whether the abdominal wall is closed or
a silo is placed depends upon the physiologic ramifications of having the intestines
inside. In the OR, the intestines are placed in the abdominal cavity. Anesthesia and
surgery look at the ventilating pressures, BP, somatic NIRS, lower extremity pulses to
assess whether there is a prohibitive increase in the abdominal pressure. If the baby
cannot be oxygenated or ventilated (too much “push” on the diaphragm), BP decreases