(decreased preload due to caval compression), dampened pulse tracings of the lower
extremities, decreased somatic NIRS, the baby is re-eviscerated and a silo is placed.
In other institutions, all babies with gastroschisis get a silo placed over the
intestines while in the NICU. This practice commits all babies with gastroschisis to a
staged closure. It makes operative closure an elective procedure.
Post-operative Management:
Primary Abdominal Closure: The baby is extubated as soon as possible. A PICC line is
placed so TPN can be started. It takes several weeks (mean 21 days) for GI tract to
work. Enteral feeds are slowly started, since up to 30% of gastroschisis babies can
develop NEC.
Silo Closure: The baby remains intubated usually. Serial reduction of abdominal
contents occur over several days (start on POD 2). The baby requires sedation and
pain medication about 15 minutes before the reduction. The baby’s ventilator settings
may need to be temporarily increased during the reduction due to the sedation and
increased abdominal pressure. The reduction is done under sterile conditions. Apply
gentle pressure on the intestines, pushing the intestines about 2-3 cm during each
reduction. Tie with an umbilical tape. Keep the silo vertical by securing the bag with
another umbilical tape to the top of the bed. Apply iodine ointment along the base and
wrap with sterile Kerlix.
The nurses weigh the dressings. If there is significant fluid loss, it is replaced.