Gastroschisis

[size=20px]An otherwise healthy 38-week-gestation, three-kg newborn with gastroschisis undergoes bedside closure using an umbilical flap (i.e. sutureless closure). On the second day of life the baby is making adequate urine. Nasogastric tube output is 20 mL/kg/day. The current total fluid requirement per day for this infant following gastroschisis closure is A 60 mL/kg B 80 mL/kg C 100 mL/kg D 120 mL/kg E 150 mL/kg[/size]

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Which of the following statements regarding the abdominal wall defect shown in the folllowing photograph is true? [size=20px]a this can reliably be predicted on prenatal ultrasound b tolerance of full enteral feeds is expected in the neonatal period c the exposed tissue may represent a significant length of intestine d prenatal bowel dilation is an indication for early delivery e delivery at lung maturity can prevent this outcome[/size]

[size=20px]Which intervention has been found to improve patient outcomes in gastroschisis? A Spontaneous vaginal delivery at the closest available obstetrical center. B Use of a standardized feeding protocol. C Antibiotic prophylaxis for 5 days post closure. D Postoperative use of prokinetic erythromycin. E Use of narcotics to assist with silo reduction.[/size]

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You are called to see a 38-week gestational age newborn in the neonatal ICU. The family was previously seen in your office for prenatal consultation due to a concern for gastroschisis. On examination, you identify a closed gastroschisis defect. At time of operation, you determine that based on the length of the remaining small bowel (45cm), the child will likely have intestinal failure secondary to short gut syndrome. Which of the following may improve the child’s ability to wean from TPN? [center][/center] [size=20px]A Teduglutide B Dexamethasone C Reglan D Loperamide E Pantoprazole​[/size]

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A term baby girl with prenatal diagnosis of gastroschisis is delivered by C-section at 37 weeks. No other anomalies. Appearance of the gastroschisis at birth is shown below. What is your management plan and how will you counsel the parents?

[size=20px]A baby girl is born with gastroschisis and transferred to a children’s hospital. A decision must be made between primary closure or placing a spring loaded silo as the initial intervention. What is the most common complication of a temporary spring silo placement for gastroschisis? A prolonged time to full feeds B sepsis C prolonged hospital stay D ventral hernia E silo displacement​[/size]

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[size=20px]While having a discussion with a woman who is carrying a fetus with gastroschisis, she asks about silo and delayed repair versus immediate closure. You explain that compared to immediate repair, a standard three to five day silo closure is associated with A increased use of parenteral nutrition. B increased duration of ventilator use. C increased incidence of abdominal infections. D similar length of neonatal intensive care unit stay. E increased risk of bowel damage.​[/size]

[size=20px]A former 2.7-kg, ex 34-week premature infant was born with gastroschisis. The patient’s course was complicated by ischemic bowel requiring a prolonged use of silo. At 3 weeks of age, the fascia and skin are unable to be closed. A temporary mesh is placed to close the fascia. What is a contraindication of using negative pressure wound therapy (NPWT) in this patient? A Weight of patient B History of prematurity C Exposed bowel D Exposed mesh E Exposed superior mesenteric artery​[/size]

A 36-week female infant with gastroschisis has just arrived in the neonatal intensive care unit. The appearance is shown below. [center][/center] [size=20px]The most appropriate operative management of this infant is which of the following? A Ostomy creation B Enlargement of the defect C Sutureless closure D Excision with primary anastomosis E Placement of the bowel in a silo​[/size]

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[size=20px]Which of the following interventions has been found to improve patient outcomes in gastroschisis? A Spontaneous vaginal delivery at the closest available obstetrical center. B Use of a standardized feeding protocol. C Antibiotic prophylaxis for 5 days post closure. D Postoperative use of prokinetic erythromycin. E Use of narcotics to assist with silo reduction.[/size]

[size=20px]You are counseling parents with a fetus with gastroschisis. You recommend which type of delivery for a patient with gastroschisis? A vaginal induced before 35 week gestation. B vaginal at spontaneous labor. C Cesarean before 35 week gestation. D scheduled Cesarean at term. E Cesarean after 40 week gestation.[/size]

[size=20px]A newborn with gastroschisis is noted at primary closure to have abnormal intestinal rotation with a duodenojejunal junction to the right of the midline. Operative treatment for this apparent malrotation with gastroschisis should consist of A closure only. B closure only with upper gastrointestinal series at three-month follow-up. C Ladd procedure and closure. D Ladd procedure without appendectomy and closure.[/size]

First one with correct answer with justification win. [size=20px]A 36-week gestation male infant is born with gastroschisis. On your exam the bowel is not necrotic and there is no obvious intestinal atresia. As you consider attempted primary closure versus staged closure of the gastroschisis, which of the following is true regarding outcomes? A necrotizing enterocolitis is more likely in primary closure patients B length of stay is shorter in primary closure patients C short bowel syndrome is more common in staged closure patients D central line associated blood stream infection is more common in secondary closure patients E mortality is higher in primar…