Abdominal repairs completed without sutures lower the risk of infections in newborns, and thus the need for antibiotics, a recent review in Surgical Infections has shown.
The retrospective review of available data can help inform protocol for infections, one of the most common complications of gastroschisis, in which the abdominal wall fails to close properly. Researchers at Vanderbilt University Medical Center conducted the review.
“Our protocol calls for 48 hours of antibiotics to be given in the first 48 hours after birth. We only continue the antibiotics if there is clearly an infection, a reason for them.”
“We analyzed the current research to review what people are doing, what infectious complications have been reported, and how we should think about this problem moving forward,” said Jamie Robinson, M.D., Ph.D., assistant professor of pediatric surgery at Vanderbilt. “When we can do the repairs without a real operation, with a sutureless closure that’s like putting a Band-Aid over the hole on the abdominal wall, it really decreases the risk of infection.”
The traditional open operation approach requires sutures for closure, as well as general anesthesia, which the suture-free repair does not.
Congenital Abnormality
Gastroschisis is a congenital condition resulting from a failure of the abdominal wall to completely close during fetal development. This allows the contents of the abdomen, such as the intestines and sometimes other organs, to extrude.
Affecting four in 100,000 births, it is the most common type of congenital abdominal wall defect and has, for reasons that remain unclear, become increasingly prevalent worldwide. Risk of infection following repair is an ongoing concern.
“A sutureless closure….really decreases the risk of infection.”
“The evidence overwhelmingly demonstrates that infections are common and have significant impact,” the authors wrote. “Infections occur primarily from a multitude of sites, including the surgical of gastroschisis wound site, blood stream, and urinary tract.”
Data on the frequency of surgical-site infection vary widely, “ranging from 4 percent to 32 percent,” the authors wrote.
Repairs That Reduce Risk
Patients face less risk when foregoing sutures during the procedure.
Suture-less closure for patients with gastroschisis is sometimes known as “plastic” or “flap” closure, a bedside procedure first described in 2004. The patient’s umbilical cord is left longer than usual at birth and can be used to cover the opening following the abdominal repair.
This closure method is not always possible, however. In some cases that is due to insufficient umbilical cord viability.
“In some cases, there is not enough umbilical cord, or it necroses,” Robinson said.
Within the literature, the research team observed a higher incidence of surgical-site incisions in neonates whose abdominal closure took place more than 24 hours after delivery as opposed to a prompter procedure.
“Our protocol calls for 48 hours of antibiotics to be given in the first 48 hours after birth. We only continue the antibiotics if there is clearly an infection, a reason for them. If the baby is stable, we stop them,” Robinson said.
“This is a pretty rare condition; generally, there aren’t a lot of randomized controlled trials because of the rarity of the diseases we treat.”
Multi-institution collaborations will be required to devise protocols that are truly translatable to different institutions, including determining the true best methods to limit infection, she said.
