Minimizing complications in neonatal sutureless gastroschisis closure with hydrophobic technology

Gastroschisis, a congenital anomaly of the anterior wall, is defined as “a congenital malformation characterized by visceral herniation through a right-side abdominal wall defect to an intact umbilical cord and not covered by a membrane". Traditionally gastroschisis was managed by either primary abdominal content reduction and closure of abdominal wall or staged reduction. The modern technique involves sutureless closure.Sutureless closure utilizes umbilical cord as a biologic dressing.

Once the eviscerated bowel is reduced into the cavity, the defect is covered by umbilical cord. Various dressings including acrylates, hydrocolloids, foams and silicones have been used as secondary dressings. Complications include fluid seepage and need for absorptive dressing, periwound dermatitis, wound and periwound bacterial colonization and concerns for fungal /bacterial infection.

We describe use of hydrophobic dressings*as a secondary dressing for neonatal patients with sutureless gastroschisis closure. Initially hydrophobic technology was used as a rescue in 2 neonates with significant periwound dermatitis and fungal infection. Successful treatment and timely skin closure, lead to preventative use of these dressings to prevent colonization and infection development. In addition, these dressings come in different configurations, proving moisture control and soft non-traumatic secondary dressing.

We initially put a piece of folded hydrophobic gauze, followed by silicon-based hydrophobic border dressing to provide necessary weight over the defect and prevent excessive bulging. During the first week dressings were changed every 2-3 days to avoid fluid saturation, later on every 3-4 days changes were adequate. Images of both types of approaches will be provided.The average time to first feeding was similar to “historical control“ group of dressings(11 days).Time to discharge was shorter with hydrophobic dressings( 26 days vs 23 days), likely related to integrity of periwound skin and less need for systemic antibiotics treatments.

No baby developed skin reaction to dressings or their removal. We recommend considering hydrophobic technology in the care of neonates with gastroschisis undergoing sutureless closure as it provides effective physical protection, maintains a moist wound environment, physically binds and removes microorganisms without the use of an antimicrobial, while allowing non-toxic, easy-to-apply dressing care that can support healing without the need for daily manipulation.