A presumption that paralysis in infants with gastroschisis leads to quicker resolution in silo-assisted closure is not correct (J Pediatr 2012; 161: 125-8). This presumption had been based on the idea that abdominal muscular relaxation with paralysis would facilitate visceral reduction.
This retrospective Canadian study examined 186 infants with gastroschisis, between 2005-2009. Standardized data for this study was collected prospectively from 16 perinatal centers in Canada. Findings:
- 79 had paralysis and 88 did not. These groups were nearly identical in birth weight, gestational age, and presence of bowel atresia.
- Paralyzed infants took longer to achieve closure, 8 days versus 5 days. In addition, the paralyzed group had longer ventilation period, 12 days versus 7 days.
- These findings persisted after regression analysis/adjusting for other variables. The analysis included examination of illness severity scores (SNAP-II); it was not simply the sicker infants receiving paralysis.
Besides debunking a false premise with gastroschisis management, this study highlights the necessity of collecting data so that our presumptions can be challenged.
Additional references:
- -J Pediatr Surg 2011; 46: 801-7. Outcomes/variation in diaphragmatic hernia and gastroschisis from Canadian Pediatric Surgery network.
- -J Pediatr Surg 2008; 43: 30-4. Outcomes in 100 cases of gastroschisis.
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