Journal of pediatric surgery · 2026
Is 24 hours enough? Evaluating prophylactic antibiotic duration after abdominal wall closure in neonatal gastroschisis.
СтатьяНазвание и аннотация: Перевод в очереди
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Zrinyi Anna, Shawyer Anna, Keijzer Richard, Lum Min Suyin A
Аннотация
BACKGROUND: While the current American Pediatric Surgical Association (APSA) recommendation is to discontinue prophylactic antibiotics 24 h after abdominal wall closure in otherwise healthy gastroschisis patients managed with a silo, the evidence supporting this recommendation is limited. We aimed to determine if at our center the odds of infection in cases who received prophylactic antibiotics only up to 24 h after closure was greater than cases who received longer courses of antibiotics.
METHODS: We conducted a retrospective review of neonates with gastroschisis managed with a silo at a tertiary care center from 1991 to 2022. Infants were included if they survived to closure. Excluded infants had ischemia, perforation, no documented prophylactic antibiotics, or delayed closure (>30 days). Patients were classified as receiving either a short-course (≤24 h post-closure) or prolonged-course (>24 h) of prophylactic antibiotics. The primary outcome was infection within 30 days of closure (e.g. sepsis, wound infection, central line-associated blood stream infection). Logistic regression adjusted for gestational age, birth weight, delivery type, and time to closure was calculated.
RESULTS: Fifty-three neonates were included: 28 received short-course and 25 received prolonged-course antibiotics. Infection occurred in 16/28 (57 %) short-course patients and 11/25 (44 %) prolonged-course patients. The adjusted odds ratio of infection for prolonged versus short-course antibiotics was 0.82 (95%CI = 0.25,2.65, p = 0.74).
CONCLUSION: Discontinuation of prophylactic antibiotics up to 24 h after closure was not associated with an increased likelihood of infection in our cohort. This finding supports the current APSA recommendation to discontinue prophylactic antibiotics 24 h after abdominal wall closure in uncomplicated gastroschisis.
METHODS: We conducted a retrospective review of neonates with gastroschisis managed with a silo at a tertiary care center from 1991 to 2022. Infants were included if they survived to closure. Excluded infants had ischemia, perforation, no documented prophylactic antibiotics, or delayed closure (>30 days). Patients were classified as receiving either a short-course (≤24 h post-closure) or prolonged-course (>24 h) of prophylactic antibiotics. The primary outcome was infection within 30 days of closure (e.g. sepsis, wound infection, central line-associated blood stream infection). Logistic regression adjusted for gestational age, birth weight, delivery type, and time to closure was calculated.
RESULTS: Fifty-three neonates were included: 28 received short-course and 25 received prolonged-course antibiotics. Infection occurred in 16/28 (57 %) short-course patients and 11/25 (44 %) prolonged-course patients. The adjusted odds ratio of infection for prolonged versus short-course antibiotics was 0.82 (95%CI = 0.25,2.65, p = 0.74).
CONCLUSION: Discontinuation of prophylactic antibiotics up to 24 h after closure was not associated with an increased likelihood of infection in our cohort. This finding supports the current APSA recommendation to discontinue prophylactic antibiotics 24 h after abdominal wall closure in uncomplicated gastroschisis.