Original article
Routine use of a SILASTIC spring-loaded silo for infants with gastroschisis: a multicenter randomized controlled trial

https://doi.org/10.1016/j.jpedsurg.2008.04.003Get rights and content

Abstract

Background

Retrospective studies have suggested that routine use of a preformed silo for infants with gastroschisis may be associated with improved outcomes. We performed a prospective multicenter randomized controlled trial to test this hypothesis.

Methods

Eligible infants were randomized to (1) routine bedside placement of a preformed Silastic spring-loaded silo, with gradual reduction and elective abdominal wall closure, or (2) primary closure.

Results

There were 27 infants in each group. There was no significant difference between groups with respect to age, weight, sex, Apgar scores, prenatal diagnosis, or mode of delivery. The total number of days on the ventilator was lower in the spring-loaded silo group, although it did not reach statistical significance (3.2 vs 5.3, P = .07). There was no significant difference between groups with respect to length of time on total parenteral nutrition, length of stay, or incidence of sepsis and necrotizing enterocolitis.

Conclusion

Routine use of a preformed silo was associated with similar outcomes to primary closure for infants with gastroschisis but with a strong trend toward fewer days on the ventilator. Use of a preformed silo has the advantage of permitting definitive abdominal wall closure in a more elective setting.

Section snippets

Methods

Children born with gastroschisis at the Hospital for Sick Children (Toronto, Ontario, Canada), Primary Children's Medical Center (Salt Lake City, Utah), and University of North Carolina Children's Hospital (Chapel Hill) were eligible for the study. Inclusion criteria were diagnosis of gastroschisis, birth weight of 1500 grams or greater, and gestational age of 34 weeks or more. Infants with suspected or visible intestinal atresia were eligible for enrollment into the study. Infants were

Results

A total of 195 infants with gastroschisis were admitted to the participating centers between June 2001 and December 2006 (Fig. 1). After screening for eligibility and obtaining consent for enrollment, 55 patients were randomized (Toronto, 20; Chapel Hill, 6; Utah, 30), with 28 infants in the spring-loaded silo group and 27 infants in the primary closure group. One patient in the spring-loaded silo group was excluded from the study because of repeated dislodgment of the silo, requiring use of a

Discussion

The optimal approach to abdominal closure for infants with gastroschisis has remained controversial over many years. The significant risk for morbidity and mortality associated with gastroschisis has prompted critical evaluation of current methods of treatment. Although most early reports documented better outcomes in children who underwent primary closure, these studies suffered from treatment bias because the children with severe intestinal damage were generally the ones that could not be

Cited by (101)

  • Abdominal Wall Defects

    2023, Avery's Diseases of the Newborn
  • Congenital anterior abdominal wall defects

    2022, Surgery (United Kingdom)
  • Congenital anterior abdominal wall defects

    2019, Surgery (United Kingdom)
  • Care of infants with gastroschisis in low-resource settings

    2018, Seminars in Pediatric Surgery
    Citation Excerpt :

    Allotey compared 53 consecutive neonates that underwent either primary closure or preformed silo application and reported lower mean airway pressures and inspired oxygen requirements, higher urine output and no inotropic support in the latter group; 43% of those undergoing primary closure required inotropes.48 A randomised controlled trial comparing primary closure with preformed silo reported a lower requirement for ventilation in the silo group with no difference in other outcomes.49 A meta-analysis comparing primary closure with all methods of staged closure also reported fewer ventilator days (p < 0.0001), reduced time to first feed (p = 0.04) and lower infection rates (p = 0.03) in the latter group amongst studies with least selection bias.50

  • Closure methods in gastroschisis

    2018, Seminars in Pediatric Surgery
View all citing articles on Scopus
View full text