Is 24 Hours Enough? A Retrospective Review of Antibiotic Duration After Closure in Gastroschisis

Abstract

Background: Gastroschisis is a congenital abdominal wall defect exposing intestines to the uterine then external environments, increasing infection risk. Prophylactic antibiotics are often used postnatally but optimal duration remains unclear. The American Pediatric Surgical Association (APSA) recommends discontinuing antibiotics 24 hours after abdominal wall closure in clinically stable patients. Objective: To evaluate whether extending antibiotics beyond 24 hours post-closure reduces 30-day infection risk in neonates with gastroschisis. Methods: We performed a retrospective cohort study of neonates with gastroschisis born between 1991 and 2022. Included patients had a silo placed, survived until closure, and had complete antibiotic data. Data collected included demographics, antibiotic use, timing of closure and infection. Patients were classified as receiving a short (≤24 hours post-closure) or prolonged course (>24 hours) of antibiotics. Infections were defined using clinical and microbiological criteria. Statistical analyses included t-tests and logistic regression. Results: 53 neonates were included (28 short course, 25 prolonged course). The 30-day post-closure infection rate was 57% (16/28) for the short course and 44% (11/25) for the prolonged course, which was not significantly different. Mean pre-closure prophylactic antibiotics was similar between those who did not develop an infection (15.6 days) and those who developed an infection (13.9 days), (p = 0.667). Prolonged antibiotics post-closure did not significantly reduce infection risks (OR: 0.82, 95% CI: 0.255–2.65, p=0.74). Demographics, such as gestational age, birth weight and delivery type did not affect infections. Conclusions: Antibiotics beyond 24 hours after abdominal wall closure did reduce infection rates. This supports the APSA guidelines to discontinue antibiotics at 24 hours post-closure.