Background: Animal studies have shown that visceral circulation is well preserved when intraabdominal pressure does not exceed 20 mmHg. Our aim was to analyze the outcomes of a series of infants with gastroschisis whose surgical management was directed by the intraoperative measurement of bladder pressure. Methods: Forty-two neonates with gastroschisis were surgically managed using intraoperative measurement of bladder pressure at a tertiary care center between July 31, 1992, and March 20, 2004, and their outcome was evaluated. Primary closure with orwithout prosthetic material was performed when pressures measured 20 mmHg or less. Delayed closure using a silon pouch was performed when pressures measured more than 20 mmHg. Categorical variables were analyzed including mode of delivery, associated anomalies, type of closure, complications, and mortality. Continuous variables were analyzed including gestational age, birth weight, bladder pressure, time to full feeds, and length of hospital stay. Categorical and continuous variables for both groups were compared using Fisher’s Exact and Wilcoxon’s rank-sumtes-ts, respectively, and a significance level of. 05 was used. Preapproval of this study was obtained from the Institutional Review Board (No. 6690). Results: Thirty-three (79%) neonates with a mean bladder pressure of 16 mmHg underwent primary closure and 9 neonates with a mean bladder pressure of 27 mmHg underwent delayed closure with a silon pouch that was not spring loaded(P < .03). Patients treated with primary closure had faster return to full feeds and significantly shorter hospital length of stay compared with patients treated by delayed closure (P =. 04). Surgical morbidity and mortality was nil in patients after primary closure. One patient with total abdominal evisceration died during attempted delayed closure and another patient required reoperation for bowel necrosis after delayed closure. Conclusion: Primary closure was safely accomplished in 100%of neonates with gastroschisis whose bladder pressure measured 20 mmHg or less. Further, this group of patients had a faster return to full feeds and a significantly shorter hospital length of stay compared with neonates who required delayed closure. Background: Animal studies have shown that visceral circulation is well preserved when intraabdominal pressure does not exceed 20 mmHg. Our aim was to analyze the outcomes of a series of infants with gastroschisis whose surgical management was directed by the intraoperative measurement of bladder pressure. Methods: Forty-two neonates with gastroschisis were surgically managed using intraoperative measurement of bladder pressure at a tertiary care center between July 31, 1992, and March 20, 2004, and their outcome was evaluated. Primary closure with or without prosthetic material was performed when pressures measured 20 mmHg or less. Delayed closure using a silon pouch was performed when pressures measured more than 20 mmHg. Categorical variables were analyzed including mode of delivery, associated anomalies, type of closure, complications, and mortality. weight, bladder pressure, time to full feeds, and length of hospit al stay. Categorical and continuous variables for both groups were compared using Fisher’s Exact and Wilcoxon’s rank-sumtes-ts, respectively, and a significance level of. 05 was used. Preapproval of this study was obtained from the Institutional Review Board (No. 6690 Results: Thirty-three (79%) neonates with a mean bladder pressure of 16 mmHg underwent primary closure and 9 neonates with a mean bladder pressure of 27 mmHg underwent delayed closure with a silon pouch that was not spring loaded (P <. 03). Patients treated with primary closure had faster return to full feeds and significantly shorter hospital length of stay compared with patients treated by delayed closure (P =. 04). Surgical morbidity and mortality was nil in patients after primary closure. One patient with total abdominal evisceration died during attempted delayed closure and another patient required reoperation for bowel necrosis after delayed closure. Conclusion: Primary closure was safely accomplished in 100% of neonates with gastroschisis whose bladder pressure measured 20 mmHg or less. Further, this group of patients had a faster return to full feeds and a significantly shorter hospital length of stay compared with neonates who required delayed closure.