Related Experiment Videos
Pulmonary dysfunction after primary closure of an abdominal wall defect and its improvement with bronchodilators
D K Nakayama1, R Mutich, E K Motoyama
1Department of Pediatric Surgery, Children's Hospital of Pittsburgh, PA 15213-3417.
Insights
Abdominal wall defect repair in newborns causes significant, but temporary, pulmonary dysfunction. Lung function like forced vital capacity (FVC) improves within 4 weeks, but respiratory system compliance (Crs) remains reduced.
Area of Science:
- Pediatric Surgery
- Neonatology
- Pulmonary Medicine
Background:
- Congenital abdominal wall defects like gastroschisis and omphalocele require surgical repair.
- Postoperative pulmonary complications are a concern in neonates undergoing these procedures.
Purpose of the Study:
- To assess the extent of pulmonary dysfunction after primary closure of abdominal wall defects.
- To evaluate changes in pulmonary function over time post-surgery.
Main Methods:
- Pulmonary function tests (PFTs), including flow-volume curves and passive mechanics, were performed on 17 neonates (11 gastroschisis, 6 omphalocele) and 21 controls.
- Tests measured forced vital capacity (FVC), maximal expiratory flow at 25% (MEF25), respiratory system compliance (Crs), and resistance (Rrs).
- PFTs were conducted at three intervals: within 48 hours, 3-7 days, and 8-30 days post-repair. Bronchodilator response was tested in some infants.
Main Results:
- Abdominal wall defect closure led to a significant decrease (up to 50%) in FVC, MEF25, and Crs compared to normal reference values.
- FVC and MEF25 values approached those of normal infants by 4 weeks post-surgery.
- Respiratory system compliance (Crs) remained approximately 50% lower than normal even at 4 weeks post-repair.
Conclusions:
- Primary closure of abdominal wall defects results in substantial, though often transient, pulmonary dysfunction in neonates.
- While some lung function parameters recover, reduced respiratory system compliance may persist, indicating potential long-term implications.
Abstract:
To determine the extent of pulmonary dysfunction following primary closure of an abdominal wall defect, we obtained pulmonary function tests (PFT) in 11 newborn infants with gastroschisis and 6 with large omphaloceles admitted to a newborn ICU in a children's hospital. Patients were 1 to 30 days of age at the time of the PFT; all required endotracheal intubation and mechanical ventilation for operative procedures or for postoperative ventilatory support. Full-term infants (n = 21) undergoing minor surgical procedures provided comparative measurements. Flow-volume curves were obtained with manual inflation of the lungs followed by forced deflation using negative pressure, or by passive expiration, under sedation and pharmacologic paralysis. Deflation flow-volume curves gave measurements of forced vital capacity (FVC) and maximal expiratory flow at 25% of vital capacity from residual volume (MEF25). Modified passive mechanics technique gave passive expiratory curves that provided measurements of respiratory system compliance (Crs) and resistance (Rrs). Tests were done: within 48 h (period A), 3-7 days (period B), and 8-30 days after surgical repair (period C). Pulmonary function testing after nebulized 0.1% isoetharine (a bronchodilator), to test for bronchial reactivity, began midway during the study period in 15 patients. Preoperative and postoperative tests were obtained in 5 patients. Closure of an abdominal wall defect decreased FVC, Crs, and MEF25 by up to 50% of normal, reference values after surgery (P less than 0.05). FVC and MEF25 approached values of normal infants by 4 weeks, whereas Crs remained 50% lower.(ABSTRACT TRUNCATED AT 250 WORDS)