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Gastroschisis and omphalocele: retrospective study of initial postoperative management in the ICU
S Aizenfisz1, S Dauger, E Gondon
1Paediatric Intensive Care Unit, Robert Debré Teaching Hospital, Paris, France. sophie.aizenfisz@rdb.ap-hop-paris.fr
Insights
Infants with gastroschisis (G) and omphalocele (O) require intensive care post-surgery. Omphalocele patients had higher ventilatory needs, while gastroschisis patients experienced more hemodynamic instability.
Area of Science:
- Pediatric Surgery
- Neonatal Intensive Care
- Congenital Abdominal Wall Defects
Background:
- Gastroschisis and omphalocele are congenital conditions requiring surgical correction.
- Postoperative management in the neonatal intensive care unit (NICU) is critical for patient outcomes.
Purpose of the Study:
- To outline the initial 7-day postoperative management strategies for infants diagnosed with gastroschisis or omphalocele.
- To compare the clinical course and resource utilization between gastroschisis and omphalocele infants.
Main Methods:
- Retrospective review of neonates with gastroschisis (G) or omphalocele (O) treated between 1993 and 2000.
- Analysis included ventilatory support, fluid requirements, hemodynamic management, and outcomes.
Main Results:
- Higher mean airway pressure (MAP) was observed in omphalocele infants compared to gastroschisis infants after postoperative day 4.
- Fluid requirements were significantly lower in unruptured omphalocele cases than in gastroschisis or ruptured omphalocele.
- Gastroschisis infants were more likely to require norepinephrine for hemodynamic support.
Conclusions:
- Hemodynamic instability is a significant concern in infants with gastroschisis or ruptured omphalocele.
- Omphalocele infants generally exhibit greater ventilatory support needs during the first postoperative week compared to gastroschisis infants.
Aim Of The Study:
The purpose of this study is to describe the management of infants with gastroschisis (G) and omphalocele (O) during the first 7 days after surgery.
Methods:
A retrospective review of all cases of O or G managed at the ICU of the Robert Debré Teaching Hospital between January 1993 and July 2000 was carried out.
Patients:
29 infants with G, 15 with O (12 unruptured O [UO] and 3 ruptured O [RO]).
Results:
Ventilatory support consisted of conventional mechanical ventilation (46 %) and/or in high-frequency oscillatory ventilation (61 %). After day 4, ventilatory requirements evaluated by mean airway pressure (MAP) differed significantly between G (n = 10/29) and O (n = 7/15; group vs. day of life, p = 0.04). The average of MAP measured on days 5, 6, and 7 was significantly higher in O than in G (14.7 +/- 3.0 versus 10.9 +/- 2.8, p < 0.01, respectively). Volume expansion was required at least once in 90 % of patients. Mean fluid requirements were significantly lower in UO than in G and in RO (41 +/- 31 ml/kg, 91 +/- 73 ml/kg, and 137 +/- 25 ml/kg, respectively; p = 0.02 for each comparison). Patients with G were significantly more likely to receive norepinephrine (59 % vs. 20 %, p = 0.027) than patients with O. Twenty-six infants with G (90 %) and 11 with O (73 %) were discharged alive from ICU.
Conclusions:
Haemodynamic instability can be expected in patients with G or RO, and ventilatory requirements were higher in infants with O than in infants with G during the first week after surgery.
