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Preoperative metabolic acidosis in infants with gastroschisis
W El-Naggar1, A Almudeer1, M Vincer1
1Department of Pediatrics, Division of Neonatal Perinatal Medicine, Dalhousie University, Halifax, NS, Canada.
Insights
Preoperative metabolic acidosis occurs in 18% of infants with gastroschisis, even with high fluid intake. This condition does not appear linked to the severity of gut compromise in these newborns.
Area of Science:
- Neonatal surgery
- Pediatric gastroenterology
- Critical care medicine
Background:
- Preoperative management of gastroschisis is not well-defined in medical literature.
- The causes of metabolic acidosis in infants with gastroschisis, whether intrauterine gut compromise or dehydration, remain unclear.
Purpose of the Study:
- To determine the incidence of preoperative metabolic acidosis in infants diagnosed with gastroschisis.
- To investigate the correlation between preoperative metabolic acidosis and the extent of gastrointestinal compromise in these infants.
Main Methods:
- A retrospective review of infants with gastroschisis from May 2005 to April 2013 was conducted.
- Metabolic acidosis was defined using specific pH, serum bicarbonate, and base excess thresholds.
- Infants with significant birth depression were excluded from the analysis.
Main Results:
- Out of 60 identified infants, 9 (18%) presented with preoperative metabolic acidosis.
- No significant association was observed between metabolic acidosis and the gastroschisis prognostic score (GPS).
- Metabolic acidosis did not correlate with the time to first or full enteral feeds.
Conclusions:
- A notable proportion of infants with gastroschisis experience preoperative metabolic acidosis, despite receiving substantial fluid resuscitation.
- The findings suggest that preoperative metabolic acidosis in gastroschisis is not indicative of the degree of gut compromise.
- Further research is warranted to understand the role of metabolic acidosis as a marker for dehydration in this patient population.
Introduction:
There is little in literature regarding preoperative management of infants with gastroschisis. It is unclear if these infants develop metabolic acidosis as a consequence of prolonged intrauterine gut compromise or dehydration secondary to increased fluid loss.
Aim:
To assess the frequency of preoperative metabolic acidosis in infants with gastroschisis and investigate whether this acidosis reflects degree of gut compromise.
Methods:
All infants with gastroschisis born between May 2005 and April 2013 in a single tertiary care center were reviewed. Metabolic acidosis was defined by the presence of pH <7.26 and serum bicarbonate <18.5 or base excess < -8.5 mmol/l. Infants with significant birth depression were excluded. Maternal and neonatal data were collected. Frequency of preoperative metabolic acidosis and its association with gastroschisis prognostic score (GPS), time to first and time to reach full feeds were investigated.
Results:
Sixty infants were identified, 11 were excluded (birth depression/lack of preoperative blood gases). Median preoperative total fluid intake was 130 ml/kg/d. Nine infants (18%) had metabolic acidosis at a median age of 1.2 hours. No association was found between metabolic acidosis or serum lactate and GPS, age at first feed or age at full feeds.
Conclusion:
Preoperative metabolic acidosis was identified in a significant number of patients with gastroschisis despite high fluid intake. It does not appear to be associated with the degree of gut compromise. Using metabolic acidosis as an indication of dehydration in these patients needs more investigation.
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