Hemodynamic effects of primary closure of omphalocele/gastroschisis in human newborns
Related Experiment Videos
M Yaster1, J R Buck, D L Dudgeon
1Department Anesthesiology/Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland.
Insights
Objective criteria can predict safe closure of abdominal wall defects in newborns. Measuring intra-gastric pressure (IGP), central venous pressure (CVP), and cardiac index (CI) intraoperatively helps determine surgical success.
Area of Science:
- Neonatal surgery
- Pediatric surgery
- Surgical outcomes
Background:
- Abdominal wall defects like omphalocele and gastroschisis require surgical intervention in neonates.
- Predicting the success of primary closure is crucial for optimizing patient outcomes.
Purpose of the Study:
- To establish reliable, objective criteria for predicting safe, primary closure of abdominal wall defects in newborn infants.
- To assess the utility of intraoperative physiological measurements in predicting surgical success.
Main Methods:
- Measured intraoperative changes in intra-gastric pressure (IGP), central venous pressure (CVP), cardiac index (CI), systolic arterial blood pressure (BP), and heart rate (HR) in 11 neonates.
- Analyzed physiological data in relation to the need for re-operation due to complications like oliguria or poor perfusion.
Main Results:
- Four out of eight infants who underwent primary closure required re-operation.
- Infants needing re-operation exhibited intra-gastric pressures ≥20 mmHg, a decrease in cardiac index ≥0.78 L/min/m², and an increase in central venous pressure ≥4 mmHg.
- Heart rate, blood pressure, and systemic vascular resistance did not significantly differ between groups.
Conclusions:
- Intraoperative measurements of IGP, CVP, and CI changes can reliably predict the success or failure of primary operative repair for abdominal wall defects in neonates.
- These objective criteria aid in surgical decision-making and management planning for neonates with these conditions.
Abstract:
To determine whether they could establish reliable, objective criteria that would predict safe, primary closure of abdominal wall defects (omphalocele/gastroschisis) in newborn infants, the authors measured intraoperative changes in intra-gastric pressure (IGP), central venous pressure (CVP), cardiac index (CI), systolic arterial blood pressure (BP), and heart rate (HR). Eleven neonates, who averaged 2.7 kg (range 1.5-4.1 kg) and 36 weeks gestation (range 30-41 weeks) were anesthetized with fentanyl (7.5-12.5 micrograms/kg), metocurine (0.3 mg/kg), and oxygen. Three infants had defects that were too large to close primarily. Of the eight infants who underwent primary closure, four required re-operation within 24 h because of oliguria or poor peripheral perfusion. Infants who required re-operation had intra-gastric pressures of 20 mmHg or more, a decrease in CI of 0.78 1.min.m2 or more, and an increase in CVP of 4 mmHg or more. Heart rate, BP, and systemic vascular resistance did not differ in infants requiring and not requiring re-operation. The authors conclude that intraoperative measurement of changes in IGP, CVP, and/or CI can reliably predict success or failure of primary operative repair of abdominal wall defects in human neonates.