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Temporary impairment of lung function in infants with anterior abdominal wall defects who have undergone surgery
G Dimitriou1, A Greenough, F Giffin
1Department of Child Health, King's College Hospital, London, England.
Insights
Infants with anterior abdominal wall defects (AWD) experience temporary lung stiffening after primary surgical closure. Respiratory system compliance improves after initial surgery but may worsen temporarily before recovery.
Area of Science:
- Pediatric Surgery
- Neonatal Respiratory Physiology
Background:
- Anterior abdominal wall defects (AWD), including exomphalos and gastroschisis, are congenital conditions requiring surgical intervention.
- Respiratory system compliance (CRS) is a critical indicator of lung function in neonates.
Purpose of the Study:
- To evaluate the impact of primary surgical closure for AWD on respiratory system compliance in infants.
- To assess the temporal changes in lung function post-operatively.
Main Methods:
- Respiratory system compliance (CRS) was measured in 14 infants with AWD (7 exomphalos, 7 gastroschisis) before and after surgical repair.
- Measurements were taken on postoperative days 1, 2, 3, and 4 in a subset of patients.
Main Results:
- Infants presented with stiff lungs pre-operatively (median CRS: 0.58 mL/cm H2O/kg).
- Postoperative CRS significantly decreased on days 1 and 2 (median: 0.33 mL/cm H2O/kg, P < .05), indicating lung stiffening.
- CRS showed a temporary increase on postoperative days 3 and 4 (median: 0.47 mL/cm H2O/kg, P < .05) in seven cases.
Conclusions:
- Primary surgical closure of anterior abdominal wall defects in infants is associated with a transient deterioration in lung function.
- The observed changes in respiratory system compliance suggest a temporary negative impact on lung mechanics following surgical repair.
Abstract:
Compliance of the respiratory system (CRS) was measured before and after surgical intervention in 14 infants who had anterior abdominal wall defects (AWD) (7 exomphalos, 7 gastroschisis). The median gestational age was 37 weeks (range, 34 to 40) and median birth weight was 2.38 kg (range, 1.94 to 3.45). The infants had stiff lungs before surgery (median CRS, 0.58 mL/cm H2(O)/kg). During the first and second postoperative days, the median CRS decreased to 0.33 mL/cm H2(O)/kg (P < .05). In seven cases, measurements also were obtained on the third and fourth postoperative days, which showed an increase in the median CRS (day 3, 0.47 mL/cm H2(O)/kg; P < .05). These findings show that in infants with AWD, primary surgical closure is associated with deterioration of lung function, but this effect is temporary.