Temporary impairment of lung function in infants with anterior abdominal wall defects who have undergone surgery

Dimitriou, Gabriel; Greenough, Anne; Giffin, F.; Davenport, Mark; Nicolaides, Kypros H.

doi:10.1016/s0022-3468(96)90671-5

Cited by 34 publications

(17 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Primary closure was not feasible for this group possibly because of their unfavorable morphologic characteristics, primarily greater visceroabdominal disproportion. Certainly, previous studies from our institution [20][21][22] and others [23] have shown a relationship between size of exomphalos and diminished respiratory function (reduced lung volume and decreased compliance) because of their small, narrow thoracic cages, and may explain the higher observed rate of acute respiratory complications.…”

Section: Discussionmentioning

confidence: 83%

Definitive surgical management of antenatally diagnosed exomphalos

Rijhwani

Davenport

Dawrant

et al. 2005

Journal of Pediatric Surgery

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 83%

Definitive surgical management of antenatally diagnosed exomphalos

Rijhwani

Davenport

Dawrant

et al. 2005

Journal of Pediatric Surgery

View full text Add to dashboard Cite

“…The pulmonary compromise observed in omphalocele patients has previously been attributed to increased intra-abdominal pressure after repair [9,26]. However, in our study, all echocardiograms demonstrating PH were obtained prior to abdominal closure.…”

Section: Discussionmentioning

confidence: 83%

High Prevalence of Pulmonary Hypertension Complicates the Care of Infants with Omphalocele

Hutson

Baerg²,

Deming³

et al. 2017

Neonatology

View full text Add to dashboard Cite

Background: Omphalocele is one of the most common abdominal wall defects. Many newborn infants born with omphalocele present with significant respiratory distress at birth, requiring mechanical ventilatory support, and have clinical evidence of pulmonary hypertension. Little information exists on the prevalence of and risk factors associated with pulmonary hypertension in this cohort of infants. Objectives: To describe the prevalence of and risk factors associated with pulmonary hypertension among infants with omphalocele. Methods: This is a multicenter retrospective chart review of demographic data and clinical characteristics of infants with omphalocele admitted to the neonatal intensive care units of Loma Linda University Children's Hospital and Children's Mercy Hospital between 1994 and 2011. Echocardiogram images were reviewed for pulmonary hypertension, and statistical analyses were performed to identify risk factors associated with the presence of pulmonary hypertension. Results: Pulmonary hypertension was diagnosed in 32/56 (57%) infants with omphalocele. Compared to infants without pulmonary hypertension, infants with pulmonary hypertension were more likely to have a liver-containing defect (16/32 [50%] vs. 5/24 [21%], p = 0.03), require intubation at birth (18/32 [56%] vs. 6/24 [17%], p = 0.03), and die during initial hospitalization (12/32 [38%] vs. 2/24 [8%], p = 0.01). Conclusion: The majority of infants with omphalocele have evidence of pulmonary hypertension which is associated with increased mortality. Echocardiograms to screen for pulmonary hypertension should be obtained at ≥2 days of life in infants with omphalocele, especially in those with liver within the omphalocele sac and/or in those infants who require intubation at birth to screen for pulmonary hypertension.

show abstract

“…Unfortunately, the number of infants with a right-sided defect was too small to make statistical comparisons, but one infant with a right-sided defect had very low right TwPdi. Increased intra-abdominal pressure after surgical closure (38) impairs respiratory function of AWD infants (39), but again this effect is temporary, with improvements in compliance of the respiratory system being demonstrated by postoperative d 3. All of the AWD infants were studied at least 1 wk after surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

Diaphragmatic Function in Infants with Surgically Corrected Anomalies

et al. 2003

View full text Add to dashboard Cite

Infants with surgically correctable anomalies, abdominal wall defects (AWD) or congenital diaphragmatic hernia (CDH) may have poor postnatal diaphragmatic function, because the low intra-abdominal pressure experienced by such patients in utero could result in impaired diaphragmatic development. Our objective was to compare postoperative diaphragmatic function of infants with CDH or AWD to that of gestational age-matched controls. Diaphragmatic function was assessed by measurement of the transdiaphragmatic pressure and maximum inspiratory pressure at the mouth generated during crying against an occlusion. In addition, the transdiaphragmatic pressure produced by unilateral and/or bilateral magnetic stimulation of the phrenic nerves (TwPdi) was examined. Lung volume was assessed by measurement of functional residual capacity (FRC) using a helium gas dilution technique. Ten infants with CDH, 26 with AWD infants (19 gastroschisis, seven exomphalos), and 36 gestational age-matched controls were studied. Compared with their matched controls, the eight CDH infants with left-sided defects had significantly lower left (p Ͻ 0.01) and right (p Ͻ 0.05) TwPdi and FRC (p Ͻ 0.01), and the gastroschisis infants, but not those with exomphalos, had significantly lower left and right TwPdi (p Ͻ 0.05). There were no significant differences in transdiaphragmatic pressure and maximum inspiratory pressure at the mouth between the CDH or AWD infants and the controls. Surgically correctable birth defects, CDH, and AWD are common and associated with respiratory morbidity. Infants with CDH can suffer bronchopulmonary dysplasia and recurrent infections (1, 2) and, in both conditions, pulmonary function abnormalities are demonstrated outside the perinatal period (1-4). These problems may be due to poor antenatal lung growth. Abnormal diaphragmatic function impairs antenatal lung growth (5-8) and we hypothesize that infants with CDH or AWD may have abnormal diaphragmatic development and function. CDH and AWD infants experience low intraabdominal pressure in utero, as viscera are extra-abdominal. Repetitive (9) or passive (10) stretch of skeletal muscles is important to increase myofiber diameter and area. The ipsilateral diaphragm of a CDH infant would be expected to function poorly immediately after operative repair but, if our hypothesis is correct, then the contralateral diaphragm function would also be reduced because of the low intra-abdominal pressure in utero. Diaphragmatic function in neonates has previously been assessed by measurement of cPdi (11)

show abstract

Temporary impairment of lung function in infants with anterior abdominal wall defects who have undergone surgery

Cited by 34 publications

References 13 publications

Definitive surgical management of antenatally diagnosed exomphalos

Definitive surgical management of antenatally diagnosed exomphalos

High Prevalence of Pulmonary Hypertension Complicates the Care of Infants with Omphalocele

Diaphragmatic Function in Infants with Surgically Corrected Anomalies

Contact Info

Product

Resources

About