title: Pulmonary dysfunction after primary closure of an abdominal wall defect and its improvement with bronchodilators.
abstract: To determine the extent of pulmonary dysfunction following primary closure of an abdominal wall defect, we obtained pulmonary function tests (PFT) in 11 newborn infants with gastroschisis and 6 with large omphaloceles admitted to a newborn ICU in a children's hospital. Patients were 1 to 30 days of age at the time of the PFT; all required endotracheal intubation and mechanical ventilation for operative procedures or for postoperative ventilatory support. Full-term infants (n = 21) undergoing minor surgical procedures provided comparative measurements. Flow-volume curves were obtained with manual inflation of the lungs followed by forced deflation using negative pressure, or by passive expiration, under sedation and pharmacologic paralysis. Deflation flow-volume curves gave measurements of forced vital capacity (FVC) and maximal expiratory flow at 25% of vital capacity from residual volume (MEF25). Modified passive mechanics technique gave passive expiratory curves that provided measurements of respiratory system compliance (Crs) and resistance (Rrs). Tests were done: within 48 h (period A), 3-7 days (period B), and 8-30 days after surgical repair (period C). Pulmonary function testing after nebulized 0.1% isoetharine (a bronchodilator), to test for bronchial reactivity, began midway during the study period in 15 patients. Preoperative and postoperative tests were obtained in 5 patients. Closure of an abdominal wall defect decreased FVC, Crs, and MEF25 by up to 50% of normal, reference values after surgery (P less than 0.05). FVC and MEF25 approached values of normal infants by 4 weeks, whereas Crs remained 50% lower.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Pediatric Surgery, Children's Hospital of Pittsburgh, PA 15213-3417.
authors.forename: D K
authors.initials: DK
authors.lastname: Nakayama
authors.forename: R
authors.initials: R
authors.lastname: Mutich
authors.forename: E K
authors.initials: EK
authors.lastname: Motoyama
mesh_terms: D000009:Abdominal Muscles / Q000002:abnormalities* / Q000601:surgery; D006554:Hernia, Umbilical / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007528:Isoetharine / Q000494:pharmacology / Q000627:therapeutic use*; D008171:Lung Diseases / Q000188:drug therapy* / Q000453:epidemiology; D011183:Postoperative Complications / Q000188:drug therapy* / Q000453:epidemiology; D015656:Respiratory Mechanics / Q000187:drug effects
chemical_list: D007528:Isoetharine