Gastroschisis and omphalocele: retrospective study of initial postoperative management in the ICU.
OBJECTIVE
The purpose of this study is to describe the management of infants with gastroschisis (G) and omphalocele (O) during the first 7 days after surgery.


METHODS
A retrospective review of all cases of O or G managed at the ICU of the Robert Debré Teaching Hospital between January 1993 and July 2000 was carried out.


METHODS
29 infants with G, 15 with O (12 unruptured O [UO] and 3 ruptured O [RO]).


RESULTS
Ventilatory support consisted of conventional mechanical ventilation (46 %) and/or in high-frequency oscillatory ventilation (61 %). After day 4, ventilatory requirements evaluated by mean airway pressure (MAP) differed significantly between G (n = 10/29) and O (n = 7/15; group vs. day of life, p = 0.04). The average of MAP measured on days 5, 6, and 7 was significantly higher in O than in G (14.7 +/- 3.0 versus 10.9 +/- 2.8, p < 0.01, respectively). Volume expansion was required at least once in 90 % of patients. Mean fluid requirements were significantly lower in UO than in G and in RO (41 +/- 31 ml/kg, 91 +/- 73 ml/kg, and 137 +/- 25 ml/kg, respectively; p = 0.02 for each comparison). Patients with G were significantly more likely to receive norepinephrine (59 % vs. 20 %, p = 0.027) than patients with O. Twenty-six infants with G (90 %) and 11 with O (73 %) were discharged alive from ICU.


CONCLUSIONS
Haemodynamic instability can be expected in patients with G or RO, and ventilatory requirements were higher in infants with O than in infants with G during the first week after surgery.
Aizenfisz
S
S
Paediatric Intensive Care Unit, Robert Debré Teaching Hospital, Paris, France. sophie.aizenfisz@rdb.ap-hop-paris.fr
Dauger
S
S
Gondon
E
E
Saizou
C
C
De Lagausie
P
P
Luton
D
D
Aigrain
Y
Y
Beaufils
F
F