Nk. Puffinbarger et al., END-TIDAL CARBON-DIOXIDE FOR MONITORING PRIMARY CLOSURE OF GASTROSCHISIS, Journal of pediatric surgery, 31(2), 1996, pp. 280-282
Previous criteria for primary reduction of the herniated viscera in ne
wborn infants with gastroschisis included intraoperative respiratory r
ate, cardiac indices, degree of viscero-abdominal disproportion, size
of defect, and lower extremity turgor. From 1976 through 1993, 129 neo
nates with gastroschisis were treated at Children's Hospital of Oklaho
ma. Intraoperative end-tidal carbon dioxide (ETCO(2)) monitoring was s
tandard therapy beginning in 1985. The authors evaluated the eff ect o
f abdominal closure on ETCO(2) to determine if there was a particular
ETCO(2) level at which closure was not feasible. There was no differen
ce in overall mortality, birth weight, or postoperative ventilation re
quirements between children who had closure before 1985 (ie, without E
TCO(2) monitoring) and those who had repair after 1985. However, more
cases in the 1985 1993 group had primary closure, and none of these re
quired conversion to a staged procedure. An ETCO(2) of greater than or
equal to 50 suggests that primary closure may be unsafe. These data s
uggest that infants with gastroschisis can have primary closure based
on intraoperative ETCO(2) monitoring; no additional invasive monitorin
g would be necessary to assess closure. Copyright (C) 1996 by W.B. Sau
nders Company