End-tidal carbon dioxide for monitoring primary closure of gastroschisis.

Previous criteria for primary reduction of the herniated viscera in newborn infants with gastroschisis included intraoperative respiratory rate, cardiac indices, degree of viscero-abdominal disproportion, size of defect, and lower extremity turgor. From 1976 through 1993, 129 neonates with gastroschisis were treated at Children's Hospital of Oklahoma. Intraoperative end-tidal carbon dioxide (ETCO2) monitoring was standard therapy beginning in 1985. The authors evaluated the effect of abdominal closure on ETCO2 to determine if there was a particular ETCO2 level at which closure was not feasible. There was no difference in overall mortality, birth weight, or postoperative ventilation requirements between children who had closure before 1985 (ie, without ETCO2 monitoring) and those who had repair after 1985. However, more cases in the 1985-1993 group had primary closure, and none of these required conversion to a staged procedure. An ETCO2 of > or = 50 suggests that primary closure may be unsafe. These data suggest that infants with gastroschisis can have primary closure based on intraoperative ETCO2 monitoring; no additional invasive monitoring would be necessary to assess closure.

Gastroschisis: a birth defect seen in increasing numbers in Oklahoma?

OBJECTIVE: To identify if an actual increase in children born with gastroschisis is occurring in Oklahoma. To compare findings with historical and current literature concerning the incidence of this congenital malformation of the abdominal wall. DATA: Derived from Children's Hospital of Oklahoma (CHO) medical records, inventory sheets completed by nurses and resident physicians on admission of gastroschisis infants at CHO, hospital records of Tulsa pediatric surgeons (Subramania Jegathesan, MD, and Richard Ranne, MD), and the state health departments of Oklahoma and Iowa. FINDINGS: 1. Increase in number of gastroschisis children born in Oklahoma. 2. Comparable findings in the state of Iowa. 3. No specific maternal or environmental factor to account for increase. CONCLUSIONS: Children born with gastroschisis in Oklahoma and other areas of the country, as well as internationally, have shown an increase in number over the past two decades. This increase cannot be attributed to any one identifiable factor.

Production and characterization of multiple antigenic peptide antibodies to the adenosine A2b receptor.

A polyclonal antibody to the human adenosine A2b receptor (A2bR) was produced by immunizing a chicken with a multiple antigenic peptide consisting of eight copies of a 16-amino acid peptide, corresponding to the presumed second extracellular loop of the A2bR, linked to a branched lysine core. Western blotting with affinity-purified antibody revealed the human A2bR to be a protein of approximately 50-55 kDa, found in a variety of tissues including thymus, colon, and small intestine. The antibody also recognized mouse and rat A2bRs and revealed heterogeneity in size, with a 35-kDa protein being detected in small intestine in addition to the larger 50-52-kDa species in thymus, colon, and placenta. The chicken anti-human A2bR peptide antibody recognized the receptor in both frozen and formalin-fixed tissue sections. In human colon, the A2bR was highly expressed in epithelial cells of the crypts. A2bR immunoreactivity was also apparent in syncytiotrophoblast cells of human placental villi and in the basal zone of murine chorioallantoic placenta. These cell type-specific patterns of expression are consistent with the hypothesized roles of the A2bR in mediating electrogenic Cl- secretion and the resulting secretory diarrhea caused by colonic crypt abscesses and in regulating morphogenesis of the placenta. Insight into the multiple physiological consequences of A2bR engagement will be forthcoming from an analysis of the cell type-specific expression of this receptor in additional tissues.

Abdominal wall defects in infants. Survival and implications for adult life.

OBJECTIVE: The authors study reviewed patients who underwent operations for omphalocele and gastroschisis to determine survival, morbidity, and long-term quality of life. METHOD: Clinical follow-up of 94 patients cared for with omphalocele and gastroschisis during a 10- to 20-year period after birth. RESULT: Eighty-three patients survived initial treatment. Sixty-one had long-term follow-up. Mean follow-up in the group was 14.2 years. Survival was favorable in the absence of lethal or co-existing major congenital anomalies. Nineteen patients required 31 reoperations, most for abdominal wall hernias and the sequelae of intestinal atresia. Current quality of life was described as favorable (good) in 80% of patients. CONCLUSIONS: Survival rate in patients with abdominal wall defects is favorable and deaths occur substantially in patients with co-existing lethal, or multiple, congenital anomalies. Reoperative surgery is necessary principally in those patients who have postclosure abdominal wall hernias, and in those with bowel atresia at birth. Reoperations are not likely to be necessary after school age. Quality of life in survivors is patient-perceived as entirely satisfactory.

Rapid isotonic fluid resuscitation in pediatric thermal injury.

Intravenous fluid resuscitation within the first 24 hours after a burn is critical to prevent shock and maintain organ function. The Parkland burn resuscitation formula suggests that one half of the first 24-hour fluid requirement be given in the first 8 hours. Results of recent studies in animals suggest that compression of the first half of the initial resuscitation from 8 to 4 hours may have a physiological benefit. We reviewed the medical records of 44 children under 12 years of age who had burns of greater than 29% of total body surface. Twenty-two children received a standard resuscitation of one-half volume given over the first 8 hours, followed by one-half volume over the next 16 hours. Twenty-two children received a rapid isotonic fluid resuscitation of one-half volume over 4 hours or less, followed by the remainder given over 20 hours. Vital signs, urine output, urine specific gravity, blood gases (acidosis), ventilator need, morbidity, and mortality were compared between the two groups. The rapid group had increased normalization of vital signs (P < .001), increased urine output and normalization of urine specific gravity (P < .01), and decreased requirement for ventilator support (P < .05). The authors conclude that rapid isotonic fluid resuscitation is well tolerated by pediatric patients and may be better than the standard burn resuscitation technique.