Respiratory management of the newborn with an omphalocele

Abstract

Despite advances in neonatal care, infants with omphalocele have a mortality rate ranging between % and %. Respiratory insufficiency is a common clinical challenge and an independent predictor of mortality in these infants. The causes of respiratory failure are diverse and are not well understood. This chapter discusses the unique aspects of respiratory management in omphalocele infants. The authors have chosen references in this chapter with appropriate sample size, variable comparisons, regression analyses, and documented median follow-up times. Omphalocele is rare therefore, the case reports of chapter references have important information.Omphalocele infants are sometimes born with inadequate lung volume to support survival. Prenatal predictors of pulmonary hypoplasia are discussed in the context of fetal magnetic resonance imaging MRI and postnatal clinical-radiologic correlation studies. Two recent retrospective articles explain the unique aspects of pulmonary hypertension in omphalocele infants and distinguish it from pulmonary hypoplasia. The avoidance of abdominal compartment syndrome at the time of omphalocele closure is discussed. Clinical strategies that improve the respiratory care of these infants, based on Specific definitions and diagnoses, may reduce the high mortality rate.

Comprehensive Echocardiographic Assessment of Ventricular Function and Pulmonary Pressure in the Neonatal Omphalocele Population

“…GO status has been associated with increased requirements for medical and surgical care, respiratory failure, prolonged hospitalization, and mortality. 2,3,[27][28][29][30][31] One study of 36 newborns with omphalocele did not report increased mortality in a population with GO. 32 Similar to our results, this finding is likely impacted by the small sample size of the cohort, as we described double the amount of mortality cases in GO but did not reach statistical significance.…”

“…Omphalocele has been associated with varying degrees of pulmonary hypoplasia, possibly explaining the underlying increase in pulmonary pressures and the disturbed transition to extra-uterine life. 27,33 While there have been reports advocating early echocardiographic screening of the neonatal omphalocele population for early identification and management of PH, 1,2 we aimed to evaluate the specific contribution of underlying impaired RV performance at initial echocardiography on mortality. RV dysfunction in the overall omphalocele population was significantly associated with mortality.…”

“…34 Many reports have discussed the use of pulmonary vasodilators, high-frequency ventilation, and extracorporeal membrane oxygenation as therapeutic options for the management of PH in the population of infants born with omphalocele. 1,2,27,35 However, there is not currently a precise treatment strategy for newborns with omphalocele complicated by PH, and future studies should aim to resolve which treatment options are most effective for this population of patients. 1 In our population of patients, only three patients were managed with inhaled nitric oxide during hospitalization and they had an outcome of mortality.…”

Critical care nurses' perception of care coordination competency for management of mechanically ventilated patients

“…An analytical cross-sectional survey conducted in 2014 among ICU nurses in five hospitals in Johannesburg revealed nurses' lack of knowledge of the criteria for weaning mechanically ventilated patients and that there was no significant relationship between nurses' knowledge and their ICU work experience (Perrie, Schmollgruber, Bruce, & Becker, 2014). Furthermore, a recent study in Nepal found that 54.4% of ICU nurses had inadequate knowledge of weaning criteria for MV patients (Pradhan & Shrestha, 2017).…”

“…Therefore, due to the combined problems of ineffective collaboration, coordination, and poor knowledge and competence of nurses (Balas et al, 2016;Couchman et al, 2007;Lavelle & Dowling, 2011;Perrie et al, 2014;Pradhan & Shrestha, 2017), there is a gap between the expected care and the actual care provided to patients requiring MV in critical care settings. Nurses' care coordination has been identified as an effective and efficient strategy for narrowing this gap in this multifaceted setting (Lamb, Schmitt, & Sharp, 2014;Schraeder & Shelton, 2014).…”