10.4 Pneumothorax

Iatrogenic pneumothorax secondary to barotrauma is an unfortunate complication in ventilated neonates and occurs in around 8.7% of the cases [82]. In GS this may be due to high intra-abdominal pressure after bowel reduction. This is best anticipated in theatre and if pressures exceed 24 cm H2O, a staged reduction should

Figure 12. Large abdominal wall defect with granulation in long-standing silo.

10.5 Others

Management of Gastroschisis

DOI: http://dx.doi.org/10.5772/intechopen.85510

Author details

Cairo, Egypt

129

Alaa Obeida\* and Aly Shalaby

• NEC: It follows the same patterns and risk factors as with non-GS infants. Prematurity, formula feeds, rapid increase in feed volume—have all been implicated. Treatment is standard: nasogastric tube decompression, gut rest

• Large abdominal defect: The GS defect is seldom large to start with and is occasionally enlarged by the surgeon to facilitate bowel reduction. Hence a large defect is a rare complication which may occur in long-standing cases of staged-reduction (Figure 12). Standard closure techniques include the use of a prosthetic material or plastic surgery techniques such as abdominal wall

• Enterocutaneous fistula: (Figure 13) rare complication which may occur secondary to wound infection, NEC, or a combination of both. Vacuum dressings have been of value in treating such a complication [55, 86]. It is the authors' experience that vacuum dressings may paradoxically cause an enterocutaneous fistula if incorrectly placed or if the suction is too vigorous. Surgical closure when the infant is in a positive nitrogen balance is beneficial.

Pediatric Surgery Department, Cairo University, Specialized Pediatric Hospital,

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

\*Address all correspondence to: alaa.obeida@gmail.com

provided the original work is properly cited.

rotational flaps with or without lateral release incisions [85].

and antibiotics will often suffice [83, 84].

Figure 13. Entero-cutaneous fistula.

be the surgery of choice. If post-operative ventilation is unavoidable then positive end-expiratory pressure (PEEP) or high-frequency oscillation ventilation (HFOV) is used. Neuromuscular paralysis may also help reduce ventilation pressures but is not always available in low-resource settings.

A pneumothorax is suspected when oxygen saturation drops and ventilation pressures rise sharply with absent ipsilateral air entry. An urgent plain chest x-ray will confirm this and should be followed by immediate needle decompression then a formal chest drain with an underwater seal. Bilateral asynchronous pneumothoraces are not uncommon [82].
