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 (ETCO(2)) monitoring was standard therapy beginning in 1985. The authors evaluated the eff ect of abdominal closure on ETCO(2) to determine if there was a particular ETCO(2) 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 ETCO(2) 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 ETCO(2) of greater than or equal to 50 suggests that primary closure may be unsafe. These data suggest that infants with gastroschisis can have primary closure based on intraoperative ETCO(2) monitoring; no additional invasive monitoring would be necessary to assess closure. Copyright (C) 1996 by W.B. Saunders Company