[Omphalocele and gastroschisis: problems in intensive medical treatment].

Aetiologically and pathognomically, omphalocele and gastroschisis are different forms of occlusive disorders in the anterior abdominal wall of newborns. Their prognosis has clearly improved in recent years, owing to progress in surgical and conservative treatment, primarily on account of improved intensive medical care of the children concerned. Courses and survival rates of newborns with either malformation have proved to depend strongly on the initial condition of the patients. The authors' own studies, in agreement with most of the literature, have shown that the incidence of severe syndromes of malformation has been comparatively high among newborns with omphalocele, whereas children with gastroschisis are usually small-for-date newborns with low birth weight. This has been a frequent limitation to successful treatment. Major importance, in terms of intensive medical treatment, should be attributed to postoperative completely parenteral feeding, throughout the early postsurgical phase during which the patient is particularly endangered from recurrent disorders of passage, as well as to artificial respiration due to respiratory constraint on account of elevated diaphragm and disproportionality between the abdominal cavity and retroposed viscera. Early administration of amino acids, carbohydrates, fat, trace elements, immunoglobulins, and vitamins, with doses being systematically increased by a prespecified pattern, has proved to be necessary to counteract catabolism accompanied by somewhat severe disorders in wound healing, subacute obstruction, and massive attacks of septic infections. This is possible only through central venous catheterization. Resulting thrombotic or septic complications may be mitigated by partial heparinization of the children.(ABSTRACT TRUNCATED AT 250 WORDS)