Matinum

Taking Charge of Your Health


>>FOR A SMALL- TO MODERATE-SIZE OMPHALOCELES AS LONG AS THE BABY’S TESTING IS REASSURING
AND THERE’S NO OBSTETRICAL CONTRAINDICATIONS, THOSE ARE
BABIES THAT ACTUALLY DO BETTER WITH A VAGINAL DELIVERY. BABIES WITH GIANT OMPHALOCELES
OR OMPHALOCELES THAT CONTAIN LIVER ARE A WHOLE
DIFFERENT ISSUE.>>IT IS IMPORTANT IN OUR VIEW
FOR FETUSES THAT HAVE A LARGE OR GIANT OMPHALOCELE IN WHICH THERE
IS A PORTION OR MAJORITY OF THE LIVER IN THE OMPHALOCELE SAC
TO HAVE A PLANNED DELIVERY BY CESAREAN SECTION BECAUSE OF THE RISK OF DYSTOCIA
OR DIFFICULTY IN THE DELIVERY WITH A GIANT OMPHALOCELE, OR
BECAUSE THE RISK OF DAMAGE TO THE LIVER DURING
THE VAGINAL DELIVERY.>>CHARLIE WAS DELIVERED BY
C-SECTION AND IMMEDIATELY RUSHED OVER HERE TO CHILDREN’S HOSPITAL
AND PUT IN THE NEONATAL I.C.U.>>IN BABIES WITH OMPHALOCELES
THEIR BOWEL AND LIVER ARE COVERED WITH A SAC. AND THAT SAC IS CRITICAL.>>IF THE OMPHALOCELE SAC
RUPTURES, THEN THE COMPLICATION RISK AND THE RISK OF DEATH
SKYROCKETS.>>SO IT’S ONE OF OUR TOP
CONCERNS WHEN THE BABY IS BORN THAT SOMEONE’S SOLE
RESPONSIBILITY IS MANAGEMENT OF THAT OMPHALOCELE SAC WHILE
SOMEONE ELSE’S RESPONSIBILITY IS MANAGEMENT OF THE AIRWAY.>>A LOT OF TIMES INFANTS WITH A
GIANT OMPHALOCELE WILL HAVE SMALL LUNGS AND REQUIRE
ASSISTANCE RIGHT FROM THE MOMENT THEY’RE DELIVERED.>>CHARLIE WAS PUT IMMEDIATELY
ON A VENTILATOR AND WAS ON A VENTILATOR FOR
ALMOST TWO MONTHS.>>FOR AN OMPHALOCELE WE USUALLY
WRAP WITH A STERILE DRESSING THE ENTIRE OMPHALOCELE AND THEN
BRING THE BABY TO THE INTENSIVE CARE NURSERY.>>JUST GOING TO THE N.I.C.U.
FOR THE FIRST TIME WAS VERY SCARY BECAUSE YOU SAW ALL
THESE VERY, VERY SICK BABIES AND REALIZED THAT
THAT WOULD BE YOU.>>ONCE THE BABY IS STABILIZED,
THE ISSUE IS HOW IS THE OMPHALOCELE GOING TO BE CLOSED.>>BABIES WITH SMALL
OMPHALOCELES OFTEN ARE ABLE TO GO TO THE O.R. AND HAVE
WHAT’S KNOWN AS A PRIMARY REPAIR, WHICH MEANS THEY GO
TO THE O.R. ONE TIME AND ARE ABLE TO HAVE IT CLOSED
RIGHT THEN AND THERE.>>THEN THERE ARE INFANTS WITH
GIANT OMPHALOCELES THAT CONTAIN DIFFERENT COMPONENTS OF BOWEL
AND LIVER. AND THOSE INFANTS ARE A LITTLE
MORE COMPLICATED.>>THERE’S NOT MUCH ABDOMINAL
CAPACITY BECAUSE VIRTUALLY EVERYTHING IS OUT PARTICULARLY
THE LIVER. THE MAJORITY OF THE LIVER IS IN
THE OMPHALOCELE SAC. SO THE ISSUE THERE IS HOW YOU
CAN GRADUALLY REDUCE THE CONTENTS OF THE OMPHALOCELE SAC
BACK INTO THE ABDOMEN AND EVENTUALLY CLOSE IT WITHOUT
CAUSING HARM TO THE BABY.>>YOU COULD IMAGINE TRYING TO
SLOWLY REDUCE ALL OF THOSE ORGANS BACK IN. WELL, AS YOU DO THAT WHAT DOES
IT DO? IT PUSHES THE DIAPHRAGM UP. IF YOU HAVE A SMALL CHEST CAVITY
AND SMALL LUNGS, ANY KIND OF DISTURBANCE
CAN JUST PUSH THE KID, YOU KNOW, OVER THE EDGE AND
TO A MAJOR RESPIRATORY CRISIS.>>WE USE A TECHNIQUE WHICH
INVOLVES BRINGING THE BABY TO THE OPERATING ROOM, FIND
THE FASCIA OR THE STRENGTH LAYER, TWO BANDS OF MUSCLE ALONG
EACH SIDE OF THE OMPHALOCELE DEFECT. THEN SEWING A TEFLON-COATED MESH
SHEET ON EACH SIDE TO THE FASCIA SO YOU HAVE TWO SHEETS
COMING UP. AND THEN YOU SEW THE SHEETS
TOGETHER AND YOU LEAVE THE OMPHALOCELE SAC INTACT. THEN USUALLY ON AN EVERY-
OTHER-DAY BASIS, YOU CAN THEN CRIMP DOWN ON THESE
TWO SHEETS AND SEW THEM BACK TOGETHER SO YOU EVENTUALLY CLOSE
THE BABY ALL THE WAY.>>DURING THAT TIME WE HAVE TO
FOLLOW THEM VERY CLOSELY TO MAKE SURE THAT WITH THE CHALLENGES OF
CLOSING THE ABDOMINAL WALL DEFECT, WE DON’T INTERFERE OR
HAVE ANY SETBACKS WITH THEIR PULMONARY PERFORMANCE.>>WE WATCH THE PRESSURES THAT
IT TAKES TO FILL THEIR LUNGS WITH AIR. WE EXPECT THAT THOSE PRESSURES
WILL BE HIGH INITIALLY POSTOP. AND ONCE THEY BEGIN
TO COME DOWN, THEN THAT TELLS US THAT
THE BABY’S READY TO GO BACK TO THE O.R.>>HE WENT THROUGH SEVEN
DIFFERENT SURGERIES IN THE COURSE OF THREE WEEKS. IT SEEMED LIKE IT WAS EVERY
OTHER DAY.>>AND SO THIS CAN TAKE PLACE
OVER A PERIOD OF A WEEK OR LONGER WHERE THEY GO TO
THE O.R. EVERY OTHER DAY, EVERY THIRD DAY
UNTIL FINAL CLOSURE.

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