ASA Monitor 11 2018, Vol.82, 44.
Which of the following characteristics is most likely in a neonate with a gastroschisis rather than an omphalocele?
- (A) Congenital heart disease
- (B) Inborn errors of metabolism
- (C) Absence of coverage with a membranous sac
- (D) Urologic abnormalities
Omphalocele (Figure 1) and gastroschisis (Figure 2) represent two of the more common neonatal abdominal wall defects. The abdominal defect in gastroschisis is located in the periumbilical region, and the exposed abdominal contents lack a membranous covering, thereby potentially dramatically increasing evaporative and third-space fluid losses. Depending on the amount of abdominal contents that are exposed, intraoperative fluid requirements may exceed 10 mL/kg/h for third space losses alone. In contrast, the defect in omphalocele occurs within the umbilical cord, and the abdominal contents are commonly covered with some form of membranous sac. Although fluid requirements are increased in this condition, the presence of the membranous sac tends to reduce evaporative losses compared to a gastroschisis.
There are other significant differences between gastroschisis and omphalocele. Omphalocele occurs more often (1:6,000) than gastroschisis (1:15,000) and is more often associated with other anomalies, including congenital heart disease. Neonates with an omphalocele are more likely to have inborn errors of metabolism (e.g., Beckwith-Wiedemann syndrome) and urologic disorders (e.g., bladder exstrophy) than are neonates with a gastroschisis.
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