Bertsun K. Diagnostic and treatment tactics in omphalocele and gastroschisis in newborns with account for the degree of intraabdominal hypertension

Object – congenital malformations of the anterior abdominal wall (gastroschisis (GS), omphalocele (OC)) in newborns; goal – to improve the treatment results of newborns with congenital malformations of the abdominal wall by applying pathogenetically substantiated correction of perioperative complications arising from the background of intra-abdominal hypertension syndrome and surgical correction of GS and OC; methods – anamnestic, clinical, laboratory, prenatal ultrasound, respiratory, instrumental, bacteriological, statistical; results – studied and detailed common disorders of vital organs and systems in full-term and premature babies, their analysis was carried out and the negative impact of the revealed violations on the course of pathology was proved; studied and clarified changes in hemodynamics and mechanical properties of the lungs in newborns with GS and ОC, their assessment was carried out and the effect on the prognosis of treatment results; for the first time the main directions and methods of correction of disorders of hemodynamics and mechanical properties of the lungs (compliance and resistance) in newborns with malformations at different stages of treatment under conditions of intra-abdominal hypertension syndrome have been determined; for the first time, the main complications of the postoperative period are summarized and systematized, their frequency and nature are reflected depending on the syndrome of intra-abdominal hypertension and other background conditions; based on the data obtained, a comprehensive approach to the treatment of newborns with congenital malformations of the anterior abdominal wall is proposed taking into account the background conditions and the level of intraperitoneal hypertension; for the first time, the role of stress markers (insulin and cortisol) in assessing the effectiveness of pain relief in newborns was determined and the feasibility of continuous fentanyl infusion was scientifically substantiated; for the first time, an integrated approach to the treatment of newborns with GS and ОC was proposed, which includes not only optimal surgical correction of the defect, but also adequate pre- and postoperative management of patients and anesthetic management of surgical intervention; branch – medicine.