Abstract
Arterial hypertension has been reported as a complication of surgical closure of an abdominal wall defect. No report studying the incidence, the characteristics and the clinical significance of hypertension after surgical correction of an omphalocele or gastroschisis has been published so far. The medical records of all newborns with surgically corrected gastroschisis or omphalocele identified in two centers were retrospectively evaluated. Arterial hypertension was defined as a mean daily systolic and/or diastolic blood pressure value higher than the 95 percentile for age and/or weight, according to literature data. The timing of surgery, weight gain, plasma creatinine and the use of diuretics or vasoactive drugs were compared between the groups with and without hypertension. Seventy-two patients were identified and included in the study, 29 with omphalocele and 43 with gastroschisis. Those with omphalocele were born at a mean age of 37.3±2.6 weeks with a mean birth weight of 2,971±715 g, and those with gastroschisis were born at 36.1±2.0 weeks with a mean birth weight of 2,527±498 g. Blood pressure values of 66 patients were available for analysis. Of the omphalocele patients, 46.2% (12/26) developed systolic hypertension, compared to 17.5% (7/40) of the patients with gastroschisis ( P =0.024). Hypertension was always transient, lasting an average of 4 and 1 day in the omphalocele and gastroschisis groups, respectively. Two patients with omphalocele were given anti-hypertensive therapy. There was no difference between patients with or without hypertension regarding weight gain, use of vasoactive drugs or diuretics, mean weekly creatinine values or the timing of surgery. Newborns with an abdominal wall defect frequently present with transient arterial hypertension. Hypertension occurs significantly more often, is more severe and lasts longer in patients with omphalocele than in patients with gastroschisis. In both groups, hypertension is transient and rarely requires therapy. The cause of hypertension remains unclear.
Similar content being viewed by others
References
Adelman RD, Sherman MP (1980) Hypertension in the neonate following closure of abdominal wall defects. J Pediatr 97:642–644
Guignard JP, Drukker A (1999) Clinical neonatal nephrology. In: Barratt TM, Avner ED, Harmon WE (eds) Pediatric nephrology. Lippincott Williams & Wilkins, Philadelphia, pp 1051–1066
Boyd PA, Bhattacharjee A, Gould S, Manning N, Chamberlain P (1998) Outcome of prenatally diagnosed anterior abdominal wall defects. Arch Dis Child Fetal Neonatal Ed 78:F209–213
Kitchanan S, Patole SK, Muller R, Whitehall JS (2000) Neonatal outcome of gastroschisis and exomphalos: a 10-year review. J Paediatr Child Health 36:428–430
Tawil KA, Gillam GL (1995) Gastroschisis: a 13 years’ experience at RCH Melbourne. J Paediatr Child Health 31:553–556
Dykes EH (1996) Prenatal diagnosis and management of abdominal wall defects. Semin Pediatr Surg 5:90–94
Heydanus R, Raats MA, Tibboel D, Los FJ, Wladimiroff JW (1996) Prenatal diagnosis of fetal abdominal wall defects: a retrospective analysis of 44 cases. Prenat Diagn 16:411–417
Bryant MS, Tepas JJ 3rd, Mollitt DL, Talbert JL, String DL (1989) The effect of initial operative repair on the recovery of intestinal function in gastroschisis. Am Surg 55:209–211
Lafferty PM, Emmerson AJ, Fleming PJ, Frank JD, Noblett HR (1989) Anterior abdominal wall defects. Arch Dis Child 64:1029–1031
Novotny DA, Klein RL, Boeckman CR (1993) Gastroschisis: an 18-year review. J Pediatr Surg 28:650–652
Dimitriou G, Greenough A, Mantagos JS, Davenport M, Nicolaides KH (2000) Morbidity in infants with antenatally diagnosed anterior abdominal wall defects. Pediatr Surg Int 16:404–407
Dunn JCY, Fonkalsrud EW (1997) Improved survival of infants with omphalocele. Am J Surg 173:284–287
Snyder CL (1999) Outcome analysis for gastroschisis. J Ped Surg 34:1253–1256
DeLuca FG, Gilchrist BF, Paquette E, Wesselhoeft CW, Luks FI (1996) External compression as initial management of giant omphaloceles. J Pediatr Surg 31:965–967
Buchi KF, Siegler RL (1986) Hypertension in the first month of life. J Hypertens 4:525–528
Hegyi T, Anwar M, Carbone MT, Ostfeld B, Hiatt M, Koons A, Pinto-Martin J, Paneth N (1996) Blood pressure ranges in premature infants: II. The first week of life. Pediatrics 97:336–3342
Hegyi T, Carbone MT, Anwar M (1994) Blood pressure ranges in premature infants: I. The first hours of life. J Pediatr 124:627–633
Flynn JT (2000) Neonatal hypertension: diagnosis and management. Pediatr Nephrol 14:332–341
Tan KL (1988) Blood pressure in very low birth weight infants in the first 70 days of life. J Pediatr 112:266–270
Singh HP, Hurley RM, Myers TF (1992) Neonatal hypertension. Incidence and risk factors. Am J Hypertens 5:51–55
Diebel LN, Wilson RF, Dulchavsky SA (1992) Effect of increased intra-abdominal pressure on hepatic arterial, portal venous, and hepatic microcirculation blood flow. J Trauma 33:279–282
Lacey SR, Bruce J, Brooks SP, Griswald J, Ferguson W, Allen JE, Jewett TC Jr, Krap MP, Cooney DR (1987) The relative merits of various methods of indirect measurement of intraabdominal pressure as a guide to closure of abdominal wall defects. J Pediatr 22:1207–1211
Bloomfield GL, Blocher CR, Fakhry IF, Sica DA, Sugerman HJ (1997) Elevated intra-abdominal pressure increases plasma renin activity and aldosterone levels. J Trauma Inj Infect Crit Care 42:997–1005
Casadevall I, Kazandjian V, Germain JF, Daoud P, Maherzi S, Desplanques L, Beaufils F (1993) Anuria after abdominal surgery in two newborn infants. Beneficial effect of noradrenaline. Arch Fr Pediatr 50:417–419
Harmon PK, Kron IL, McLachlan HD, Freedlender AE, Nolan SP (1982) Elevated intraabdominal pressure and renal function. Ann Surg 196:594–597
Yaster M, Buck JR, Dudgeon DL, Manolio TA, Simmons RS, Zeller P, Haller JA Jr (1988) Hemodynamic effects of primary closure of omphalocele/gastroschisis in human newborns. Anesthesiology 69:84–88
Schaer GL, Fink MP, Parrillo JE (1985) Norepinephrine alone versus norepinephrine plus low-dose dopamine enhanced renal blood flow with combination pressure therapy. Crit Care Med 13:492–496
Norwood VF, Carey RM, Geary KM (1994) Neonatal ureteral obstruction stimulates recruitment of renin-secreting renal cortical cells. Kidney Int 45:1333–1339
Acknowledgments
We wish to express our gratitude to Mrs. S. Showalter for her assistance as a clinical research nurse at the University of Virginia, USA.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Cachat, F., Van Melle, G., McGahren, E.D. et al. Arterial hypertension after surgical closure of omphalocele and gastroschisis. Pediatr Nephrol 21, 225–229 (2006). https://doi.org/10.1007/s00467-005-2117-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00467-005-2117-0