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"Waterseal" gastrostomy in the management of premature infants with tracheoesophageal fistula and pulmonary insufficiency.

Authors
  • Fann, J I
  • Hartman, G E
  • Shochat, S J
Type
Published Article
Journal
Journal of pediatric surgery
Publication Date
Jan 01, 1988
Volume
23
Issue
1 Pt 2
Pages
29–31
Identifiers
PMID: 3351723
Source
Medline
License
Unknown

Abstract

The perioperative management of premature infants with esophageal atresia and tracheoesophageal fistula (EA/TEF) complicated by pulmonary insufficiency continues to be a challenge. Definitive repair is usually delayed or staged and a gastrostomy is initially placed to prevent reflux aspiration. In patients with decreased pulmonary compliance, gastrostomy placement results in decreased intragastric pressure leading to a loss of ventilatory pressure via the tracheoesophageal fistula. A technique using the principle of underwater seal to maintain effective ventilatory pressure after gastrostomy placement is described, and two illustrative cases are presented. After acute respiratory decompensation in these patients, the gastrostomy tube was connected to underwater seal resulting in improved respiratory status. The underwater seal is allowed to intermittently "bubble," thereby permitting partial gastric decompression. This technique maintains effective ventilatory pressure after gastrostomy placement in premature infants with EA/TEF and pulmonary insufficiency until definitive therapy can be achieved.

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