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>> ONCE AN INFANT HAS AN ABDOMINAL WALL CLOSURE,
THE NEXT CHALLENGE IS TO INITIATE FEEDS.
AND THAT'S A CHALLENGE.
>> IT TOOK THEM A WEEK TO DO THE CLOSURE SURGERY.
IT TOOK ANOTHER WEEK AT LEAST IF NOT A LITTLE LONGER FOR HIM
TO POOP.
AND THEN THEY STARTED FEEDING HIM FIVE MILLILITERS AT A TIME.
>> THE FEEDS ARE VERY SMALL INITIALLY OFTEN TIMES NOT MORE
THAN A TEASPOON.
AND WE WAIT AND WATCH.
>> AND TRY TO WORK THEM UP TO WHERE THEY'RE TAKING ENOUGH
CALORIES AND ENOUGH VOLUME TO BE ABLE TO GAIN AND GROW TO GET OFF
THEIR I.V. FLUIDS.
>> WE DEFINITELY HAD OUR PATIENTS TESTED WITH TRYING
TO GET HIM TO FULL FEEDS ESPECIALLY, I THINK,
IT WAS EVEN HARDER THAT HE WANTED TO EAT.
>> SO IT'S A DELICATE BALANCE.
YOU WANT TO ADVANCE THE FEEDS AS FAST AS YOU CAN TO GET THEM OFF
BUT YET YOU DON'T WANT TO GO TOO QUICKLY AND HAVE A SETBACK.
INFANTS WITH ABDOMINAL WALL DEFECTS ARE AT RISK OF HAVING
A LOT OF TROUBLE WITH REFLUX.
AND WE TRY TO DO EVERYTHING POSSIBLE TO TREAT THEM
MEDICALLY.
>> THE NEED FOR THERAPY FOR GASTROESOPHAGEAL REFLUX IS QUITE
COMMON WITH GIANT OMPHALOCELE.
AND THOSE BABIES WHO DON'T RESPOND TO MEDICAL THERAPY,
THEY MAY REQUIRE AN OPERATION CALLED A FUNDOPLICATION WHICH
CREATES A ONE-WAY VALVE TO PREVENT GASTROESOPHAGEAL REFLUX.
>> TO MAKE IT MORE DIFFICULT ANATOMICALLY FOR REFLUX TO OCCUR
BUT WE REALLY TRY EVERYTHING ELSE BEFORE WE GET THERE.
BABIES WITH GASTROSCHISIS ARE AT RISK OF SOMETHING CALLED
LATE NECROTIZING ENTEROCOLITIS.
>> THAT'S A SERIOUS INFECTION OF THE BOWEL THAT WE'D LIKE
TO MINIMIZE THE RISK THEREOF.
AND IF IT OCCURS IT USUALLY RESPONDS TO BOWEL REST
AND INTRAVENOUS ANTIBIOTICS.