Homeostatic Disorders Case Study

1. Definitions: Omphalocele and gastroschisis represent two major congenital abdominal wall defects that are similar in presentation and appearance in the neonatal period, yet they have distinct differences that will affect treatments/outcomes.
a. Omphalocele: an anterior abdominal wall defect at the base of the umbilical cord with herniation of abdominal contents through the umbilical ring. The herniated organs are covered by the peritoneal sac, amnion and Wharton’s jelly. With the large variation in sizes, the defect may involve the liver and other organs. Omphalocele is associated with a high incidence (up to 70 percent) of other congenital/chromosomal defects and syndromes (e.g., Beckwith-Wiedemann syndrome, trisomies 18, 13, 21, Turner
Decreased core temperature. Hypothermia results when heat loss (e.g., conduction, convection, radiation and evaporation) exceeds heat production (e.g., chemical thermogenesis). Hypothermia/cold stress is due to a disturbance in the net regulation of heat production and heat loss that can result from defective homeostatic regulation, reduced metabolism (e.g., diminished cellular metabolism) or increased loss from exposure to extreme cold. (31) Exposure to cold stimulates the hypothalamus through afferent fibers of cold receptors and via cold circulating blood. Hypothalamic response includes immediate stimulation of autonomic nervous system and delayed endocrine, behavioral and skeletal muscle responses (the neonate is not developmentally able to shiver to increase heat production). Initial effects mimic intense sympathetic stimulation (e.g., tremulousness, vasoconstriction, increased oxygen consumption, accelerated heart rate, increased minute ventilation). Mild hypothermia reduces platelet aggregation leading to bleeding. Rapid rewarming results in metabolic acidosis; rewarming shock can
Microorganisms may contain/produce toxins that increase their ability to invade a host (abdominal contents at great risk due to exposure), damage the host or survive on or in host tissue. Infection occurs when microorganisms invade healthy tissue and proliferate to the point of overwhelming the host’s immune response. Infection is viewed as a continuum of injury, from local infection to bacteremia leading to sepsis, then severe sepsis-induced hypotension leading finally to multiple organ dysfunction syndrome. Glycemic control is imperative for infection prevention. The exposed abdominal content places the infant at high risk for infection, as normal barriers are absent. In addition, the abdominal contents may be irritated from prolonged exposure to amniotic fluid in utero causing tissue compromise. (29; 40;