Abdominal wall defects in infants with very low birth weight.

Management strategies for infants with very low birth weight (VLBW) who have abdominal wall defects essentially are the same as for those in larger infants. The authors favor primary closure in infants with gastroschisis, and have achieved this goal in 91% of infants since 1985. Treatment of infants with omphalocele is based on the size of the defect and the presence of respiratory insufficiency or severe associated anomalies. Nonoperative treatment is used initially for infants with large defects or associated anomalies, with planned closure of the resultant ventral hernia when the infant weighs 20 pounds or is 1 year old. This technique helps avoid the complications associated with mechanical ventilation and with tight primary closure such as intestinal dysfunction and wound problems.