Neonatal gasless abdomen: another cause.

Abstract

In the neonate, the gasless abdomen is a sinister radiographic finding. There is a common association between the gasless abdomen and esophageal atresia and a less common association with other entities, including diaphragmatic hernia, long-term gastric suction, peritonitis, dehydration, electrolyte imbalance, and the rarely used orotracheal tubes [1 -4]. We add a relatively benign entity to this list. The gasless abdomen results from the use of curare and other curariform drugs in the neonate. Curare and other curariform drugs have been used in respiratory care centers to reduce resistance to mechanical ventilation [5]. During the past 2 years some neonatal centers have begun using curare in the treatment of hyaline membrane disease. Intermittent positive pressure ventilation is often required by such afflicted prematures, and air leak (e.g. , interstitial emphysema, pneumomediastinum, or pneumothorax) is a not uncommon sequela. The risk for such an air leak is even greater if the infant resists the ventilator with respiratory bucking. Such resistance necessitates raising the peak inspiratory pressure for adequate ventilation, and in return there is a greater risk of air leak. Curare and curariform drugs have been used to break this cycle at some nurseries, including the Regional Newborn Center at the City of Memphis Hospitals. With total paralysis of voluntary muscles, resistance to the ventilator decreases, and this permits reduction in peak inspiratory pressure while maintaining adequate ventilation. Thus curare may reduce the potential for air leak.