Abdominal compartment syndrome monitoring in neonates with an acute abdomen - A pilot, retrospective, observational study

Amy Hort; Himanshu Popat; Robert Halliday; Claire Galea; Soundappan Soundappan

doi:10.1016/j.jpedsurg.2019.08.003

Abdominal compartment syndrome monitoring in neonates with an acute abdomen - A pilot, retrospective, observational study

J Pediatr Surg. 2020 Jul;55(7):1296-1301. doi: 10.1016/j.jpedsurg.2019.08.003. Epub 2019 Nov 6.

Authors

Amy Hort¹, Himanshu Popat², Robert Halliday³, Claire Galea⁴, Soundappan Soundappan⁵

Affiliations

¹ The Department of Surgery, The Children's Hospital Westmead, Sydney, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, Australia. Electronic address: amy.hort@health.nsw.gov.au.
² Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Grace Centre for Newborn Care, The Children's Hospital Westmead, Sydney, Australia.
³ Grace Centre for Newborn Care, The Children's Hospital Westmead, Sydney, Australia.
⁴ Grace Centre for Newborn Care, The Children's Hospital Westmead, Sydney, Australia; Cerebral Palsy Alliance, The University of Sydney, Sydney, Australia.
⁵ The Department of Surgery, The Children's Hospital Westmead, Sydney, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, Australia.

PMID: 31753610
DOI: 10.1016/j.jpedsurg.2019.08.003

Abstract

Background: Abdominal compartment syndrome (ACS) is a pathological increase of the intra-abdominal pressure (IAP) with dysfunction of one or more organs. There is lack of clarity in neonates regarding what intravesical pressure (IVP) value, a surrogate marker for IAP, indicates the need for intervention for ACS.

Methods: The medical records at a Children's Hospital NICU were reviewed to identify all neonates that had IVP/s monitored over a 10-year period (2008-2017). Demographic parameters, IVPs, and important clinical outcomes were obtained. Associations between IVP monitoring and clinical outcomes were explored.

Results: Forty-six neonates had IVP monitoring, with 4 (8%) being diagnosed with ACS requiring further operative intervention. There was no significant correlation between IVP and need for surgery. There was a significant positive correlation between the maximum IVP and the need for total parenteral nutrition (rs = 0.350, p = 0.017), ventilator support (rs = 0.321, p = 0.034) and length of stay (rs = 0.362, p = 0.016) and between a diagnosis of ACS and neonatal mortality (rs = 0.299, p = 0.044).

Conclusions: IVP monitoring and raised IVP did not correlate with the need for surgical intervention. Raised IVP was associated with neonatal morbidity and maybe neonatal mortality. A large, prospective, observational study is required to evaluate the role of IVP monitoring in ACS and its associated outcomes.

Level of evidence: III.

Keywords: Abdominal compartment syndrome; Intra-abdominal pressure; Intravesical pressure.

Publication types

Observational Study

MeSH terms

Abdomen, Acute*
Humans
Infant, Newborn
Infant, Newborn, Diseases*
Intra-Abdominal Hypertension*
Monitoring, Physiologic / methods*
Pilot Projects
Retrospective Studies