Bladder pressure and intra-abdominal hypertension in sick neonates

Gerstmann, Dale R.; Null, Donald M.

doi:10.3233/npm-2010-0129

Cited by 5 publications

(2 citation statements)

References 13 publications

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“…Normal intra-abdominal pressure (IAP) in neonatal age is about 10 mmHg, whereas intra-abdominal hypertension (IAH) is defined as a sustained rise of IAP > 10 mmHg ( 3 ). ACS is a sustained IAP of >10 mmHg associated with organ dysfunction ( 7 , 8 ). Abdominal perfusion pressure (APP) is more accurate in the evaluation of visceral blood supply and a need for resuscitation.…”

Section: Introductionmentioning

confidence: 99%

High Abdominal Perfusion Pressure Using Umbilical Cord Flap in the Management of Gastroschisis

et al. 2021

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Background: Gastroschisis management remains a controversy. Most surgeons prefer reduction and fascial closure. Others advise staged reduction to avoid a sudden rise in intra-abdominal pressure (IAP). This study aims to evaluate the feasibility of using the umbilical cord as a flap (without skin on the top) for tension-free repair of gastroschisis.Methods: In a prospective study of neonates with gastroschisis repaired between January 2018 to October 2020 in Tanta University Hospital, we used the umbilical cord as a flap after the evacuation of all its blood vessels and suturing the edges of the cord with the skin edges of the defect. They were guided by monitoring abdominal perfusion pressure (APP), peak inspiratory pressure (PIP), central venous pressure (CVP), and urine output during 24 and 48 h postoperatively. The umbilical cord flap is used for tension-free closure of gastroschisis if PIP > 24 mmHg, IAP > 20 cmH2O (15 mmHg), APP <50 mmHg, and CVP > 15cmH2O.Results: In 20 cases that had gastroschisis with a median age of 24 h, we applied the umbilical cord flap in all cases and then purse string (Prolene Zero) with daily tightening till complete closure in seven cases, secondary suturing after 10 days in four cases, and leaving skin creeping until complete closure in nine cases. During the trials of closure, the range of APP was 49–52 mmHg. The range of IAP (IVP) was 15–20 cmH2O (11–15 mmHg), the range of PIP was 22–25 cmH2O, the range of CVP was 13–15 cmH2O, and the range of urine output was 1–1.5 ml/kg/h.Conclusion: The umbilical cord flap is an easy, feasible, and cheap method for tension-free closure of gastroschisis with limiting the PIP ≤ 24 mmHg, IAP ≤ 20 cmH2O (15 mmHg), APP > 50 mmHg, and CVP ≤ 15cmH2O.

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Section: Introductionmentioning

confidence: 99%

High Abdominal Perfusion Pressure Using Umbilical Cord Flap in the Management of Gastroschisis

et al. 2021

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“…8 However, there are only few reports dealing ACS in newborns and only a proposal of critical abdominal pressure value in newborns. 5,[9][10][11][12][13] We present a retrospective study of 21 cases of clinical ACS in newborns with the aim to extrapolate predictive factors. Compared with adults and older children, leading causes of ACS in newborns are different and vary from congenital gastrointestinal atresia and abdominal wall defects to ileus and sepsis.…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors of Abdominal Compartment Syndrome in Neonatal Age

et al. 2013

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In the pediatric population, abdominal compartment syndrome (ACS) is a known complication of abdominal wall defect repair. However, there are only few reports on ACS in newborns and only a proposal of critical intra-abdominal pressure value (IAP) in term newborns, absent in preterm newborns. Although the prevalent clinical sign is tense abdominal distension, it may be difficult to distinguish ACS from pathologies that will not require decompression. The purpose of this study was to identify predictors for ACS and therefore morbidity or mortality indicators. We reviewed newborns presenting with tense abdominal distension and end organ failure. Anamnestic, clinical, laboratory, and instrumental investigations were analyzed to extrapolate predictors. Outcomes were compared with a control group. The incidence of ACS in our neonatal intensive care unit was 5% in the overall population of babies, 16% in tracheal-ventilated newborns, and 57% in infants with abdominal wall defects. We found that, with onset of acidosis or high gastric residuals, the lactate values will be predictive for mortality. We can also suggest paying particular attention to high lactate values just at the onset of distension, in infants with more advanced gestational age, with previously surgical repair, to determine early surgical intervention independently of a specific IAP measurement.

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