Intra-abdominal hypertension in neonates following congenital diaphragmatic hernia repair: Correlation with early postoperative respiratory and gastrointestinal outcomes

Thambusamy, Elango; Cr, Thambidorai; Nah, Shireen Anne; Gan, Chin Seng; Wang, Qi Yuee; Singaravel, Srihari; Sanmugam, Anand

doi:10.1016/j.jpedsurg.2021.10.029

Cited by 4 publications

(3 citation statements)

References 12 publications

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“…studied 24 neonates with CDH, with 83% having increased IAP on POD-1. [ 18 ] These patients had liver herniation, long ventilator support, delay in establishing full feeding, splinting of diaphragm, and bowel ischemia. da Costa and Saxena reviewed 16 studies with a total of 118 cases with CDH and found that ACS was more common in neonates when compared to other ages.…”

Section: Discussionmentioning

confidence: 99%

“…[ 14 15 16 17 ] The abdominal cavity is comparatively small, and closure may present a challenge. Reduction of thoracic contents can lead to an increase in the intra-abdominal pressure (IAP) in up to 50% of patients[ 18 ] and can cause intra-abdominal hypertension and abdominal compartment syndrome (ACS),[ 19 ] worsening of PPHN and, rapid onset of multi-organ dysfunction syndrome. [ 20 ] The increased IAP can lead to compression of the inferior vena cava and renal shutdown.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of the Surgical Outcomes in Neonates with Left-sided Congenital Diaphragmatic Hernia with Only Skin Closure versus Abdominal Muscle Closure

Vutukuru,

Menon,

Solanki

2024

Journal of Indian Association of Pediatric Surgeons

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Aim: This study aims to compare the outcome of neonatal left congenital diaphragmatic hernia (CDH, Bochdalek type) repair through laparotomy with and without abdominal muscle closure. Materials and Methods: This retrospective study was conducted between January 2012 and May 2021 at a neonatal surgical unit of a Tertiary Care Center. Demographic details, preoperative management, Two-dimensional-echo, intra-operative findings, postoperative course, and follow-up data were collected and analyzed. Results: The study group comprised 50 neonates with a mean standard deviation (SD) age at admission: 4.44 (5.12) days, male: female ratio of 3:2, and mean (SD) weight: 2.73 (0.51) kg. Following repair of the diaphragmatic defect through laparotomy, 26 (52%) underwent skin closure alone, whereas 24 (48%) underwent abdominal muscle closure. Postoperatively, there was a significant fall in the level of platelets (P = 0.021), increase in pressure support by at least 4–5 cm H2O (P = 0.027), and increase in the blood urea (P < 0.001), creatinine (P = 0.005), lactate (P = 0.019), and acidosis (P = 0.048) in the muscle closure group. Although not statistically significant, there was a fall in the urine output and blood pressure in this group. There was no significant difference in the duration of inotropes. Mortality was 8 (32%) in the skin closure group, and 14 (61%) in the muscle closure group (P = 0.05). Conclusions: Neonates undergoing left CDH repair through the abdominal route with skin closure alone, had better survival, as well as hematological, renal, and ventilatory parameters than those who underwent muscle closure. It is a useful surgical modification to improve outcome in centers with limited facilities.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of the Surgical Outcomes in Neonates with Left-sided Congenital Diaphragmatic Hernia with Only Skin Closure versus Abdominal Muscle Closure

Vutukuru,

Menon,

Solanki

2024

Journal of Indian Association of Pediatric Surgeons

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“…In paediatric patients, ACS following congenital diaphragmatic hernia repair is commonly encountered. In a study by Thambusamy et al [13], IAP measurement was found to be well tolerated and a valuable tool in monitoring postsurgical patients, as it predicted ventilatory support requirements and the time needed to establish feeding.…”

Section: Epidemiology Updatementioning

confidence: 99%

Intra-abdominal hypertension and abdominal compartment syndrome

Waele

2022

Current Opinion in Critical Care

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Purpose of reviewIntra-abdominal hypertension (IAH) has been acknowledged as an important contributor to organ dysfunction in critically ill patients, both in surgical and medical conditions. As our understanding of the pathophysiology evolves, risk factors are better recognized, preventive measures can now be implemented and therapeutic interventions tailored to the physiology of the patient. In the current review, we want to highlight developing insights in the epidemiology and treatment of patients with IAH and ACS. Recent findingsThe impact of IAH and ACS on kidney function and other outcomes continues to draw attention in recent studies. New methods for IAP measurement are under development, and the search for biomarkers to detect IAH or ACS continues. In conditions wherein IAH and ACS are common, recent studies allow better prevention and treatment of these conditions, based on the contemporary ICU management consisting of IAP measurement, judicious fluid resuscitation and decompressive laparotomy where necessary. Surgical treatment options including open abdomen therapy continue to be improved with demonstrable impact on outcomes.

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Congenital Diaphragmatic Hernia

Skinner

2022

Pediatric Surgery

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Intra-abdominal hypertension in neonates following congenital diaphragmatic hernia repair: Correlation with early postoperative respiratory and gastrointestinal outcomes

Cited by 4 publications

References 12 publications

Comparison of the Surgical Outcomes in Neonates with Left-sided Congenital Diaphragmatic Hernia with Only Skin Closure versus Abdominal Muscle Closure

Comparison of the Surgical Outcomes in Neonates with Left-sided Congenital Diaphragmatic Hernia with Only Skin Closure versus Abdominal Muscle Closure

Intra-abdominal hypertension and abdominal compartment syndrome

Congenital Diaphragmatic Hernia

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