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

Background: Increased intra-abdominal pressure (IAP) is seen in patients after congenital diaphragmatic hernia (CDH) repair owing to reduction of thoracic contents into the relatively smaller abdominal cavity. In infants, IAP >= 11 mmHg is considered intra-abdominal hypertension (IAH). We aim to determine the incidence of IAH and its relationship with duration of ventilatory support, and gastrointestinal function post CDH repair. Methods: We prospectively recruited all neonates who had CDH repair in four hospitals in Malaysia from June 2018 to October 2020. Intra vesical pressure was used as a proxy for IAP and was measured for 5 consecutive days post surgery. The daily median value was used for analysis. We categorized IAP as < 11 mmHg (no IAH), 11-15 mmHg (IAH), and > 15 mmHg (severe IAH). Incidence of IAH, its effects on the duration of ventilatory support, and gastrointestinal function were studied. Results: There were 24 neonates included in this study. They were operated between day 1 and 6 of life (median: 4 days old). IAH was detected within the first 3 days post surgery, with 83% occurring on day one. Those requiring ventilatory support for more than 3 days contributed the largest proportion of IAH ( n = 17, 71%). There was strong correlation between days of IAH and duration of ventilation ( p < 0.001, r = 0.70). There was moderate correlation between days of IAH and duration taken to achieve full enteral feeding ( p < 0.005, r = 0.70). Conclusion: IAP measurement is a safe and useful adjunct in post CDH monitoring and in predicting ventilatory support requirements and the time needed to establish feeding. (c) 2021 Elsevier Inc. All rights reserved.

Automated summary

The aim of this study was to determine the incidence of intra-abdominal hypertension (IAH) after congenital diaphragmatic hernia (CDH) repair and its relationship with duration of ventilatory support and gastrointestinal function. The study found that IAH occurred within the first 3 days post surgery, with a strong correlation between the duration of IAH and the duration of ventilation, as well as a moderate correlation between the duration of IAH and the time taken to achieve full enteral feeding.