Identification, management and complications of intra-abdominal hypertension and abdominal compartment syndrome in neonatal intensive care unit (a single centre retrospective analysis).

The abdominal compartment syndrome (ACS) is a result of increased intra-abdominal pressure (IAP) due to tissue edema or free fluid collecting in the abdominal cavity. Elevated pressure in the abdomen is referred to as intra-abdominal hypertension (IAH). The end result of ACS, if undetected and untreated, is multisystem organ failure and patient death. Intra-abdominal pressure monitoring should be strongly considered in all patients with this clinical presentation. Normal intra-abdominal pressure is 0-5 mm Hg. Physiologic compromise begins when the pressure rises above 8-10 mm Hg. Once the pressures increase beyond 20 mm Hg irreversible tissue injury occurs, ultimately resulting in ACS and multiple organ failure. Early recognition of rising abdominal pressure is critically important, because it allows prompt intervention which will prevent ACS from developing, leading to a much better prognosis for the patient. The purpose of the research was to: 1) Detect abdominal compartment syndrome in newborns with clinically suspicious intra-abdominal hypertension; 2) Identify intra-abdominal pressure numbers presented with clinical manifestation; 3) Measure and detect intra-abdominal pressure numbers presented with abdominal compartment syndrome; 4) Find correlation between intra-abdominal hypertension grade and patient outcome. For completion of our goal we selected and reviewed medical records of 155 neonatal patients from 2008 to 2010, who stayed in surgical neonatal intensive care unit for more than 7 days. We monitored IAP in patients with suspected ACS and different clinical presentation. According to our research we may come to the following conclusion: Intra-abdominal hypertension was confirmed in most suspected cases. Intra-abdominal pressure of >10 mmHg in patients with clinical suspicion may be considered as intra-abdominal hypertension. Intra-abdominal hypertension is in close correlation with presence of fluid in abdominal cavity proved by ultrasound investigation. Intra-abdominal pressure of ≥20 mmHg can be considered as a point of development of abdominal compartment syndrome. The grade of hypertension is in close correlation with patient outcome.