Dipartimento Universitario Materno Infantile, Unità Operativa Complessa di Neonatologia e Terapia Intensiva Neonatale, Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone, Università degli Studi di Palermo, Palermo, Italy.
Unità Operativa di Chirurgia Pediatrica, Dipartimento Universitario Materno Infantile, Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone, Università degli Studi di Palermo, Palermo, Italy.
Am J Perinatol. 2014 Jan;31(1):49-54. doi: 10.1055/s-0033-1334447. Epub 2013 Mar 1.
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.
在儿科人群中，腹腔间隔室综合征（ACS）是腹壁缺陷修复的已知并发症。然而，只有少数关于新生儿 ACS 的报告，只有一个关于足月新生儿临界腹腔内压（IAP）的建议，早产儿则没有。尽管常见的临床体征是紧张性腹胀，但可能难以将 ACS 与不需要减压的病理区分开来。本研究的目的是确定 ACS 的预测因素，从而确定发病率或死亡率的指标。我们回顾了表现为紧张性腹胀和终末器官衰竭的新生儿。分析了病史、临床、实验室和仪器检查结果，以推断出预测因素。将结果与对照组进行比较。我们新生儿重症监护病房的 ACS 发生率在婴儿总体人群中为 5%，在气管插管新生儿中为 16%，在腹壁缺陷婴儿中为 57%。我们发现，酸中毒或高胃残余物出现时，乳酸值将对死亡率有预测作用。我们还建议，对于那些在腹胀初期、胎龄较大、以前接受过手术修复的婴儿，应特别注意高乳酸值，以便在不进行特定 IAP 测量的情况下，尽早进行手术干预。
