Incidence and prognosis of intraabdominal hypertension and abdominal compartment syndrome in children.

PURPOSE: Intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are associated with high mortality rates in children (40-60%). However, literature lacks comprehensive series in childhood. In this study, we aimed to determine the incidences of IAH and ACS, to identify high risk disorders for the development of IAH/ACS and to decrease ACS-associated mortality by early diagnosis and timely intervention.

METHODS: A prospective study was performed between December 2009 and October 2010 in our institution. IAH was defined by a sustained or repeated pathological elevation in IAP≥12mmHg without a new organ failure. ACS was identified as a sustained IAP>15mmHg with a new organ dysfunction/failure. After recognition of IAH or ACS, patients underwent prompt decompressive interventions as medical or surgical procedures.

RESULTS: 150 patients were enrolled to the study (86 M, 64 F). The incidences of IAH and ACS were 9% and 4%, respectively. High risk disorders were trauma, ileus, necrotizing enterocolitis, abdominal wall defects, diaphragmatic hernia and septic shock with massive fluid resuscitation. 14 patients with IAH were treated and mean IAP was decreased from 13.9±1.9mmHg to 9.2±2.1mmHg (p<0.001). None of them progressed to ACS. Six patients with ACS underwent decompressive laparotomy. Mean IAP decreased significantly from 20±3mmHg to 9±1.4mmHg (p=0.001). Vital signs like mean urine output, abdominal perfusion pressure (APP) and respiratory rate were significantly improved after surgery (p<0.05). ACS-associated mortality rate was determined as 16%.

CONCLUSIONS: IAH or ACS was occurred in nearly one tenth of patients admitted to neonatal and pediatric intensive care units. High clinical suspect must be drawn on to recognize and treat these clinical complications more efficiently. Regular and frequent IAP measurement in high risk disorders is essential for early diagnosis. Lower mortality rates can be achieved by early recognition and timely intervention in children.