Intra-Abdominal Hypertension in Neonates Following Congenital Diaphragmatic Hernia Repair: Correlation with Early Postoperative Respiratory and Gastrointestinal Outcomes

ABSTRACT BACKGROUND : Increased intra-abdominal pressure (IAP) is seen in patients after congenital diaphragmatic hernia (CDH) repair due 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 15mmHg (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 to 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 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.