Ascites in infants with severe sepsis - treatment with peritoneal drainage.
BACKGROUND
Ascites in neonates and infants is usually caused by cardiac failure and urinary or biliary tract obstruction. The objective of this study was to characterize our experience with ascites as a complication of sepsis.


METHODS
We retrospectively collected and analyzed data of patients treated in the intensive care unit (ICU) of the university-based children's hospital, in whom ascites developed during nosocomial sepsis. Ten infants admitted to the ICU in the first 2 days of life developed sepsis on the mean 31.5 (+/-21.9) postnatal day. Gram-negative bacteria were the causative organism in nine cases, and Staphylococcus hemolyticus in one. Because of sepsis, reintubation and mechanical ventilation were necessary. All patients received broad spectrum antibiotics (including meropenem and ciprofloxacin), blood transfusions, catecholamines and intravenous immunoglobulin preparations. Ascites was observed on the median 13.5 day of sepsis (range 3-36), and severely compromised gas exchange. Continuous peritoneal drainage was applied by means of an intravascular catheter placed in the right lower abdominal quadrant.


RESULTS
The mean drained fluid volume was 44.7 (+/-20.4) ml.kg(-1).day(-1), drainage was continued for a median of 5.5 (range 1-56) day, and enabled significant reduction of ventilator settings 24 h after its implementation. No severe complications related to drainage occurred; six of 10 babies survived.


CONCLUSIONS
Ascites can develop in infants with sepsis and cause respiratory compromise. Continuous drainage of ascitic fluid by means of an intravenous catheter is relatively safe and can improve gas exchange.
Piotrowski
Andrzej
A
Department of Anaesthesia and Intensive Care, Paediatric Hospital, Medical University of Lodz, Lodz, Poland. andrzej-oiom@wp.pl
Sobala
Wojciech
W
Krajewski
Paweł
P
Fendler
Wojciech
W
Dabrowska-Wojciak
Iwona
I
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001201:Ascites / Q000209:etiology / Q000628:therapy*; D003428:Cross Infection / Q000150:complications / Q000628:therapy; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007362:Intensive Care Units; D008297:Male; D012129:Respiratory Function Tests; D012131:Respiratory Insufficiency / Q000628:therapy; D012189:Retrospective Studies; D018805:Sepsis / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D018709:Statistics, Nonparametric
D000900:Anti-Bacterial Agents