Temporary abdominal vacuum-packing closure in the neonatal intensive care unit.
BACKGROUND
Temporary abdominal vacuum-packing (vac-pac) closure is well known in adult literature, yet has not been reported in infants.


METHODS
A review of children in the neonatal intensive care unit who underwent vac-pac closure from 2000 to 2006 was performed.


RESULTS
During this time, 7 infants underwent vac-pac closure after abdominal surgery. Median age was 39 days, with a median weight of 3.2 kg. Reasons for vac-pac included abdominal compartment syndrome (3), ongoing intraabdominal sepsis (1), anticipated second-look procedures (2), and abdominal observation after repair of congenital diaphragmatic hernia on extracorporeal membrane oxygenation (1). PaCO2 revealed a drop from a median preoperative level of 50.3 to 44.0 mm Hg postoperatively. Median preoperative urine output was 3.9 and 3.1 mL/(kg h) postoperatively. One patient died with an open abdomen from overwhelming Escherichia coli sepsis, and all surviving patients (85.7%) proceeded to definitive abdominal closure with the median time of vac-pac use being 4 days.


CONCLUSIONS
Vac-pac closure in infants is a safe and effective method of temporary abdominal closure. The detrimental effects of intraabdominal hypertension as well as risk of hemorrhage after repair of congenital diaphragmatic hernia while on extracorporeal membrane oxygenation also make this an important technique for abdominal observation.
Fenton
Stephen J
SJ
Department of Surgery, University of Utah, Salt Lake City, UT 84132, USA.
Dodgion
Christopher M
CM
Meyers
Rebecka L
RL
Nichol
Peter F
PF
Scaife
Eric R
ER
D000005:Abdomen / Q000601:surgery*; D002245:Carbon Dioxide / Q000097:blood; D004231:Diuresis; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D008150:Lower Body Negative Pressure / Q000295:instrumentation / Q000379:methods; D008297:Male; D009779:Occlusive Dressings / Q000706:statistics & numerical data*; D010313:Partial Pressure; D012086:Reoperation; D012121:Respiration, Artificial; D012189:Retrospective Studies; D013396:Suction / Q000295:instrumentation; D014618:Vacuum
D002245:Carbon Dioxide