Temporary Vacuum-Assisted Closure of the Open Abdomen in Neonates

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Abstract

Introduction

The need for open abdomen in the treatment of severely ill neonates will increase in time as more complex abdominal procedures are undertaken. However, the experience of temporary closure of an open abdomen using vacuum-assisted closure (VAC) system is still relatively limited in premature and term neonates. The aim of this study is to describe and review our experience in the use of temporary VAC of the open abdomen for neonates with varying pathological processes.

Materials and Methods

A retrospective folder review of all neonates treated with VAC for open abdomen over the study period of 2010 to 2014 at our institution was performed.

Results

A total of 15 neonates were included in this study. Mean gestational age and postbirth age at VAC application were 33.6 ± 4.1 (28-40) weeks and 14 ± 10.2 (2-30) days, respectively. Mean weight at VAC application was 1,797.7 ± 730.8 (960-3,200) g. Initial diagnoses were necrotizing enterocolitis (seven), intestinal perforation (three), gastroschisis (two), congenital diaphragmatic hernia (two), and primary abdominal compartment syndrome (ACS) (one). Reasons for VAC application included confirmed ACS (2) and application to prevent ACS (13). Duration of VAC use was 4 ± 3.4 (0-13) days during which 2 ± 1.2 (1-5) applications were performed. Overall survival rate was 80% (12 of 15 patients). One patient with primary ACS died from sepsis with an open abdomen. The only potential VAC-related complication was an enterocutaneous fistula.

Conclusion

Temporary VAC of the open abdomen is a safe method of temporary abdominal closure to prevent ACS in high-risk postoperative conditions in neonates of any gestational age and birth weight.

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