Front Pediatr
. 2026 Apr 9:14:1763422.
doi: 10.3389/fped.2026.1763422. eCollection 2026. https://pubmed.ncbi.nlm.nih.gov/42038219/
Bladder pressure-guided delayed abdominal closure in a neonate treated with ECMO for congenital diaphragmatic hernia repair: a case report
Bo Xia 1, Qiu-Ming He 1, Wei Zhong 1, Jun-Jian Lv 1, Qiang Wu 1
Affiliations Expand
- PMID: 42038219
- PMCID: PMC13102819
- DOI: 10.3389/fped.2026.1763422
Abstract
Background: Delayed abdominal closure (DAC) after congenital diaphragmatic hernia (CDH) repair is often guided by subjective assessment. This is particularly critical in neonates receiving extracorporeal membrane oxygenation (ECMO), where inappropriate closure can precipitate abdominal compartment syndrome (ACS), yet objective guidance is lacking. Here, we describe a case where intraoperative bladder pressure (BP) monitoring provided an objective guide for DAC.
Case introduction: A term male neonate with severe left-sided CDH and pulmonary hypertension required veno-arterial ECMO. On ECMO day 4, he underwent repair of the diaphragmatic defect. Following visceral reduction, abdominal wall tension increased, and BP was measured at 20mmHg. Based on this objective evidence of intra-abdominal hypertension, DAC was performed with placement of a temporary silastic silo. Following decompression, the BP decreased to 8 mmHg. The patient was successfully weaned from ECMO on postoperative day 1. Definitive abdominal wall closure was performed on day 7. The infant recovered and was discharged on day 38 of life.
Conclusion: Intraoperative BP monitoring is a simple, reproducible, and objective tool that can effectively guide the decision for DAC in neonates undergoing ECMO-assisted CDH repair, potentially preventing ACS and improving outcomes.
Keywords: ECMO; abdominal compartment syndrome; bladder pressure; case report; congenital diaphragmatic hernia; delayed abdominal closure.
© 2026 Xia, He, Zhong, Lv and Wu.
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