Asphyxiated bladder syndrome in a pediatric intensive care unit

Area of Science:

• Pediatric Intensive Care
• Neonatal Medicine
• Urology

Background:

• Asphyxiated bladder syndrome (ABS) is a condition of transient urinary bladder distention in neonates and infants following asphyxial events.
• It presents as delayed micturition without obstructive lesions.
• The condition's incidence and characteristics in a Pediatric Intensive Care Unit (PICU) setting require further elucidation.

Purpose of the Study:

• To prospectively investigate the incidence, clinical presentation, and management outcomes of asphyxiated bladder syndrome (ABS) in neonates and infants.
• To assess the coexistence of ABS with intestinal dysfunction and infection.
• To evaluate the long-term renal and urinary tract outcomes in affected patients.

Main Methods:

• Prospective study of 16 neonates and infants diagnosed with ABS over two years.
• Utilized suprapubic bladder expression (Crede's maneuver) for bladder decompression.
• Assessed for coexisting intestinal dysfunction, bacterial infections, and performed sonography and post-mortem examinations when applicable.

Main Results:

• The incidence of ABS was 1.9% in the PICU and 2.8% in patients under three years old.
• All patients responded to Crede's maneuver for bladder decompression; mean duration of dysfunction was 66.9 hours.
• 81.3% of ABS cases had coexisting intestinal dysfunction (paralytic ileus or gas-less abdomen); 50% of patients ultimately died, with no urinary tract abnormalities found in post-mortem exams.

Conclusions:

• Suprapubic bladder expression (Crede's maneuver) is an effective method for managing asphyxiated bladder syndrome (ABS).
• ABS frequently coexists with intestinal dysfunction, and carries a significant mortality rate.
• Despite severe presentation, renal and collecting systems appear normal, suggesting ABS is a functional, transient bladder issue.