Kitchanan S, Patole S K, Muller R, Whitehall J S
Kirwan Hospital for Women, James Cook University, Townsville, Queensland, Australia.
J Paediatr Child Health. 2000 Oct;36(5):428-30. doi: 10.1046/j.1440-1754.2000.00551.x.
To study neonatal outcomes associated with gastroschisis and exomphalos in a regional neonatal unit.
A retrospective (1988-97) data analysis to study the effect of the type of defect/surgery, mode/place of delivery and associated anomalies on time to start and reach full feeds, duration of total parental nutrition (TPN) support and total hospital stay. Exact bivariate test procedures were used for data analysis.
Twenty-one cases of gastroschisis (17 inborn) and five cases (four inborn) of exomphalos were identified. Of these, 23.8% cases of gastroschisis and 60% of cases of exomphalos had associated gut anomalies. The survival rates for gastroschisis and exomphalos were 91 and 100%, respectively. The median time to start and reach full enteral feeds in outborn neonates was longer than in inborn neonates (9 vs 25 days, respectively, P = 0.01; and 16 vs 49 days, respectively, P = 0.01), as was the duration of TPN support (14 vs 42 days, respectively; P = 0.02). Neonates with gastroschisis had significant delays in starting and reaching full feeds compared with neonates with exomphalos (median 13 vs 4.5 days, respectively, P = 0.03; and 24 vs 8, respectively, P = 0.02) and they required prolonged support with TPN (median 23 vs 6 days, respectively; P= 0.01). Antenatal detection was significantly more frequent in inborn compared with outborn neonates (100 vs 67%, respectively; P = 0.03). The severity of associated gut anomalies and the delivery to surgery interval did not differ significantly to explain the increased morbidity in outborn neonates. Outcome was not significantly different after analysis by type of surgery and mode of delivery.
Increased morbidity in outborn neonates may be related to factors such as temperature, care, hydration status, care of the defect and vascular compromise of prolapsed gut during prolonged transportation.
在一个地区性新生儿病房研究与腹裂和脐膨出相关的新生儿结局。
进行一项回顾性（1988 - 1997年）数据分析，以研究缺陷/手术类型、分娩方式/地点及相关畸形对开始完全经口喂养的时间、达到完全经口喂养的时间、全胃肠外营养（TPN）支持的持续时间及住院总时长的影响。采用精确双变量检验程序进行数据分析。
共确定21例腹裂患儿（17例为顺产）和5例脐膨出患儿（4例为顺产）。其中，23.8%的腹裂患儿和60%的脐膨出患儿伴有肠道畸形。腹裂和脐膨出的存活率分别为91%和100%。顺产新生儿开始完全经口喂养的时间和达到完全经口喂养的时间中位数长于顺产新生儿（分别为9天对25天，P = 0.01；16天对49天，P = 0.01），TPN支持的持续时间也是如此（分别为14天对42天；P = 0.02）。与脐膨出新生儿相比，腹裂新生儿在开始完全经口喂养和达到完全经口喂养方面有显著延迟（中位数分别为13天对4.5天，P = 0.03；24天对8天，P = 0.02），并且他们需要更长时间的TPN支持（中位数分别为23天对6天；P = 0.01）。顺产新生儿的产前检出率显著高于顺产新生儿（分别为100%对67%；P = 0.03）。相关肠道畸形的严重程度及分娩至手术间隔时间并无显著差异，无法解释顺产新生儿发病率增加的原因。按手术类型和分娩方式分析后，结局无显著差异。
顺产新生儿发病率增加可能与温度、护理、水合状态、缺陷护理以及长时间转运过程中脱垂肠道的血管受压等因素有关。
