Wales Paul W, de Silva Nicole, Kim Jae H, Lecce Loreto, Sandhu Amarpreet, Moore Aideen M
Division of General Surgery, The Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada M5G 1X8.
J Pediatr Surg. 2005 May;40(5):755-62. doi: 10.1016/j.jpedsurg.2005.01.037.
To date, our knowledge of morbidity and mortality in neonatal short bowel syndrome (SBS) is based on individual case series. Shortcomings of the published literature include long patient recruitment time, selection bias, variable SBS definitions, failure to account for gestational age, and incomplete follow-up. By applying more rigorous methodology, our aim was to determine outcomes of SBS neonates compared with a control group of neonates without SBS.
A cohort study of all neonates with abdominal pathology requiring laparotomy between January 1, 1997, and December 31, 1998, with observation through July 1, 2001. Short bowel syndrome was defined as patients requiring parenteral nutrition for more than 42 days or residual small bowel length of less than 25% predicted by gestational age. Student's t test, Mann-Whitney U test, and chi2 were used where appropriate. Kaplan-Meier curves were used to determine cumulative survival. Covariates important in the development of SBS were examined using forward step-wise logistic regression.
There were 175 patients (with SBS = 40, without SBS = 135) with a mean gestational age of 30.7 +/- 4.6 weeks vs 35.9 +/- 4.8 weeks, respectively (P < .0005). The patients with SBS suffered significantly more morbidity than the group without SBS in all categories of investigation (surgical complications, septic events, central venous line complications, duration to adaptation and parenteral nutrition independence, cholestasis and liver failure, and duration of hospitalization). The case fatality rate was 37.5% in patients with SBS vs 13.3% in patients without SBS (P = .001). Most of the deaths were caused by liver failure or sepsis and occurred within 1 year from the date of surgery. Presence of an ileostomy (exp(B) = 12.29; P < .0005) and a residual small bowel length less than 50% of the original length (exp(B) = 26.84; P < .0005) were the only 2 variables in a logistic regression analysis found to be independently associated with the development of SBS.
This cohort study clearly illustrates the tremendous morbidity experienced by infants with SBS relative to other surgical neonates. Accurate estimates of the morbidity associated with SBS enables clinicians to appropriately counsel parents, allocate resources and initiate therapeutic trials.
迄今为止，我们对新生儿短肠综合征（SBS）发病率和死亡率的了解基于个别病例系列。已发表文献的缺点包括患者招募时间长、选择偏倚、SBS定义可变、未考虑胎龄以及随访不完整。通过应用更严格的方法，我们的目的是确定SBS新生儿与无SBS的新生儿对照组相比的结局。
对1997年1月1日至1998年12月31日期间所有因腹部病变需要剖腹手术的新生儿进行队列研究，并随访至2001年7月1日。短肠综合征定义为需要肠外营养超过42天或残余小肠长度小于根据胎龄预测的25%的患者。在适当情况下使用学生t检验、曼-惠特尼U检验和卡方检验。采用Kaplan-Meier曲线确定累积生存率。使用向前逐步逻辑回归分析检查在SBS发生过程中重要的协变量。
共有175例患者（SBS组 = 40例，非SBS组 = 135例），平均胎龄分别为30.7±4.6周和35.9±4.8周（P <.0005）。在所有调查类别（手术并发症、感染事件、中心静脉导管并发症、适应和肠外营养独立的持续时间、胆汁淤积和肝功能衰竭以及住院时间）中，SBS患者的发病率明显高于非SBS组。SBS患者的病死率为37.5%，而非SBS患者为13.3%（P =.001）。大多数死亡是由肝功能衰竭或败血症引起的，且发生在手术日期后的1年内。在逻辑回归分析中，回肠造口术的存在（exp(B)=12.29；P <.0005）和残余小肠长度小于原始长度的50%（exp(B)=26.84；P <.0005）是仅有的2个与SBS发生独立相关的变量。
这项队列研究清楚地表明，与其他外科新生儿相比，SBS婴儿的发病率极高。准确估计与SBS相关的发病率使临床医生能够适当地为家长提供咨询、分配资源并启动治疗试验。
