Jeffries Howard E, Wells Winfield J, Starnes Vaughn A, Wetzel Randall C, Moromisato David Y
Department of Anesthesiology, Critical Care Medicine, Childrens Hospital Los Angeles, Los Angeles, California, USA.
Ann Thorac Surg. 2006 Mar;81(3):982-7. doi: 10.1016/j.athoracsur.2005.09.001.
Neonates with hypoplastic left heart syndrome are at high risk for developing gastrointestinal complications after first stage palliation. These complications likely play a major role in their morbidity and mortality. The goal of this review was to examine the incidence and clinical impact of gastrointestinal morbidities in these newborns.
The charts of all neonates with hypoplastic left heart syndrome who underwent stage-one palliation between January 1997 and December 2001 were reviewed to determine the incidence of gastrointestinal complications. Demographic, perioperative, and procedural variables were collected and correlated with major gastrointestinal problems.
There were 117 patients in our study population, and survival to discharge was 87% (102 of 117). Gastrointestinal complications occurred in 48 (41%), including 18% with necrotizing enterocolitis, 18% who required home feeding tubes, and 8% who required prolonged hospital length of stay for nutritional support. These infants had a longer length of stay (52 days versus 22 days; p < 0.0001). Multivariate logistic regression analysis revealed that weight less than 2.5 kg and development of necrotizing enterocolitis were each independently related to death. Neonates with a birth weight less than 2.5 kg had an odds ratio for death of 5.7 (95% confidence interval: 1.14 to 28.86), and the odds ratio for death with necrotizing enterocolitis was 5.6 (95% confidence interval: 1.55 to 20.67).
Gastrointestinal complications in infants with hypoplastic left heart syndrome are common, and necrotizing enterocolitis increases the risk of death. Measures directed at reducing the incidence of gastrointestinal complications may improve outcomes and reduce costs in this population.
患有左心发育不全综合征的新生儿在一期姑息治疗后发生胃肠道并发症的风险很高。这些并发症可能在其发病率和死亡率中起主要作用。本综述的目的是研究这些新生儿胃肠道疾病的发生率及其临床影响。
回顾了1997年1月至2001年12月期间接受一期姑息治疗的所有左心发育不全综合征新生儿的病历，以确定胃肠道并发症的发生率。收集人口统计学、围手术期和手术相关变量，并将其与主要胃肠道问题进行关联分析。
我们的研究人群中有117例患者，出院存活率为87%（117例中的102例）。48例（41%）发生了胃肠道并发症，其中18%患有坏死性小肠结肠炎，18%需要家庭喂养管，8%因营养支持需要延长住院时间。这些婴儿的住院时间更长（52天对22天；p<0.0001）。多因素逻辑回归分析显示，体重低于2.5kg和发生坏死性小肠结肠炎各自独立与死亡相关。出生体重低于2.5kg的新生儿死亡比值比为5.7（95%置信区间：1.14至28.86），坏死性小肠结肠炎患儿的死亡比值比为5.6（95%置信区间：1.55至20.67）。
左心发育不全综合征婴儿的胃肠道并发症很常见，坏死性小肠结肠炎会增加死亡风险。针对降低胃肠道并发症发生率的措施可能会改善该人群的治疗效果并降低成本。
