Department of Clinical Medicine, University of Bergen, Haukeland University Hospital, Norway.
Acta Paediatr. 2011 Jan;100(1):71-4. doi: 10.1111/j.1651-2227.2010.01944.x.
To evaluate the effect of elective caesarean section (CS) before term and early enteral nutrition on length of parenteral nutrition and hospital stay in infants with gastroschisis.
Retrospective review of all infants with gastroschisis treated in a regional level III hospital from 1993 to 2008. During 1993-97, there was no established standard for management of pregnancy or delivery while a protocol on close foetal monitoring and early elective CS was adhered to for 1998-2008. Introduction of human milk on the first day after complete closure of the abdominal wall and rapid increase was the policy during the whole period.
With early elective CS, no foetal deaths occurred after 28-week gestational age (GA). Ten infants were born during the first period and 20 during the second period at a median GA (range) of 36.5 (34-40) and 35 (34-37) weeks (p = 0.013). Seven and 20, respectively, were born by CS. Median (range) days before full enteral feeds and hospital stay were 11.5 (7-39) and 13.0 (7-46) (p = 0.85), and 17.5 (12-36) and 22.5 (13-195) (p = 0.67), respectively. One child died of volvulus after discharge.
Close surveillance of pregnancy, elective preterm caesarean section, early surgery and active approach to primary closure and early enteral feeds appears to be a safe and effective line of management in gastroschisis.
评估择期剖宫产（CS）和早期肠内营养对先天性脐膨出患儿肠外营养时间和住院时间的影响。
回顾性分析 1993 年至 2008 年在一家地区三级医院接受治疗的所有先天性脐膨出患儿。1993-97 年，妊娠和分娩管理没有既定标准，1998-2008 年遵循密切胎儿监测和早期择期 CS 方案。在整个时期，采用腹壁完全闭合后第一天引入母乳并快速增加的策略。
早期择期 CS 后，28 周后胎死率为 0。10 名患儿出生于第一时期，20 名患儿出生于第二时期，中位（范围）GA（范围）分别为 36.5（34-40）和 35（34-37）周（p = 0.013）。分别有 7 名和 20 名患儿通过 CS 分娩。完全肠内喂养前的中位（范围）天数和住院时间分别为 11.5（7-39）和 13.0（7-46）（p = 0.85），17.5（12-36）和 22.5（13-195）（p = 0.67）。1 名患儿出院后死于肠扭转。
对妊娠进行密切监测、择期早产 CS、早期手术以及积极行一期修补和早期肠内喂养，似乎是先天性脐膨出的一种安全有效的治疗方法。
