Snyder Christopher W, Biggio Joseph R, Bartle Donna T, Georgeson Keith E, Muensterer Oliver J
Division of Pediatric Surgery, Department of Surgery, University of Alabama, Birmingham, AL 35294-0011, USA.
Pediatr Surg Int. 2011 Nov;27(11):1155-8. doi: 10.1007/s00383-011-2921-5. Epub 2011 May 20.
This study attempted to evaluate the association of early hypoalbuminemia with the risk of intestinal failure in gastroschisis patients.
Neonates with gastroschisis treated at a tertiary children's hospital over a 10-year period were initially categorized into groups based on the lowest serum albumin measurement during the first 7 days of life. Based on preliminary analysis, patients with serum albumin <1.5 g/dL were considered to have early severe hypoalbuminemia. Intestinal failure was defined as inability of the patient to wean from parenteral nutrition (PN) during the initial hospital admission, thus requiring home PN. Logistic regression modeling was performed to adjust for sex, gestational age, birth weight, and concomitant intestinal complications.
One hundred and thirty-five gastroschisis patients were included, of whom 21% had early severe hypoalbuminemia. Patients with early severe hypoalbuminemia had a significantly higher risk of intestinal failure compared to those with higher albumin levels (26 vs. 8%, p = 0.015). On multivariable logistic regression modeling, early severe hypoalbuminemia was strongly associated with intestinal failure (OR 6.4, 95% CI 1.8-23.3, p = 0.005).
Early severe hypoalbuminemia appears to be an independent risk factor for long-term intestinal compromise rather than merely an indicator of overall illness. Further interventional studies are needed to determine whether clinical protocols utilizing judicious fluid administration, exogenous albumin, and early enteral feeding can improve clinical outcomes in gastroschisis.
本研究试图评估早期低白蛋白血症与腹裂患儿肠衰竭风险之间的关联。
对一家三级儿童医院10年间收治的腹裂新生儿，最初根据出生后7天内测得的最低血清白蛋白水平进行分组。基于初步分析，血清白蛋白<1.5g/dL的患者被认为患有早期严重低白蛋白血症。肠衰竭定义为患者在首次住院期间无法停用肠外营养（PN），因此需要家庭肠外营养。进行逻辑回归建模以校正性别、胎龄、出生体重和并发的肠道并发症。
纳入135例腹裂患者，其中21%患有早期严重低白蛋白血症。与白蛋白水平较高的患者相比，早期严重低白蛋白血症患者发生肠衰竭的风险显著更高（26%对8%，p=0.015）。在多变量逻辑回归建模中，早期严重低白蛋白血症与肠衰竭密切相关（比值比6.4，95%置信区间1.8-23.3，p=0.005）。
早期严重低白蛋白血症似乎是长期肠道功能损害的独立危险因素，而不仅仅是整体病情的一个指标。需要进一步的干预性研究来确定，采用合理补液、外源性白蛋白和早期肠内喂养的临床方案是否能改善腹裂患儿的临床结局。
