Department of Paediatric Surgery, Royal Hospital for Sick Children, Glasgow, Scotland, UK.
BMJ. 2011 Nov 15;343:d6749. doi: 10.1136/bmj.d6749.
To describe one year outcomes for a national cohort of infants with gastroschisis.
Population based cohort study of all liveborn infants with gastroschisis born in the United Kingdom and Ireland from October 2006 to March 2008.
All 28 paediatric surgical centres in the UK and Ireland.
301 infants (77%) from an original cohort of 393.
Duration of parenteral nutrition and stay in hospital; time to establish full enteral feeding; rates of intestinal failure, liver disease associated with intestinal failure, unplanned reoperation; case fatality.
Compared with infants with simple gastroschisis (intact, uncompromised, continuous bowel), those with complex gastroschisis (bowel perforation, necrosis, or atresia) took longer to reach full enteral feeding (median difference 21 days, 95% confidence interval 9 to 39 days); required a longer duration of parenteral nutrition (median difference 25 days, 9 to 46 days) and a longer stay in hospital (median difference 57 days, 29 to 95 days); were more likely to develop intestinal failure (81% (25 infants) v 41% (102); relative risk 1.96, 1.56 to 2.46) and liver disease associated with intestinal failure (23% (7) v 4% (11); 5.13, 2.15 to 12.3); and were more likely to require unplanned reoperation (42% (13) v 10% (24); 4.39, 2.50 to 7.70). Compared with infants managed with primary fascial closure, those managed with preformed silos took longer to reach full enteral feeding (median difference 5 days, 1 to 9) and had an increased risk of intestinal failure (52% (50) v 32% (38); 1.61, 1.17 to 2.24). Event rates for the other outcomes were low, and there were no other significant differences between these management groups. Twelve infants died (4%).
This nationally representative study provides a benchmark against which individual centres can measure outcome and performance. Stratifying neonates with gastroschisis into simple and complex groups reliably predicts outcome at one year. There is sufficient clinical equipoise concerning the initial management strategy to embark on a multicentre randomised controlled trial comparing primary fascial closure with preformed silos in infants suitable at presentation for either treatment to determine the optimal initial management strategy and define algorithms of care.
描述全国性先天性脐膨出患儿队列的一年结局。
对 2006 年 10 月至 2008 年 3 月期间在英国和爱尔兰出生的所有先天性脐膨出的活产儿进行基于人群的队列研究。
英国和爱尔兰的 28 家儿科外科中心。
301 名婴儿（77%），来自最初的 393 名患儿队列。
肠外营养时间和住院时间；达到全肠内喂养的时间；肠衰竭、与肠衰竭相关的肝病、非计划性再次手术的发生率；病死率。
与单纯性脐膨出（完整、未受损、连续的肠管）患儿相比，复杂性脐膨出（肠穿孔、坏死或闭锁）患儿达到完全肠内喂养的时间更长（中位数差异 21 天，95%置信区间 9 至 39 天）；需要更长时间的肠外营养（中位数差异 25 天，9 至 46 天）和更长的住院时间（中位数差异 57 天，29 至 95 天）；更有可能发生肠衰竭（81%（25 例）比 41%（102 例）；相对风险 1.96，1.56 至 2.46）和与肠衰竭相关的肝病（23%（7 例）比 4%（11 例）；5.13，2.15 至 12.3）；更有可能需要非计划性再次手术（42%（13 例）比 10%（24 例）；4.39，2.50 至 7.70）。与接受一期筋膜闭合治疗的患儿相比，接受预制硅酮袋治疗的患儿达到完全肠内喂养的时间更长（中位数差异 5 天，1 至 9 天），且发生肠衰竭的风险更高（52%（50 例）比 32%（38 例）；1.61，1.17 至 2.24）。其他结局的发生率较低，且这两组患儿之间无其他显著差异。12 名患儿死亡（4%）。
本项全国代表性研究为各中心衡量结局和表现提供了基准。将先天性脐膨出患儿分为单纯型和复杂型，可在一年时可靠预测预后。在初始治疗策略方面存在足够的临床均衡性，可开展一项多中心随机对照试验，比较适用于两种治疗方法的患儿中接受一期筋膜闭合与预制硅酮袋治疗的效果，以确定最佳初始治疗策略，并制定护理方案。
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