Baird Robert, Puligandla Pramod, Skarsgard Erik, Laberge Jean-Martin
Division of Pediatric Surgery, McGill University Health Center, The Montreal Children's Hospital, McGill University, 2300 Tupper Street, Montreal, QC, H3H 1P3, Canada.
Pediatr Surg Int. 2012 Apr;28(4):399-404. doi: 10.1007/s00383-011-3038-6. Epub 2011 Dec 8.
BACKGROUND/PURPOSE: Neonates with gastroschisis make up an increasing proportion of prolonged surgical NICU admissions. While infectious complications are known to increase patient morbidity, it is unclear whether they vary according to abdominal closure method, or can be predicted by initial patient assessment.
A national, prospective, disease-specific database was evaluated for episodes of wound infection (WI) and catheter-related infection (CRI). Antibiotic use and timing, as well as method and location of abdominal closure were studied. The gastroschisis prognostic score (GPS) was calculated and evaluated as a predictor of infectious complications.
Of 395 patients, 48 (12.6%) had a documented abdominal WI, and 59 patients (14.9%) had at least one episode of CRI-most commonly coagulase negative staphylococcus. Most abdominal closures took place within 6 h of admission (194 = 51.3%), while 132 (34.9%) were delayed greater than 24 h. The WI rate was greater in the delayed group (21.2 vs. 8.2%, p = 0.0006). The GPS was found to predict development of an infectious complication (WI + CRI, p = 0.04).
Infectious complications remain an important consideration in the management of gastroschisis. GPS correlates with the development of infectious complications. Prophylaxis for skin flora and early closure, when feasible, may reduce WI rates.
背景/目的：腹裂新生儿在外科重症监护病房（NICU）长期住院患者中所占比例日益增加。虽然已知感染性并发症会增加患者的发病率，但尚不清楚这些并发症是否因腹部闭合方法而异，或者能否通过患者的初始评估进行预测。
对一个全国性的、前瞻性的、针对特定疾病的数据库进行评估，以了解伤口感染（WI）和导管相关感染（CRI）的发作情况。研究了抗生素的使用及时间，以及腹部闭合的方法和部位。计算并评估腹裂预后评分（GPS），将其作为感染性并发症的预测指标。
在395例患者中，48例（12.6%）有记录的腹部WI，59例（14.9%）至少有一次CRI发作，最常见的是凝固酶阴性葡萄球菌。大多数腹部闭合在入院后6小时内进行（194例 = 51.3%），而132例（34.9%）延迟超过24小时。延迟组的WI发生率更高（21.2%对8.2%，p = 0.0006）。发现GPS可预测感染性并发症的发生（WI + CRI，p = 0.04）。
感染性并发症仍是腹裂治疗中的一个重要考虑因素。GPS与感染性并发症的发生相关。对皮肤菌群进行预防以及在可行时尽早闭合，可能会降低WI发生率。
