Department of Surgery, Division of Pediatric Surgery, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada.
J Pediatr Surg. 2013 May;48(5):971-6. doi: 10.1016/j.jpedsurg.2013.02.014.
Timely initiation of enteral nutrition is pivotal to outcome optimization in gastroschisis (GS). The purpose of our study was to analyze the effect of timing of first feeds on outcome.
GS cases accrued between May 2005 and August 2011 were abstracted from a national database. Risk variables evaluated included GA, illness severity, bowel injury severity, and post-closure days to first feed (DTF). The outcomes analyzed included duration of TPN, LOS, and infectious complications. Descriptive, univariate, and multivariate regression analyses were conducted.
The study cohort comprised 570 cases (16% with "high risk" bowel injury). Group distribution by DTF was: 0-7 days (12%), 8-14 days (44%), 15-21 days (26%), and >21 days (17%), with a mean DTF of 17 ± 15 days. Mean durations of TPN and LOS were 44 ± 56 and 112 ± 71 days, respectively. DTF subgroups were comparable, except for a greater proportion of "high risk bowel injury" in DTF>21 days. Initiation of feeds between 8 and 21 days was associated with fewer TPN days and reduced LOS. Multivariate analyses revealed that TPN duration, LOS, and infectious complications were independently predicted by DTF.
Post-closure DTF predicts outcome in GS, with best outcomes observed when feeds are started 7 days post-closure.
在腹裂（GS）中，及时开始肠内营养对于优化结果至关重要。我们研究的目的是分析首次喂养时间对结果的影响。
从国家数据库中提取了 2005 年 5 月至 2011 年 8 月期间发生的 GS 病例。评估的风险变量包括 GA、疾病严重程度、肠损伤严重程度和关腹后首次喂养的天数（DTF）。分析的结果包括 TPN 持续时间、住院时间和感染并发症。进行了描述性、单变量和多变量回归分析。
研究队列包括 570 例病例（16%的病例存在“高风险”肠损伤）。按 DTF 分组的分布为：0-7 天（12%）、8-14 天（44%）、15-21 天（26%）和>21 天（17%），平均 DTF 为 17±15 天。TPN 和 LOS 的平均持续时间分别为 44±56 天和 112±71 天。除了 DTF>21 天的病例中“高风险肠损伤”比例较高外，各 DTF 亚组之间没有差异。在 8-21 天之间开始喂养与 TPN 天数减少和 LOS 缩短有关。多变量分析显示，TPN 持续时间、LOS 和感染并发症独立地由 DTF 预测。
关腹后 DTF 预测 GS 的结果，当关腹后 7 天开始喂养时，观察到最佳的结果。
