Catre Dora, Lopes Maria Francelina, Madrigal Angel, Oliveiros Barbara, Viana Joaquim Silva, Cabrita Antonio Silverio
Universitario de Coimbra, Coimbra, Portugal.
Centro Hospitalar, Universitario de Coimbra, Coimbra, Portugal.
Rev Bras Epidemiol. 2013 Dec;16(4):943-52. doi: 10.1590/s1415-790x2013000400014.
Anesthetic and operative interventions in neonates remain hazardous procedures, given the vulnerability of the patients in this pediatric population. The aim was to determine the preoperative and intraoperative factors associated with 30-day post-operative mortality and describe mortality outcomes following neonatal surgery under general anesthesia in our center.
Infants less than 28 days of age who underwent general anesthesia for surgery during an 11-year period (2000 - 2010) in our tertiary care pediatric center were retrospectively identified using the pediatric intensive care unit database. Multiple logistic regression was used to identify independent preoperative and intraoperative factors associated with 30-day post-operative mortality.
Of the 437 infants in the study (median gestational age at birth 37 weeks, median birth weight 2,760 grams), 28 (6.4%) patients died before hospital discharge. Of these, 22 patients died within the first post-operative month. Logistic regression analysis showed increased odds of 30-day post-operative mortality among patients who presented American Society of Anesthesiologists physical status (ASA) score 3 or above (odds ratio 19.268; 95%CI 2.523 - 147.132) and surgery for necrotizing enterocolitis/gastrointestinal perforation (OR 5.291; 95%CI 1.962 - 14.266), compared to those who did not.
The overall in-hospital mortality of 6.4% is within the prevalence reported for developed countries. Establishing ASA score 3 or above and necrotizing enterocolitis/gastrointestinal perforation as independent risk factors for early mortality in neonatal surgery may help clinicians to more adequately manage this high risk population.
鉴于新生儿这一儿科群体患者的脆弱性，新生儿的麻醉和手术干预仍然是具有风险的操作。本研究旨在确定与术后30天死亡率相关的术前和术中因素，并描述在我们中心接受全身麻醉的新生儿手术后的死亡结局。
利用儿科重症监护病房数据库，对在我们三级护理儿科中心11年期间（2000 - 2010年）接受全身麻醉手术的28日龄以下婴儿进行回顾性识别。采用多因素逻辑回归分析来确定与术后30天死亡率相关的独立术前和术中因素。
在该研究的437例婴儿中（出生时中位胎龄37周，中位出生体重2760克），28例（6.4%）患者在出院前死亡。其中，22例患者在术后第一个月内死亡。逻辑回归分析显示，与未出现此类情况的患者相比，美国麻醉医师协会身体状况（ASA）评分为3分或以上的患者术后30天死亡几率增加（比值比19.268；95%置信区间2.523 - 147.132），以及因坏死性小肠结肠炎/胃肠道穿孔接受手术的患者（比值比5.291；95%置信区间1.962 - 14.266）。
6.4%的总体住院死亡率在发达国家报告的患病率范围内。将ASA评分为3分或以上以及坏死性小肠结肠炎/胃肠道穿孔确定为新生儿手术早期死亡的独立危险因素，可能有助于临床医生更充分地管理这一高风险人群。
