Barriga-Rivera Alejandro, Moya María José, Lopez-Alonso Manuel
Hospital Infantil Virgen del Rocío, Sevilla, España.
Hospital Infantil Virgen del Rocío, Sevilla, España.
An Pediatr (Barc). 2016 Nov;85(5):232-239. doi: 10.1016/j.anpedi.2015.09.024. Epub 2016 Jan 19.
The evaluation of symptom association between gastroesophageal reflux and cardiorespiratory events in preterm infants remains unclear. This paper describes a conservative approach to decision-making of anti-reflux surgery through symptom association analysis.
Forty-three neonates with potentially reflux-related cardiorespiratory symptoms underwent synchronized esophageal impedance-pH and cardiorespiratory monitoring. Three indices were considered to evaluate symptom association, the symptom index (SI), the symptom sensitivity index (SSI) and the symptom association probability (SAP). A conservative strategy was adopted regarding the decision of anti-reflux surgery, and therefore, patients were scheduled for laparoscopic Nissen fundoplication if the three indices showed a positive assessment of symptom association. Retrospectively, these indices and the binomial symptom index (BSI) were contrasted against the decision of anti-reflux surgery using different windows of association.
Thirteen patients showed positive symptom association but only two underwent anti-reflux surgery. The SI and the SSI showed an increasing trend with the width of the window of association. The SAP was affected randomly by slightly altering the windowing parameters. The BSI showed the best performance with the two-minute window (κ =0.78) CONCLUSIONS: The pathology under study is known to improve with maturity. However, the severity of cardiorespiratory symptoms may threaten the neonate's life and therefore, in some occasions, invasive treatments must be considered to protect life. The BSI provides a good prediction of a combination of positive SI, SSI and SAP, which may improve clinical decisions. However, further clinical studies are required to prove the BSI as an optimal predictor of clinical outcomes.
早产儿胃食管反流与心肺事件之间症状关联的评估仍不明确。本文描述了一种通过症状关联分析进行抗反流手术决策的保守方法。
43例有潜在反流相关心肺症状的新生儿接受了同步食管阻抗-pH监测和心肺监测。考虑了三个指标来评估症状关联，即症状指数（SI）、症状敏感指数（SSI）和症状关联概率（SAP）。在抗反流手术决策方面采用了保守策略，因此，如果这三个指标对症状关联的评估为阳性，则安排患者进行腹腔镜Nissen胃底折叠术。回顾性地，使用不同的关联窗口将这些指标和二项式症状指数（BSI）与抗反流手术的决策进行对比。
13例患者症状关联呈阳性，但只有2例接受了抗反流手术。SI和SSI随着关联窗口宽度的增加呈上升趋势。SAP会因窗口参数的轻微改变而随机受到影响。BSI在两分钟窗口时表现最佳（κ=0.78）。结论：已知所研究的病理情况会随着成熟度而改善。然而，心肺症状的严重程度可能会威胁新生儿的生命，因此在某些情况下，必须考虑采用侵入性治疗来保护生命。BSI能很好地预测SI、SSI和SAP均为阳性的情况，这可能会改善临床决策。然而，需要进一步的临床研究来证明BSI是临床结果的最佳预测指标。
