Vu Lan T, McFarland Carrie, Bratton Barbara, Lee Hanmin
*Division of Pediatric Surgery, University of California, San Francisco Medical Center †UCSF Benioff Children's Hospital San Francisco, San Francisco, CA.
J Pediatr Gastroenterol Nutr. 2017 Aug;65(2):237-241. doi: 10.1097/MPG.0000000000001627.
We hypothesize that the patients after primary repair of congenital diaphragmatic hernia (CDH) can have poor nutritional outcomes and plan to identify risk factors to further stratify these patients.
Retrospective cohort of patients who had primary repair of CDH between 2000 and 2014 and had follow-up at our institution. Z scores (weight for age and weight for length) were calculated using the World Health Organization and Centers for Disease Control and Prevention growth standards.
For the 67 patients in the cohort, the median age at the time of repair was 3 days (interquartile range 2-5) and at the time of discharge was 20.5 days (interquartile range 16-30). Fifteen percent of the patients required supplemental tube feeding for inadequate oral intake and 69% required fortified feedings for inadequate growth at discharge (4 patients subsequently needed gastrostomy tube placement). The median z scores at discharge were -1.0 (-2.1 to -0.3) and -1.2 (-2.3 to -0.5) in weight for age and weight for length, respectively. The risk factors for low z scores included open repair and longer periods of postoperative intubation or hospitalization. The z scores were similar at 6 months of age compared to discharge, but then statistically improved at 12 months of age.
Patients with primary repair of CDH are at risk for poor nutritional outcomes at the time of hospital discharge and require follow-up to ensure adequate growth. Patients at highest risk are those who had an open repair and had prolonged intubation or hospitalization.
我们推测先天性膈疝（CDH）一期修补术后的患者营养结局较差，并计划确定风险因素以进一步对这些患者进行分层。
对2000年至2014年间接受CDH一期修补并在我们机构进行随访的患者进行回顾性队列研究。使用世界卫生组织和疾病控制与预防中心的生长标准计算Z评分（年龄别体重和身长别体重）。
该队列中的67例患者，修补时的中位年龄为3天（四分位间距2 - 5），出院时为20.5天（四分位间距16 - 30）。15%的患者因经口摄入量不足需要补充管饲，69%的患者因出院时生长不足需要强化喂养（4例患者随后需要放置胃造瘘管）。出院时年龄别体重和身长别体重的中位Z评分分别为-1.0（-2.1至-0.3）和-1.2（-2.3至-0.5）。Z评分低的风险因素包括开放修补以及术后插管或住院时间较长。与出院时相比，6个月龄时的Z评分相似，但在12个月龄时在统计学上有所改善。
CDH一期修补术后的患者在出院时存在营养结局不良的风险，需要进行随访以确保足够的生长。风险最高的患者是那些接受开放修补且插管或住院时间延长的患者。
