Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Department of Anesthesia, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
JPEN J Parenter Enteral Nutr. 2018 Jul;42(5):913-919. doi: 10.1002/jpen.1022. Epub 2018 Jan 8.
We aimed to describe nutrient intake and growth in infants with gastroschisis and identify factors associated with impaired growth.
Retrospective study of neonates who underwent gastroschisis repair from 2010 to 2015. Nutrient intake and weight-for-age z scores (WAZ) were recorded.
Data from 60 eligible infants with median (Q1, Q3) gestational age of 36 weeks (35, 37) and birth weight 2418 g (2098, 2665) were analyzed. Median WAZ decreased from -0.71 (-1.08, -0.17) at birth to -1.08 (-1.58, -0.63) at discharge (P < .001); 30% experienced a >1.0 decline in WAZ. Parenteral nutrition (PN) was initiated soon after birth, and 14 (23%) patients had severe intestinal failure. Fourteen patients (23%) experienced central line-associated bloodstream infection (CLABSI) at a rate of 5.0 per 1000 catheter days. Factors independently associated with lower discharge WAZ and greater WAZ decline were CLABSI (P = .02) and prematurity (P = .02). By day 7, energy and protein intake were 90-100 kcal/kg/day and 3 g/kg/day, respectively. Median age to achieve enteral autonomy was 36 days (22, 82). Atresias, CLABSI, prematurity, and staged closure were associated with delayed enteral autonomy (P < .01). Among 34 patients with 1-year follow-up, WAZ improved from -1.16 (-1.74, -0.65) at discharge to 0.19 (-0.80, 0.61) at 12 months (P < .001).
Infants with gastroschisis are dependent on PN and have a significant decline in WAZ during their hospital stay, predicted by prematurity and CLABSI. Efforts to prevent CLABSI and optimize enteral autonomy must be prioritized in this cohort.
本研究旨在描述先天性腹裂患儿的营养摄入和生长情况，并确定影响生长的因素。
本研究为回顾性队列研究，纳入 2010 年至 2015 年期间行先天性腹裂修补术的新生儿。记录患儿的营养摄入和体重-年龄 z 评分（WAZ）。
本研究共纳入 60 例符合条件的患儿，中位（四分位间距 1，3）胎龄为 36 周（35，37），出生体重为 2418 g（2098，2665）。患儿的 WAZ 由出生时的-0.71（-1.08，-0.17）降至出院时的-1.08（-1.58，-0.63）（P＜0.001）；30%的患儿 WAZ 下降超过 1.0。患儿出生后即开始接受肠外营养（PN），14 例（23%）患儿发生严重肠道衰竭。共有 14 例（23%）患儿发生中心静脉导管相关性血流感染（CLABSI），感染率为 5.0/1000 导管日。CLABSI（P=0.02）和早产（P=0.02）是导致患儿出院时 WAZ 较低和 WAZ 下降较大的独立因素。第 7 天，患儿的能量和蛋白质摄入量分别为 90-100 kcal/kg/d 和 3 g/kg/d。达到肠内自主喂养的中位时间为 36 天（22，82）。肠狭窄、CLABSI、早产和分期关闭与肠内自主喂养延迟相关（P＜0.01）。在 34 例获得 1 年随访的患儿中，出院时的 WAZ 为-1.16（-1.74，-0.65），12 个月时为 0.19（-0.80，0.61）（P＜0.001）。
先天性腹裂患儿依赖 PN，住院期间 WAZ 显著下降，这与早产和 CLABSI 相关。在该队列中，必须优先预防 CLABSI 和优化肠内自主喂养。
