Division of Epidemiology and Public Health, Clinical Sciences Building, Nottingham City Hospital.
Division of Child Health, Obstetrics and Gynaecology, Queen's Medical Centre, University of Nottingham School of Medicine.
J Pediatr Gastroenterol Nutr. 2018 Nov;67(5):580-585. doi: 10.1097/MPG.0000000000002045.
Survival in infants with gastroschisis is increasing although little is known about early childhood morbidity. In the context of a hypothesized link between the gastrointestinal (GI) tract and immune function, this study explores rates of GI and respiratory infections in children with gastroschisis.
We conducted a population-based retrospective cohort study using data from the Health Improvement Network, a large database of UK primary care medical records. We identified children born from 1990 to 2013, and extracted follow-up data to their fifth birthday. We calculate incidence rates (IR) of GI and respiratory tract infections, overall and stratified by age, sex, socioeconomic status, and gestational age at birth, and compared these between children with and without gastroschisis by calculating adjusted incidence rate ratios (aIRR).
Children with gastroschisis had a 65% higher IR of GI infection compared to children without (aIRR 1.65, 95% confidence interval [CI] 1.37-1.99, P < 0.001). Children with gastroschisis had a 27% higher IR of all respiratory tract infections (aIRR 1.27, 95% CI 1.12-1.44, P < 0.001) and more than 2-fold increase in lower respiratory tract infections compared to children without the condition (aIRR 2.15, 95% CI 1.69-2.74, P < 0.001).
Children born with gastroschisis have a significantly higher incidence of GI and respiratory tract infections compared to children without gastroschisis. This association requires further investigations but could be related to the neonatal care they receive such as delayed enteral feeding or frequent antibiotic courses altering the gut microbiome and developing immune system.
尽管人们对先天性腹裂患儿的幼儿期发病率知之甚少，但此类患儿的存活率正在提高。鉴于胃肠道（GI）和免疫功能之间存在假设性关联，本研究旨在探讨先天性腹裂患儿的 GI 和呼吸道感染发生率。
我们开展了一项基于人群的回顾性队列研究，数据来自英国初级保健医疗记录的大型数据库 Health Improvement Network。我们确定了 1990 年至 2013 年出生的儿童，并提取了他们五岁生日之前的随访数据。我们计算了 GI 和呼吸道感染的发病率（IR），按年龄、性别、社会经济状况和出生时的胎龄进行分层，并通过计算调整发病率比（aIRR）来比较先天性腹裂患儿和非先天性腹裂患儿的发病率。
与非先天性腹裂患儿相比，先天性腹裂患儿的 GI 感染发病率高 65%（aIRR 1.65，95%置信区间 [CI] 1.37-1.99，P<0.001）。与非先天性腹裂患儿相比，先天性腹裂患儿的所有呼吸道感染发病率高 27%（aIRR 1.27，95%CI 1.12-1.44，P<0.001），下呼吸道感染发病率增加了两倍多（aIRR 2.15，95%CI 1.69-2.74，P<0.001）。
与非先天性腹裂患儿相比，先天性腹裂患儿的 GI 和呼吸道感染发病率显著更高。这种关联需要进一步研究，但可能与他们接受的新生儿护理有关，例如延迟肠内喂养或频繁使用抗生素改变肠道微生物组和发育中的免疫系统。
