Yanowitz Toby Debra, Sullivan Kevin M, Piazza Anthony J, Brozanski Beverly, Zaniletti Isabella, Sharma Jotishna, DiGeronimo Robert, Nayak Sujir Pritha, Wadhawan Rajan, Reber Kristina M, Murthy Karna
University of Pittsburgh School of Medicine, Pittsburgh, PA.
Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA.
J Pediatr Surg. 2019 Apr;54(4):712-717. doi: 10.1016/j.jpedsurg.2018.12.010. Epub 2019 Jan 19.
Quantify short-term outcomes associated with initial surgery [laparotomy (LAP) vs. peritoneal drain (PD)] for necrotizing enterocolitis (NEC) in extremely-low-birth-weight (ELBW) infants.
Using the Children's Hospitals Neonatal Database, we identified ELBW infants <32 weeks' gestation with surgical NEC (sNEC). Unadjusted and multivariable regression analyses were used to estimate the associations between LAP (or PD) and death/short bowel syndrome (SBS) and length of stay (LOS).
LAP was the more common initial procedure for sNEC (n = 359/528, 68%). Infants receiving LAP were older and heavier. Initial procedure was unrelated to death/SBS in both bivariate (LAP: 43% vs PD: 46%, p = 0.573) and multivariable analyses (OR = 0.89, 95% CI = 0.57, 1.38, p = 0.6). LAP was inversely related to mortality (29% vs. 41%, p < 0.007) in bivariate analysis, but not significant in multivariable analysis accounting for markers of preoperative illness severity. However, the association between LAP and SBS (14% vs. 5%, p = 0.012) remained significant in multivariable analyses (adjusted OR = 2.25, p = 0.039). LOS among survivors was unrelated to the first surgical procedure in multivariable analysis.
ELBW infants who undergo LAP as the initial operative procedure for sNEC may be at higher risk for SBS without a clear in-hospital survival advantage or shorter hospitalization.
Level II.
量化极低出生体重（ELBW）婴儿坏死性小肠结肠炎（NEC）初次手术[剖腹手术（LAP）与腹腔引流（PD）]相关的短期结局。
利用儿童医院新生儿数据库，我们确定了孕周<32周、患有外科坏死性小肠结肠炎（sNEC）的ELBW婴儿。采用未调整和多变量回归分析来估计LAP（或PD）与死亡/短肠综合征（SBS）及住院时间（LOS）之间的关联。
LAP是sNEC更常见的初次手术方式（n = 359/528，68%）。接受LAP手术的婴儿年龄更大、体重更重。在双变量分析（LAP：43% vs PD：46%，p = 0.573）和多变量分析中，初次手术方式与死亡/SBS均无关（OR = 0.89，95%CI = 0.57，1.38，p = 0.6）。双变量分析中LAP与死亡率呈负相关（29% vs. 41%，p < 0.007），但在考虑术前疾病严重程度标志物的多变量分析中无显著性差异。然而，在多变量分析中LAP与SBS之间的关联（14% vs. 5%，p = 0.012）仍然显著（校正OR = 2.25，p = 0.039）。在多变量分析中，幸存者的住院时间与初次手术无关。
接受LAP作为sNEC初次手术的ELBW婴儿发生SBS的风险可能更高，且在院内生存方面无明显优势，住院时间也不会缩短。
二级。
