Wong Matthew K W, Haliburton Beth, Graham Ashley, Lapidus-Krol Eveline, Moraes Theo J, Marcon Margaret A, Chiu Priscilla P L
Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada.
Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada; Department of Clinical Dietetics, The Hospital for Sick Children, Toronto, ON, Canada.
J Pediatr Surg. 2019 May;54(5):895-898. doi: 10.1016/j.jpedsurg.2019.01.017. Epub 2019 Jan 31.
Oral feeds pose a challenge for congenital diaphragmatic hernia (CDH) infants. Tube feed (TF) supplementation may be required to support the achievement of normal growth. The aim of this study was to determine the duration and factors associated with TF use in CDH infants at our institution.
A single centre retrospective chart review was performed for CDH-born infants who underwent repair between 2000 to 2013 (REB #1000053124). Patient demographics, perinatal management, and feeding status of infants with at least 1-year follow-up were reviewed.
Of 160 CDH infants, 32 (20%) were discharged on partial or complete TF, and an additional 5 (3.1%) patients started TF post discharge. CDH infants with TF were more likely to have initial arterial blood pH < 7.25, patch repair, ECMO support, and prolonged ICU stay (p < 0.05). Time to TF discontinuation did not differ significantly between those partially or fully TF at discharge. Twelve patients (33.3%) remained TF at their last known follow-up.
High risk CDH patients are likely to require TF to support their nutritional intake. Parents and caregivers need to be informed and properly supported. Long-term monitoring of CDH patient oral intake, growth, and development will be required.
LEVEL OF EVIDENCE/TYPE OF STUDY: Level III Retrospective Study.
经口喂养对先天性膈疝（CDH）患儿来说是一项挑战。可能需要管饲（TF）补充来支持实现正常生长。本研究的目的是确定在我们机构中CDH患儿使用TF的持续时间及相关因素。
对2000年至2013年期间接受修复手术的CDH出生患儿进行了单中心回顾性病历审查（REB编号1000053124）。对至少随访1年患儿的人口统计学资料、围产期管理和喂养状况进行了审查。
160例CDH患儿中，32例（20%）出院时部分或完全依赖TF，另有5例（3.1%）患儿出院后开始使用TF。接受TF的CDH患儿更有可能初始动脉血pH<7.25、采用补片修复、接受体外膜肺氧合（ECMO）支持以及在重症监护病房（ICU）停留时间延长（p<0.05）。出院时部分或完全依赖TF的患儿在停止使用TF的时间上无显著差异。12例患儿（33.3%）在最后一次已知随访时仍依赖TF。
高危CDH患者可能需要TF来支持其营养摄入。需要告知家长和护理人员并给予适当支持。需要对CDH患者的经口摄入量、生长和发育进行长期监测。
证据水平/研究类型：III级回顾性研究。
