Department of Surgery, School of Medicine, Universidade Federal de Minas Gerais; Pediatric Surgical Service, Hospital das Clínicas of the Universidade Federal de Minas Gerais/Empresa, Brasileira, de Serviços Hospitalares. Belo Horizonte, Minas Gerais, Brazil.
Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
J Pediatr Surg. 2019 Jul;54(7):1481-1486. doi: 10.1016/j.jpedsurg.2019.02.020. Epub 2019 Feb 24.
Survival of newborns with gastroschisis is significantly higher in high-income versus low and middle-income countries. We reviewed treatment and outcomes of gastroschisis in a middle-income country setting with increasing protocolized management.
All newborns with gastroschisis treated during the period 1989-2013 at a single Brazilian academic surgical service were studied retrospectively. Protocolized diagnosis, delivery, nutrition, medical interventions, and surgical interventions were introduced in 2002. Outcomes before and after protocol introduction were studied using univariate and multivariate analysis.
One hundred fifty-six newborns were treated for gastroschisis: 35 (22.4%) and 121 (77.6%) before and after 2002, respectively. When compared to the earlier cohort, patients treated after 2002 had higher rates of prenatal diagnosis (90.9% vs. 60.0%, p < 0.001), delivery at a tertiary center (90.9% vs. 62.9%, p < 0.001), early closure (65.3% vs. 33.3%, p = 0.001), primary repair (55.4% vs. 31.4%, p = 0.013), monitoring of bladder pressure (62.0% vs. 2.9%, p = 0.001), PICC placement (71.1% vs. 25.7%, p < 0.001), early initiation of enteral feeding (54.5% vs. 20.0%, p < 0.001), and lower rates of electrolyte disturbances (53.7% vs. 85.7%, p = 0.001). Mortality decreased from 34.3% before 2002 to 24.8% (p = .27) after 2002 despite an increase in the complex gastroschisis rate from 11.4% to 15.7% during the same period.
Gastroschisis outcomes in a middle-income country can be gradually improved through targeted interventions and management protocols.
Therapeutic.
III.
在高收入国家和中低收入国家，先天性腹壁裂患儿的存活率明显高于中低收入国家。我们回顾了在一个中低收入国家中，随着规范化管理的引入，先天性腹壁裂患儿的治疗和结局。
对 1989 年至 2013 年期间在巴西一家学术外科服务机构接受治疗的所有先天性腹壁裂患儿进行回顾性研究。2002 年引入了规范化的诊断、分娩、营养、医疗干预和手术干预。使用单变量和多变量分析比较了规范引入前后的结果。
156 例新生儿接受了先天性腹壁裂治疗：2002 年前分别为 35 例（22.4%）和 121 例（77.6%）。与较早的队列相比，2002 年后治疗的患者产前诊断率更高（90.9%比 60.0%，p<0.001），分娩于三级中心（90.9%比 62.9%，p<0.001），早期关闭（65.3%比 33.3%，p=0.001），一期修复（55.4%比 31.4%，p=0.013），膀胱压力监测（62.0%比 2.9%，p=0.001），PICC 置管（71.1%比 25.7%，p<0.001），早期开始肠内喂养（54.5%比 20.0%，p<0.001），电解质紊乱发生率较低（53.7%比 85.7%，p=0.001）。尽管同期复杂型先天性腹壁裂的发生率从 11.4%增加到 15.7%，但 2002 年以后的死亡率从 2002 年以前的 34.3%下降到 24.8%（p=0.27）。
通过有针对性的干预和管理方案，中低收入国家的先天性腹壁裂的结局可以逐步改善。
治疗性。
III 级。
