Department of Obstetrics and Gynecology, Universidade Federal do Pará, Belém, Pará, Brazil; Programa de Pós Graduação do Núcleo de Medina Tropical da, Universidade Federal do Pará, Belém, Pará, Brazil; Postdoctoral Program of the Programa de Pós Graduação de Ciências Médicas da, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Grupo de Pesquisa Bilibio, Universidade Federal do Pará, Belém, Pará, Brazil.
Programa de Pós Graduação do Núcleo de Medina Tropical da, Universidade Federal do Pará, Belém, Pará, Brazil; Grupo de Pesquisa Bilibio, Universidade Federal do Pará, Belém, Pará, Brazil.
Eur J Obstet Gynecol Reprod Biol. 2019 Jun;237:79-84. doi: 10.1016/j.ejogrb.2019.04.015. Epub 2019 Apr 17.
To evaluate the prognostic factors related to mortality in neonates with gastroschisis, ranging from prenatal care to corrective surgery.
A retrospective cohort study was conducted and included neonates with gastroschisis who underwent surgical correction from 2010 to 2015. The patients were divided into two groups based on postoperative outcomes: those who were discharged and those who died postoperatively. Data regarding demographics, prenatal history, delivery route, surgery and postoperative outcomes were collected in both groups.
In total, 168 patients were eligible; 82 (48.8%) were discharged, and 86 (51.2%) died postoperatively. Fewer prenatal visits (4.85 versus 6.05 visits, P = 0.004), delayed prenatal diagnosis (27.6 versus 22.2 weeks of gestational age, P = 0.005), low birth weight (2159 versus 2444 g, P < 0.001), intestinal injury (OR 5.5, P = 0.001) and sepsis (OR 112.1, P < 0.001) were associated with infant mortality. The type of delivery and the mean time between birth and the first corrective surgery (16.2 versus 21.1 h, P = 0.071) were not associated with increased neonatal mortality; however, the newborns who underwent their first corrective surgery after less than 4 h of life had lower mortality, and surgery performed after more than 4 h of life increased the risk of mortality (OR 2.7, CI 1.2-6.3, P 0.014).
The mortality rate was high (51.2%) and was associated with inadequate prenatal care, low birth weight, gestational age, the severity of intestinal injury, infection and septicemia.
评估与新生儿先天性脐膨出相关的从产前护理到矫正手术的死亡率的预后因素。
本回顾性队列研究纳入了 2010 年至 2015 年间接受手术矫正的先天性脐膨出新生儿。根据术后结果将患者分为两组：出院组和术后死亡组。两组均收集了人口统计学、产前史、分娩方式、手术和术后结果的数据。
共有 168 例患者符合条件；82 例（48.8%）出院，86 例（51.2%）术后死亡。产前就诊次数较少（4.85 次与 6.05 次，P=0.004）、产前诊断延迟（27.6 周与 22.2 周，P=0.005）、出生体重较低（2159 克与 2444 克，P<0.001）、肠损伤（OR 5.5，P=0.001）和感染（OR 112.1，P<0.001）与婴儿死亡率相关。分娩方式和出生至首次矫正手术之间的平均时间（16.2 小时与 21.1 小时，P=0.071）与新生儿死亡率增加无关；然而，在生命后 4 小时内进行首次矫正手术的新生儿死亡率较低，而在生命后 4 小时以上进行手术则增加了死亡率的风险（OR 2.7，95%CI 1.2-6.3，P=0.014）。
死亡率较高（51.2%），与产前护理不足、出生体重低、胎龄、肠损伤严重程度、感染和败血症有关。
