Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida.
Pediatric Surgery, The Children's Mercy Hospital, Kansas City, Missouri.
J Surg Res. 2020 Jan;245:217-224. doi: 10.1016/j.jss.2019.07.065. Epub 2019 Aug 14.
Gastroschisis is an increasingly common congenital abdominal wall defect. Due to advances in neonatal critical care and early surgical management, mortality from gastroschisis and associated complications has decreased to less than 10% in most series. However, it has been recognized that the outcome of gastroschisis has a spectrum and that the disorder affects a heterogeneous cohort of neonates. The goal of this study is to predict morbidity and mortality in neonates with gastroschisis using clinically relevant variables.
A multicenter, retrospective observational study of neonates born with gastroschisis was conducted. Neonatal characteristics and outcomes were collected and compared. Prediction of morbidity and mortality was performed using multivariate clinical models.
Five hundred and sixty-six neonates with gastroschisis were identified. Overall survival was 95%. Median hospital length of stay was 37 d. Sepsis was diagnosed in 107 neonates. Days on parenteral nutrition and mechanical ventilation were considerable with a median of 27 and 5 d, respectively. Complex gastroschisis (atresia, perforation, volvulus), preterm delivery (<37 wk), and very low birth weight (<1500 g) were associated with worse clinical outcomes including increased sepsis, short bowel syndrome, parenteral nutrition days, and length of stay. The composite metric of birth weight, Apgar score at 5 min, and complex gastroschisis was able to successfully predict mortality (area under the curve, 0.81).
Clinical variables can be used in gastroschisis to distinguish those who will survive from nonsurvivors. Although these findings need to be validated in other large multicenter data sets, this prognostic score may aid practitioners in the identification and management of at-risk neonates.
先天性腹壁缺损中，腹裂的发病率不断上升。由于新生儿重症监护和早期手术管理的进步，大多数研究中腹裂及其相关并发症的死亡率已降至 10%以下。然而，人们已经认识到腹裂的结局存在一定范围，并且这种疾病影响了一组异质的新生儿。本研究旨在使用临床相关变量预测腹裂新生儿的发病率和死亡率。
对患有腹裂的新生儿进行了多中心回顾性观察研究。收集并比较了新生儿的临床特征和结局。使用多变量临床模型预测发病率和死亡率。
共确定了 566 例患有腹裂的新生儿。总体存活率为 95%。中位住院时间为 37 天。107 例新生儿被诊断为败血症。肠外营养和机械通气的天数都很长，中位数分别为 27 天和 5 天。复杂型腹裂（闭锁、穿孔、扭转）、早产（<37 周）和极低出生体重（<1500 克）与更差的临床结局相关，包括败血症、短肠综合征、肠外营养天数和住院时间增加。体重、5 分钟时的 Apgar 评分和复杂型腹裂的综合指标可以成功预测死亡率（曲线下面积，0.81）。
可以使用临床变量来区分那些能够存活和不能存活的腹裂新生儿。尽管这些发现需要在其他大型多中心数据集进行验证，但该预后评分可能有助于临床医生识别和管理高危新生儿。
