Department of Pediatrics, Texas Children's Hospital, Houston, TX.
Section of Neonatology, Texas Children's Hospital, Houston, TX.
Pediatr Crit Care Med. 2021 Jan 1;22(1):e91-e98. doi: 10.1097/PCC.0000000000002540.
To evaluate the association of preoperative risk factors and postoperative outcomes in infants with complex congenital heart disease.
Single-center retrospective cohort study.
Neonatal ICU and cardiovascular ICU.
Infants of all gestational ages, born at Texas Children's Hospital between 2010 and 2016, with complex congenital heart disease requiring intervention prior to discharge.
None.
A total of 399 patients were enrolled in the study. Preoperative risk factors included feeding, type of feeding, feeding route, and cardiac lesion. Postoperative outcomes included necrotizing enterocolitis, hospital length of stay, and days to full feeds. The occurrence rate of postoperative necrotizing enterocolitis (all stages) was 8%. Preoperative feeding, type of feeding, feeding route, and cardiac lesion were not associated with higher odds of postoperative necrotizing enterocolitis. Cardiac lesions with ductal-dependent systemic blood flow were associated with a hospital length of stay of 19.6 days longer than those with ductal-dependent pulmonary blood flow (p < 0.001) and 2.9 days longer to reach full feeds than those with ductal-dependent pulmonary blood flow (p < 0.001), after controlling for prematurity. Nasogastric feeding route preoperatively was associated with a length of stay of 29.8 days longer than those fed by mouth (p < 0.001) and 2.4 days longer to achieve full feeds (p < 0.001), after controlling for prematurity and cardiac lesion. Preoperative diet itself was not associated with significant change in length of stay or days to reach full feeds.
Although cardiac lesions with ductal-dependent systemic blood flow are considered high risk and may increase length of stay and days to achieve full feeds, they are not associated with a higher risk of postoperative necrotizing enterocolitis. Nasogastric route is not associated with a significantly higher risk of necrotizing enterocolitis, but longer length of stay and days to reach full feeds. These findings challenge our perioperative management strategies in caring for these infants, as they may incur more hospital costs and resources without significant medical benefit.
评估患有复杂先天性心脏病的婴儿的术前危险因素与术后结局之间的关系。
单中心回顾性队列研究。
新生儿重症监护病房和心血管重症监护病房。
2010 年至 2016 年期间在德克萨斯儿童医院出生、所有胎龄的患有复杂先天性心脏病且在出院前需要介入治疗的婴儿。
无。
共有 399 名患者入组研究。术前危险因素包括喂养、喂养类型、喂养途径和心脏病变。术后结局包括坏死性小肠结肠炎、住院时间和达到全喂养的天数。术后坏死性小肠结肠炎（所有阶段）的发生率为 8%。术前喂养、喂养类型、喂养途径和心脏病变与术后坏死性小肠结肠炎的发生几率增加无关。伴有依赖于体循环的导管前血流的心脏病变患者的住院时间比伴有依赖于肺循环的导管前血流的患者长 19.6 天（p < 0.001），达到全喂养的时间比伴有依赖于肺循环的导管前血流的患者长 2.9 天（p < 0.001），且在控制早产因素后。术前经鼻胃管喂养与经口喂养相比，住院时间长 29.8 天（p < 0.001），达到全喂养的时间长 2.4 天（p < 0.001），且在控制早产和心脏病变因素后。术前饮食本身与住院时间或达到全喂养的天数的显著变化无关。
尽管伴有依赖于体循环的导管前血流的心脏病变被认为是高危因素，可能会增加住院时间和达到全喂养的时间，但它们与术后坏死性小肠结肠炎的发生风险无关。经鼻胃管喂养与坏死性小肠结肠炎的发生风险无显著相关性，但会导致住院时间延长和达到全喂养的时间延长。这些发现挑战了我们在照顾这些婴儿时的围手术期管理策略，因为它们可能会导致更多的医院成本和资源消耗，而没有显著的医疗获益。
