Division of Pediatric Surgery, Department of Surgery, University of California San Diego, Rady Children's Hospital San Diego, 3020 Children's Way, MC 5136, San Diego, CA 92123, United States.
Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States.
J Pediatr Surg. 2021 Jun;56(6):1130-1134. doi: 10.1016/j.jpedsurg.2021.02.029. Epub 2021 Feb 24.
BACKGROUND/PURPOSE: The purpose of this study was to evaluate the characteristics of neonates with congenital diaphragmatic hernia (CDH) undergoing enteral access procedures (gastrostomy or jejunostomy) during their initial hospitalization, and establish a clinical scoring system based on these characteristics.
Data were obtained from the multicenter, multinational CDH Study Group database (CDHSG Registry) between 2007 and 2019. Patients were randomly partitioned into model-derivation and validation subsets. Weighted scores were assigned to risk factors based on their calculated β-coefficients after logistic regression.
Of 4537 total patients, 597 (13%) underwent gastrostomy or jejunostomy tube placement. In the derivation subset, factors independently associated with an increased risk for enteral access included oxygen requirement at 30-days, chromosomal abnormalities, gastroesophageal reflux, major cardiac anomalies, ECMO requirement, liver herniation, and increased defect size. Based on the devised scoring system, patients could be stratified into very low (0-4 points; <10% risk), low (5-6 points; 10-20% risk), intermediate (7-9 points; 30-60% risk), and high risk (≥10 points; 70% risk) groups for enteral access.
This study identifies risk factors associated with enteral access procedures in neonates with congenital diaphragmatic hernia and establishes a novel scoring system that may be used to guide clinical decision making in those with poor oral feeding.
Prognosis study.
背景/目的：本研究旨在评估在初始住院期间接受肠内置管（胃造口术或空肠造口术）的先天性膈疝（CDH）新生儿的特征，并基于这些特征建立临床评分系统。
数据来自 2007 年至 2019 年多中心、多国先天性膈疝研究组数据库（CDHSG 登记处）。患者被随机分为模型推导和验证子集。根据逻辑回归计算的β系数，为风险因素分配加权分数。
在 4537 例患者中，597 例（13%）接受胃造口术或空肠造口术置管。在推导子集中，与肠内置管风险增加相关的独立因素包括 30 天的氧气需求、染色体异常、胃食管反流、主要心脏异常、ECMO 需求、肝疝和缺陷增大。基于设计的评分系统，患者可分为极低危（0-4 分；<10%风险）、低危（5-6 分；10-20%风险）、中危（7-9 分；30-60%风险）和高危（≥10 分；70%风险）组进行肠内置管。
本研究确定了与先天性膈疝新生儿肠内置管相关的风险因素，并建立了一种新的评分系统，该系统可用于指导那些有不良口服喂养的患者的临床决策。
预后研究。
