Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Yamadaoka 2-2, Suita, Osaka, 565-0871, Japan.
Department of Pediatric Surgery, Osaka Women's and Children's Hospital, Murodo-Cho 840, Izumi, Osaka, 594-1101, Japan.
Pediatr Surg Int. 2021 Jul;37(7):929-935. doi: 10.1007/s00383-021-04890-6. Epub 2021 Mar 25.
The etiology of cholestasis in neonates is associated with several factors including gastrointestinal disease and surgery. We aimed to identify the potential risk factors for perioperative cholestasis in patients with duodenal atresia and determine specific cutoff values for the risk factors.
This retrospective cohort study included 76 neonates diagnosed with duodenal atresia surgically treated during the neonatal period at our institution between January 1990 and March 2017. The neonates were categorized into two groups: those with and without cholestasis. Univariate and multivariate analyses were performed to identify the possible risk factors for cholestasis.
Among the 76 neonates with duodenal atresia, 21 (27%) developed cholestasis. The duration of total parenteral nutrition was identified as a risk factor in univariate analysis; however, it was not an independent risk factor for cholestasis. Gestational age and highest C-reactive protein (CRP) values were independent risk factors, with adjusted odds ratios of 0.53 and 1.25, respectively. To predict the occurrence of cholestasis, the cutoff value for gestational age was 35.0 weeks, and highest CRP value was 2.4 mg/dL.
The occurrence of cholestasis in patients with duodenal atresia was associated with preterm delivery and severity of the inflammatory response during the perioperative period.
新生儿胆汁淤积的病因与多种因素有关，包括胃肠道疾病和手术。我们旨在确定十二指肠闭锁患者围手术期胆汁淤积的潜在危险因素，并确定危险因素的具体临界值。
本回顾性队列研究纳入了 1990 年 1 月至 2017 年 3 月期间在我院接受手术治疗的 76 例新生儿期诊断为十二指肠闭锁的患儿。将患儿分为有胆汁淤积组和无胆汁淤积组。进行单因素和多因素分析以确定胆汁淤积的可能危险因素。
在 76 例十二指肠闭锁患儿中，21 例（27%）发生胆汁淤积。全胃肠外营养时间在单因素分析中被确定为危险因素；然而，它不是胆汁淤积的独立危险因素。胎龄和最高 C 反应蛋白（CRP）值是独立的危险因素，调整后的比值比分别为 0.53 和 1.25。为了预测胆汁淤积的发生，胎龄的临界值为 35.0 周，最高 CRP 值为 2.4 mg/dL。
十二指肠闭锁患者胆汁淤积的发生与早产和围手术期炎症反应的严重程度有关。
