Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Auenbruggerplatz 34/2, 8036, Graz, Austria.
Division of Pediatric Surgery, Department of Pediatric and Adolescent Surgery, Medical University of Graz, Auenbruggerplatz 34/1, 8036, Graz, Austria.
Wien Klin Wochenschr. 2021 Jul;133(13-14):680-686. doi: 10.1007/s00508-021-01886-z. Epub 2021 Jun 10.
To evaluate gastrointestinal tract (GIT) perforations in very low birth weight infants and the effects on neurodevelopmental outcome.
Between 2000 and 2017 all cases with GIT perforation were analyzed regarding causes, associated morbidities and neurodevelopmental outcome and compared with matched (gestational age, birth weight, gender, year of birth) by 1:2 controls.
The incidence of GIT perforation was 2.0% (n = 38/1878). Diagnoses associated with GIT were meconium obstruction of prematurity (MOP,n = 19/50%), spontaneous intestinal perforation (SIP, n = 7/18%), necrotizing enterocolitis (NEC, n = 6/16%), iatrogenic perforation (n = 3/8%), volvulus (n = 2/5%) and meconium ileus (n = 1/3%). The NEC-associated perforations occurred later compared to those associated with MOP and SIP (median 8 days and 6 days vs. 17 days, p = 0.001 and 0.023, respectively) and main localization was the terminal ileum (84%). Cases had higher rates of late onset sepsis (55% vs. 24%, p = 0.003), longer duration of mechanical ventilation (median 30 days vs 18 days, p = 0.013) and longer stays at the hospital (median 122 days vs 83 days, p < 0.001); mortality rates did not differ. The 2‑year neurodevelopment follow-up revealed no differences between groups (normal development 49% vs. 40%).
Despite increased morbidities preterm infants with GIT perforation did not have a higher mortality rate and groups did not differ regarding neurodevelopmental outcome at the corrected for prematurity age of 2 years.
评估极低出生体重儿的胃肠道（GIT）穿孔，并评估其对神经发育结局的影响。
在 2000 年至 2017 年间，对所有发生 GIT 穿孔的病例进行病因、相关合并症和神经发育结局的分析，并与按胎龄、出生体重、性别和出生年份匹配的 1:2 对照组进行比较。
GIT 穿孔的发生率为 2.0%（n=38/1878）。与 GIT 相关的诊断包括早产儿胎粪性肠梗阻（MOP，n=19/50%）、自发性肠穿孔（SIP，n=7/18%）、坏死性小肠结肠炎（NEC，n=6/16%）、医源性穿孔（n=3/8%）、肠扭转（n=2/5%）和胎粪性肠梗阻（n=1/3%）。与 MOP 和 SIP 相关的穿孔相比，NEC 相关的穿孔发生时间较晚（中位数分别为 8 天和 6 天 vs. 17 天，p=0.001 和 0.023），主要发生部位为末端回肠（84%）。这些病例发生晚期败血症的比例较高（55% vs. 24%，p=0.003），需要机械通气的时间较长（中位数分别为 30 天和 18 天，p=0.013），住院时间较长（中位数分别为 122 天和 83 天，p<0.001）；死亡率没有差异。2 年的神经发育随访结果显示，两组之间没有差异（正常发育 49% vs. 40%）。
尽管合并症较多，但发生 GIT 穿孔的早产儿死亡率没有增加，且在纠正早产年龄至 2 岁时，两组在神经发育结局方面没有差异。
