Department of Visceral and Neonatal Pediatric Surgery, Sorbonne University, Armand Trousseau University Hospital, APHP.6, Paris, France.
Neonatal Intensive Care Unit, CH Poissy Saint-Germain-en-Laye, Poissy, France.
J Pediatr Surg. 2022 Jul;57(7):1336-1341. doi: 10.1016/j.jpedsurg.2021.09.044. Epub 2021 Oct 2.
Necrotizing Enterocolitis (NEC) remained a dramatic complication leading to death or neonatal morbidities in preterms. For some, Intra-Abdominal Hypertension (IAH) and Abdominal Compartment Syndrome worsened the multi-organ failure. An open abdomen surgery could be an alternative to conventional surgical treatment to move beyond this stage.
To retrospectively describe the clinical course, pre- and post-operative features of preterms suffering from severe NEC with IAH treated by open abdomen surgery and referred to our center from October 2007 to September 2019. Our secondary objective is to identify various risk factors for mortality in this population.
Data on neonatal, clinical, biological, pre and post-operative features and outcome were collected. Univariate analyses were performed to compare their pre and post-operative features stratifying on outcome.
Among 29 included patients, 14 (48%) survived to discharge without short bowel syndrome. Death was associated with an earlier postnatal age at NEC (16.3 ± 9.1 versus 31.3 ± 25.9 days; p = 0.004) and followed a withdrawal of treatment in 60% of cases. Surgery was associated with a significant improvement of respiratory and hemodynamic features (decrease of mean ventilator pressure from 13.1 ± 5.4 to 11.3 ± 4.0 cmH2O, p < 0.001), oxygen requirement (mean FiO2 decreased from 65.0% ± 31.2 to 49.0% ± 24.6, p < 0.001) and inotropic score (from 38.6 ± 70.1 to 29.9 ± 64.3, p < 0.001). In the survival group, pre and post-operative findings exhibited a significant increase of serum lactate concentrations from 2.7 ± 1.6 to 11.0 ± 20.3 mmol/L (p = 0.02) but a similar pH.
Open abdomen surgery could be considered to rescue preterms with near fatal NEC. IAH and Abdominal Compartment Syndrome in these preterms should be investigated through further studies.
Level III.
坏死性小肠结肠炎（NEC）仍然是导致早产儿死亡或出现新生儿并发症的严重并发症。对于某些患者来说，腹腔内高压（IAH）和腹腔间隔室综合征会使多器官衰竭恶化。开放性腹部手术可能是一种替代传统手术治疗的方法，可以帮助患者渡过难关。
回顾性描述 2007 年 10 月至 2019 年 9 月期间，因严重 NEC 合并 IAH 而接受开放性腹部手术治疗并转诊至我院的早产儿的临床病程、术前和术后特征。我们的次要目标是确定该人群死亡的各种危险因素。
收集新生儿、临床、生物学、术前和术后特征以及结局的数据。对术前和术后特征进行单变量分析，并根据结局进行分层比较。
在 29 名纳入的患者中，有 14 名（48%）存活并出院，没有出现短肠综合征。死亡与 NEC 的更早的出生后年龄相关（16.3±9.1 天 vs. 31.3±25.9 天；p=0.004），并且 60%的病例停止了治疗。手术与呼吸和血流动力学特征的显著改善相关（平均呼吸机压力从 13.1±5.4cmH2O 降至 11.3±4.0cmH2O，p<0.001）、氧气需求（平均 FiO2 从 65.0%±31.2%降至 49.0%±24.6%，p<0.001）和正性肌力评分（从 38.6±70.1 降至 29.9±64.3，p<0.001）。在存活组中，术前和术后的发现显示血清乳酸浓度从 2.7±1.6mmol/L 显著增加到 11.0±20.3mmol/L（p=0.02），但 pH 值相似。
开放性腹部手术可用于抢救濒临死亡的 NEC 早产儿。应通过进一步研究调查这些早产儿的 IAH 和腹腔间隔室综合征。
3 级。
