Vinit Nicolas, Talbotec Cécile, De Tristan Marie-Amélie, Salomon Laurent J, Giuseppi Agnès, Rousseau Véronique, Beaudoin Sylvie, Lambe Cécile, Ville Yves, Sarnacki Sabine, Goulet Olivier, Chardot Christophe, Lapillonne Alexandre, Khen-Dunlop Naziha
Department of Pediatric Surgery and Transplantation, Necker-Enfants Malades Hospital, APHP, Paris, France.
Department of Pediatric Gastroenterology, Hepatology and Nutrition, Intestinal Failure Rehabilitation Center, Necker-Enfants Malades Hospital, APHP, Paris, France.
J Pediatr. 2022 Apr;243:122-129.e2. doi: 10.1016/j.jpeds.2021.11.004. Epub 2021 Nov 6.
To identify prenatal and neonatal predictors of short bowel syndrome-related intestinal failure (SBS-IF) in gastroschisis.
This retrospective study included all patients with gastroschisis born between 2000 and 2017 who were enrolled in our home parenteral nutrition program, and all patients with gastroschisis born in our institution who survived 2 weeks, during the same time period. Prenatal ultrasound features, neonatal status, anatomic features, oral feeding, and parenteral nutrition dependency were analyzed.
Among 180 patients, 35 required long-term parenteral nutrition (SBS-IF group) and 145 acquired full oral feeding within 6 months (oral feeding group). The mean follow-up was 7.9 years (IQR, 1.6-17.5 years) and 5.0 years (IQR, 0.1-18.2 years), respectively. Both bowel matting (OR, 14.23; 1.07-16.7; P = .039) and secondarily diagnosed atresia or stenosis (OR, 17.78; 3.13-100.98; P = .001) were independent postnatal predictors of SBS-IF. Eighteen children (51% of the SBS-IF group) were still dependent on artificial nutrition at the last follow-up. patients with SBS-IF who achieved full oral feeding had a median residual small-bowel length of 74 cm (IQR, 51-160 cm) vs 44 cm (IQR, 10-105 cm) for those still dependent on artificial nutrition (P = .02). An initial residual small bowel length of more than 50 cm was the best predictive cut-off for nutritional autonomy, with a sensitivity of 67% and a specificity of 100%.
Bowel matting, complex gastroschisis, and secondary intestinal obstruction were associated with SBS-IF in gastroschisis. For patients with SBS-IF, a small bowel length of more than 50 cm was predictive of secondary nutritional autonomy.
确定腹裂患儿短肠综合征相关肠衰竭（SBS-IF）的产前和新生儿期预测因素。
这项回顾性研究纳入了2000年至2017年间参加我们家庭肠外营养项目的所有腹裂患儿，以及同一时期在我们机构出生且存活2周的所有腹裂患儿。分析产前超声特征、新生儿状况、解剖特征、经口喂养和肠外营养依赖情况。
180例患儿中，35例需要长期肠外营养（SBS-IF组），145例在6个月内实现完全经口喂养（经口喂养组）。平均随访时间分别为7.9年（四分位间距，1.6 - 17.5年）和5.0年（四分位间距，0.1 - 18.2年）。肠粘连（比值比，14.23；1.07 - 16.7；P = 0.039）和继发诊断的闭锁或狭窄（比值比，17.78；3.13 - 100.98；P = 0.001）均是SBS-IF独立的产后预测因素。18名儿童（占SBS-IF组的51%）在最后一次随访时仍依赖人工营养。实现完全经口喂养的SBS-IF患儿残余小肠长度中位数为74 cm（四分位间距，51 - 160 cm），而仍依赖人工营养的患儿为44 cm（四分位间距，10 - 105 cm）（P = 0.02）。初始残余小肠长度超过50 cm是营养自主的最佳预测临界值，敏感性为67%，特异性为100%。
肠粘连、复杂型腹裂和继发性肠梗阻与腹裂患儿的SBS-IF相关。对于SBS-IF患儿，小肠长度超过50 cm可预测继发性营养自主。
