Department of Paediatric Surgery, Royal Alexandra Children's Hospital, Eastern Road, Brighton, BN2 5BE, UK.
Pediatr Surg Int. 2022 Mar;38(3):409-414. doi: 10.1007/s00383-021-05056-0. Epub 2022 Jan 4.
Most studies on outcomes of surgery in extremely premature neonates include cases based on birth weight irrespective of weight at the time of surgery. Reported figures may not accurately reflect what is truly experienced in babies with smaller weight at the time of surgery. This study sought to document the outcomes of laparotomy in preterms at extremely low operative (ELOW) of < 1000 g.
Preterm infants weighing < 1000 g at the time of laparotomy were identified from a prospectively collected database. Data were collected over 12 years (Sept 2007-Mar 2020). Primary outcome investigated was in-hospital mortality. Other outcomes including long-term morbidities are reported.
79 ELOW infants were included. Median gestational age was 25 weeks (23-29 weeks) and median birth weight 680 g (382-986 g). The median weight at laparotomy was 755 g (380-993 g) at a median age of 11 days of life (1-38 days). The commonest diagnoses at laparotomy included: necrotising enterocolitis 44 (56%), spontaneous intestinal perforation 20 (25%) and meconium obstruction of prematurity 5 (6%). The median predicted mortality using CRIB II scoring system was 35%. 21 (27%) in-hospital mortality was recorded. Babies who died had significantly lower operative weight (610 vs 767 g p = 0.0303) compared to those who survived despite no significant difference in birth weight. 30% had one or more surgical complications. 50% had no recorded morbidity at 2-year assessment while 19% had severe impairment.
73% of preterm infants that underwent laparotomy at < 1000 g survived to discharge and 50% of survivors had no long-term morbidity. Association between mortality and lower operative weight at laparotomy is shown. This study provides a focused data on the ELOW category of patients which could more accurately guide counselling and management decisions.
大多数关于极早产儿手术结果的研究都包含了基于出生体重的病例，而不考虑手术时的体重。报告的数据可能无法准确反映手术时体重较小的婴儿的真实情况。本研究旨在记录极低手术体重（ELOW）<1000g 的早产儿剖腹手术的结果。
从一个前瞻性收集的数据库中确定了手术时体重<1000g 的早产儿。数据收集时间为 12 年（2007 年 9 月至 2020 年 3 月）。主要研究结果为住院死亡率。还报告了其他长期并发症。
纳入了 79 例 ELOW 婴儿。中位胎龄为 25 周（23-29 周），中位出生体重为 680g（382-986g）。手术时的中位体重为 755g（380-993g），中位年龄为 11 天（1-38 天）。手术时最常见的诊断包括：坏死性小肠结肠炎 44 例（56%）、自发性肠穿孔 20 例（25%）和胎粪性肠梗阻 5 例（6%）。使用 CRIB II 评分系统预测死亡率中位数为 35%。记录到 21 例（27%）院内死亡。尽管死亡婴儿的出生体重与存活婴儿无显著差异，但手术时体重明显较低（610 与 767g，p=0.0303）。30%的婴儿有 1 种或多种手术并发症。2 年评估时，50%的存活婴儿无记录的并发症，19%的存活婴儿有严重的损害。
73%手术时体重<1000g 的早产儿存活出院，50%的幸存者无长期并发症。研究表明，死亡率与手术时体重较低有关。本研究提供了关于极低体重早产儿的具体数据，可以更准确地指导咨询和管理决策。
