Department of Paediatric Surgery, Sheffield Children's Hospital, Sheffield, United Kingdom.
Eur J Pediatr Surg. 2022 Feb;32(1):105-110. doi: 10.1055/s-0041-1741541. Epub 2022 Jan 10.
In our practice, preformed silos are routine rather than reserved for difficult cases. We aimed to identify whether silo and bedside closure can minimize: general anesthetic (GA) exposure, need for intubation and ventilation, or days intubated for neonates with simple gastroschisis (SG).
After approval, patients were identified via the neonatal discharge log (April 2010 to April 2019). Data were collected by case-note review and analyzed with respect to GA, ventilation, and core outcomes.
Of 104 patients (50 female, mean birth weight 2.43 kg, mean gestational age 36 + 2 weeks), 85 were SG and 19 complex. Silo application was initial management in 70 SG, 57 completed successful bedside closure (by day 4 of life-median). Fifteen SG had initial operative closure.Of the 70 SG managed with silo, 46 (66%) had no GA as neonates. Twelve required GA for line insertion. Thirteen patients with initial silo had closure in theater (7 opportunistic at time of GA for line). Nine required intubation and ventilation out-with the operating theater during neonatal management. Seven had already been intubated at delivery; 3 because of meconium aspiration.One-hundred percent of those treated with operative closure had GA, 1 patient subsequently required surgery for subglottic stenosis. Time to full feeds did not differ between groups.
Silo and bedside closure allow the majority of SG neonates to avoid GA or intubation in the neonatal period, without increased risk of complication. However, it is important that the nursing expertise required to manage these patients safely is not underestimated.
在我们的实践中，预制储粪袋是常规操作，而非仅用于困难病例。我们旨在确定储粪袋和床边关闭术是否可以最小化：单纯性先天性胃壁膨出（SG）新生儿的全身麻醉（GA）暴露、需要插管和通气，或插管天数。
获得新生儿出院记录（2010 年 4 月至 2019 年 4 月）后，通过病例记录回顾识别患者。通过病例记录回顾收集数据，并根据 GA、通气和核心结局进行分析。
104 例患者（女性 50 例，平均出生体重 2.43kg，平均胎龄 36+2 周）中，85 例为 SG，19 例为复杂病例。85 例 SG 中，70 例应用储粪袋为初始治疗，其中 57 例（中位年龄 4 天）成功床边关闭。15 例 SG 初始行手术关闭。70 例 SG 中，46 例（66%）新生儿无需 GA。12 例需要 GA 进行置管。13 例初始储粪袋的患者在手术室行关闭术（7 例在 GA 置管时行关闭术）。9 例需要在新生儿管理期间在手术室外插管和通气。7 例在分娩时已插管；3 例因胎粪吸入。接受手术关闭治疗的患者均行 GA，1 例患者随后因声门下狭窄行手术。两组患儿完全经口喂养时间无差异。
储粪袋和床边关闭术可使大多数 SG 新生儿在新生儿期避免 GA 或插管，且不会增加并发症风险。然而，重要的是，不应低估管理这些患者所需的护理专业知识。
