Wang Huanhuan, Gauda Estelle B, Chiu Priscilla P L, Moore Aideen M
Division of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.
Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada.
Transl Pediatr. 2022 May;11(5):617-624. doi: 10.21037/tp-22-14.
Prolonged mechanical ventilation (MV) should be avoided in neonates. Noninvasive ventilation (NIV) can facilitate weaning from MV but has risks for patients immediately following foregut surgery due to the potential risk of anastomotic leak. We evaluated the risk factors for prolonged MV following intestinal surgery in neonates.
We retrospectively reviewed 253 neonates undergoing intestinal surgery in 2017-2018 to identify risk factors for prolonged MV, and determine the correlation between NIV and anastomotic leak in a tertiary neonatal intensive care unit that performs the greatest number of neonatal surgeries in Ontario.
The most common diagnoses were necrotizing enterocolitis/spontaneous intestinal perforation (NEC/SIP) 21%, intestinal atresia 16%, esophageal atresia/tracheoesophageal fistula 14%, ano-rectal malformation 13%, malrotation/volvulus 11%, gastroschisis 9% and omphalocele 4%. The median (IQR) duration of MV post-surgery was 3 (1-8) days with 25.7 % (n=65) of neonates on MV for >7 days. Compared to infants on MV post-surgery for ≤7 days, those with MV>7 days were of lower gestational age, birth weight and weight at surgery, but a higher proportion underwent stoma creation, had a longer duration of opioid administration and higher rates of moderate to severe bronchopulmonary dysplasia (BPD) and mortality (P<0.05). Generalized linear regression analysis showed lower gestational age (GA) and longer opioid administration were associated with longer duration of MV (P<0.001), but indication for surgery, weight at surgery and stoma creation didn't correlate with longer duration of MV (P>0.05). Of the 122 patients handled by one-stage resection with primary anastomosis, 22.1% (n=27) received NIV with 74.1% (n=20) commenced on NIV after 7 days post-surgery, anastomotic leak was detected in 2.5 % (3/122) patients and didn't correlate with NIV.
Lower GA and longer opioid administration were risk factors for prolonged MV in neonates following intestinal surgery. Further research is needed to investigate modifiable practices around pain assessment/ventilation in these patients, and the correlation between NIV and anastomotic leak.
应避免新生儿长时间机械通气（MV）。无创通气（NIV）有助于撤机，但由于存在吻合口漏的潜在风险，在前肠手术后立即应用对患者有风险。我们评估了新生儿肠道手术后长时间MV的危险因素。
我们回顾性分析了2017 - 2018年接受肠道手术的253例新生儿，以确定长时间MV的危险因素，并在安大略省进行最多新生儿手术的三级新生儿重症监护病房确定NIV与吻合口漏之间的相关性。
最常见的诊断为坏死性小肠结肠炎/自发性肠穿孔（NEC/SIP）21%、肠闭锁16%、食管闭锁/气管食管瘘14%、肛门直肠畸形13%、肠旋转不良/肠扭转11%、腹裂9%和脐膨出4%。术后MV的中位（IQR）持续时间为3（1 - 8）天，25.7%（n = 65）的新生儿MV持续时间>7天。与术后MV≤7天的婴儿相比，MV>7天的婴儿胎龄、出生体重和手术时体重较低，但造口术比例较高、阿片类药物使用时间较长，中重度支气管肺发育不良（BPD）和死亡率较高（P<0.05）。广义线性回归分析显示，较低的胎龄（GA）和较长的阿片类药物使用时间与较长的MV持续时间相关（P<0.001），但手术指征、手术时体重和造口术与较长的MV持续时间无关（P>0.05）。在122例接受一期切除并一期吻合的患者中，22.1%（n = 27）接受了NIV，74.1%（n = 20）在术后7天开始接受NIV，2.5%（3/122）的患者检测到吻合口漏，且与NIV无关。
较低的GA和较长的阿片类药物使用时间是新生儿肠道手术后长时间MV的危险因素。需要进一步研究以探讨这些患者疼痛评估/通气方面的可改变做法，以及NIV与吻合口漏之间的相关性。
