Georgeades Christina, Mowrer Alyssa, Ortega Gezzer, Abdullah Fizan, Salazar Jose H
Division of Pediatric General Surgery, Children's Wisconsin, Milwaukee, WI 53226, USA.
Department of Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
Children (Basel). 2022 Sep 30;9(10):1504. doi: 10.3390/children9101504.
The improved survival of gastroschisis patients is a notable pediatric success story. Over the past 60 years, gastroschisis evolved from uniformly fatal to a treatable condition with over 95% survival. We explored the historical effect of four specific clinical innovations—mechanical ventilation, preformed silos, parenteral nutrition, and pulmonary surfactant—that contributed to mortality decline among gastroschisis infants. A literature review was performed to extract mortality rates from six decades of contemporary literature from 1960 to 2020. A total of 2417 publications were screened, and 162 published studies (98,090 patients with gastroschisis) were included. Mortality decreased over time and has largely been <10% since 1993. Mechanical ventilation was introduced in 1965, preformed silo implementation in 1967, parenteral nutrition in 1968, and pulmonary surfactant therapy in 1980. Gastroschisis infants now carry a mortality rate of <5% as a result of these interventions. Other factors, such as timing of delivery, complex gastroschisis, and management in low- and middle-income countries were also explored in relation to gastroschisis mortality. Overall, improved gastroschisis outcomes serve as an illustration of the benefits of clinical advances and multidisciplinary care, leading to a drastic decline in infant mortality among these patients.
腹裂患儿生存率的提高是儿科领域一个值得注意的成功案例。在过去60年里，腹裂从无一例外的致命疾病发展成为一种存活率超过95%的可治疗疾病。我们探究了四项特定临床创新——机械通气、预制袋、肠外营养和肺表面活性物质——对腹裂婴儿死亡率下降所产生的历史影响。我们进行了一项文献综述，以提取1960年至2020年这60年间当代文献中的死亡率。共筛选了2417篇出版物，纳入了162项已发表研究（98090例腹裂患者）。死亡率随时间下降，自1993年以来大部分时间都低于10%。机械通气于1965年引入，预制袋于1967年开始应用，肠外营养于1968年开始应用，肺表面活性物质治疗于1980年开始应用。由于这些干预措施，现在腹裂婴儿的死亡率低于5%。我们还探讨了其他因素，如分娩时间、复杂腹裂以及低收入和中等收入国家的治疗情况与腹裂死亡率的关系。总体而言，腹裂治疗效果的改善体现了临床进展和多学科护理的益处，导致这些患者的婴儿死亡率大幅下降。
