Ejiofor Chukwudi O, Ford Steven, Duncan Jose R, Rideout Drew, Kumar Ambuj, Donda Keyur, Flores-Torres Jaime
Department of Pediatrics (Neonatal-Perinatal Medicine), Franciscan Missionaries of Our Lady Health System, Lafayette, Louisiana.
Division of Neonatology, Department of Pediatrics, University of South Florida College of Medicine, Tampa, Florida.
Am J Perinatol. 2024 May;41(S 01):e1220-e1227. doi: 10.1055/s-0043-1761298. Epub 2023 Jan 29.
Despite improvements in our ability for early diagnosis and providing supportive care for infants with gastroschisis, it continues to be associated with long length of stay and morbidity. Intestinal dysfunction secondary to chronic inflammatory insult to exposed bowel is well known; however, little research has been done on the impact of acute inflammation in the perinatal period on intestinal function. This study's aim was to investigate the impact of acute chorioamnionitis on the time to achieve full enteral feeds and length of hospital stay.
Retrospective chart review of 60 mothers and their infants born with gastroschisis at a Level IV NICU from November 2011 to June 2020 was performed. Infants were divided into two groups based on the presence of histologic chorioamnionitis, and outcomes were compared. The primary outcome was delayed full enteral feeds (full enteral feeds after 28 days of life). The secondary outcomes were differences in their time to achieve full enteral feeds and time to hospital discharge, and prolonged length of hospital stay (discharge after 30 days of life). Univariate and multivariate logistic regression analyses were performed to assess the association between the dependent and the predictor variables.
Of the 60 infants enrolled, 23 (38%) had evidence of histologic chorioamnionitis. The median gestational age was 37 weeks. Fifty-four (90%) infants achieved full enteral feeds, with a median time of 24 days. Median length of hospital stay was 31 days. The presence of histologic chorioamnionitis was not associated with delayed full enteral feeds (odds ratio [OR] = 0.79; 95% confidence interval [CI] = 0.14-4.23; = 0.80) or prolonged length of hospital stay (OR = 0.45; 95% CI = 0.1-0.23; = 0.32) in the adjusted analysis.
Acute placental inflammation during the perinatal period does not impact the infant's time to achieve full feeds or prolong their hospital stay. Larger studies are needed to confirm these findings.
· Chronic inflammatory injury to exposed bowel in utero is well known in fetuses with gastroschisis.. · Acute inflammatory injury during perinatal period may impact enteral feeding outcomes.. · No impact of acute placental inflammation on time to full enteral feeds..
尽管我们在早期诊断和为腹裂婴儿提供支持性护理方面的能力有所提高，但腹裂仍与住院时间长和发病率相关。继发于对暴露肠道的慢性炎症损伤的肠道功能障碍是众所周知的；然而，关于围生期急性炎症对肠道功能的影响的研究很少。本研究的目的是调查急性绒毛膜羊膜炎对实现完全肠内喂养的时间和住院时间的影响。
对2011年11月至2020年6月在一家四级新生儿重症监护病房出生的60名患有腹裂的母亲及其婴儿进行回顾性病历审查。根据组织学绒毛膜羊膜炎的存在将婴儿分为两组，并比较结果。主要结局是延迟完全肠内喂养（出生28天后完全肠内喂养）。次要结局是他们实现完全肠内喂养的时间和出院时间的差异，以及住院时间延长（出生30天后出院）。进行单因素和多因素逻辑回归分析以评估因变量和预测变量之间的关联。
在纳入的60名婴儿中，23名（38%）有组织学绒毛膜羊膜炎的证据。中位胎龄为37周。54名（90%）婴儿实现了完全肠内喂养，中位时间为24天。中位住院时间为31天。在调整分析中，组织学绒毛膜羊膜炎的存在与延迟完全肠内喂养（优势比[OR]=0.79；95%置信区间[CI]=0.14 - 4.23；P=0.80）或住院时间延长（OR=0.45；95%CI=0.1 - 0.23；P=0.32）无关。
围生期急性胎盘炎症不会影响婴儿实现完全喂养的时间或延长其住院时间。需要更大规模的研究来证实这些发现。
· 子宫内暴露肠道的慢性炎症损伤在患有腹裂的胎儿中是众所周知的。· 围生期急性炎症损伤可能影响肠内喂养结局。· 急性胎盘炎症对完全肠内喂养时间没有影响。
