School of Medicine, Vanderbilt University, Nashville, Tennessee, USA.
Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Surg Infect (Larchmt). 2023 Jun;24(5):405-413. doi: 10.1089/sur.2022.397. Epub 2023 Apr 10.
Gastroschisis is a challenging neonatal condition often with prolonged hospitalizations, need for parenteral nutrition, infectious complications, and can even result in death. Infection is reported to occur in up to two-thirds of patients with gastroschisis and is a strong risk factor for increased morbidity and mortality. Increased days with a central venous catheter, complex gastroschisis, and delayed abdominal wall closure have been consistently found to be associated with increased risk of infection, whereas sutureless gastroschisis closure has been associated with fewer infections. Although one of the most common complications of gastroschisis is infection, the use of antibiotic agents varies widely with variability in the literature to guide management. Antibiotic usage should be selective and short-term, especially in neonates with simple gastroschisis regardless of method for abdominal wall closure. Future initiatives should focus on development of evidence-based guidelines on the care of these patients with the goal of reducing variability and improve outcomes within and across institutions.
先天性腹壁发育不全是一种具有挑战性的新生儿疾病，常伴有住院时间延长、需要肠外营养、感染并发症，甚至可能导致死亡。据报道，先天性腹壁发育不全患者中有多达三分之二发生感染，是发病率和死亡率增加的一个强烈危险因素。中心静脉导管留置时间增加、复杂的先天性腹壁发育不全和延迟的腹壁关闭一直与感染风险增加相关，而无缝线的先天性腹壁发育不全关闭与更少的感染相关。尽管感染是先天性腹壁发育不全最常见的并发症之一，但抗生素的使用在文献中差异很大，指导管理的方法也不同。抗生素的使用应该是有选择性的和短期的，尤其是对于无论采用何种腹壁关闭方法的简单先天性腹壁发育不全的新生儿。未来的举措应侧重于制定这些患者护理的循证指南，目标是减少各机构之间的变异性并改善结果。
