早产儿坏死性小肠结肠炎或局灶性肠穿孔手术治疗的转归。

Impact of Transfer for Surgical Management of Preterm Necrotising Enterocolitis or Focal Intestinal Perforation.

机构信息

Neonatal Intensive Care Unit, Royal Victoria Infirmary, Newcastle-upon-Tyne Hospitals (NuTH) NHS Trust, Newcastle, NE2 4BJ, United Kingdom; Translational and Clinical Research Institute, Newcastle University, Framlington Place, Newcastle, NE2 4HH, United Kingdom.

Neonatal Intensive Care Unit, Royal Victoria Infirmary, Newcastle-upon-Tyne Hospitals (NuTH) NHS Trust, Newcastle, NE2 4BJ, United Kingdom.

出版信息

J Pediatr Surg. 2023 Oct;58(10):1976-1981. doi: 10.1016/j.jpedsurg.2023.03.016. Epub 2023 Mar 30.

DOI:10.1016/j.jpedsurg.2023.03.016

PMID:37100685

Abstract

OBJECTIVE

To compare outcomes after surgically managed necrotising enterocolitis (NEC) and focal intestinal perforation (FIP) in infants <32 weeks requiring transfer to or presenting in a single surgical centre.

DESIGN

Retrospective review of transferred and inborn NEC or FIP, from January 2013 to December 2020.

PATIENTS

107 transfers with possible NEC or FIP contributed 92 cases (final diagnoses NEC (75) and FIP (17)); 113 inborn cases: NEC (84) and FIP (29).

RESULTS

In infants with a final diagnosis of NEC, medical management after transfer was as common as when inborn (41% TC vs 54% p = 0.12). Unadjusted all-cause mortality was lower in inborn NEC (19% vs 27%) and FIP (10% vs 29%). In infants undergoing surgery unadjusted mortality attributable to NEC or FIP was lower if inborn (21% vs 41% NEC, 7% vs 24% FIP). In regression analysis of surgically treated infants, being transferred was associated with increased all-cause mortality (OR 2.55 (1.03-6.79)) and mortality attributable to NEC or FIP (OR 4.89 (1.80-14.97)).

CONCLUSIONS

These data require replication, but if confirmed, suggest that focusing care for infants at highest risk of developing NEC or FIP in a NICU with on-site surgical expertise may improve outcomes.

摘要

目的

比较需要转院或在单个外科中心就诊的<32 周患有坏死性小肠结肠炎（NEC）和局灶性肠穿孔（FIP）的婴儿手术后的结局。

设计

对 2013 年 1 月至 2020 年 12 月期间转院或院内确诊的 NEC 或 FIP 患儿进行回顾性研究。

患者

107 例疑似 NEC 或 FIP 的转院患儿贡献了 92 例（最终诊断为 NEC75 例和 FIP17 例），113 例院内确诊患儿：NEC84 例和 FIP29 例。

结果

对于最终诊断为 NEC 的患儿，转院后的治疗方法与院内治疗一样常见（41%TC 与 54%，p=0.12）。院内 NEC（19%）和 FIP（10%）患儿的全因死亡率均较低。未校正的 NEC（21%）和 FIP（7%）患儿的手术死亡率归因于 NEC 或 FIP 较低。在接受手术治疗的患儿的回归分析中，如果是院内患儿，全因死亡率（OR2.55（1.03-6.79））和死亡率归因于 NEC 或 FIP（OR4.89（1.80-14.97））均更高。