Besendörfer Manuel, Günster Simone, Linz Katja, Reutter Heiko Martin, Diez Sonja
Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Pediatric Surgery, University Hospital Erlangen, Erlangen, Germany.
Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Hospital for Children and Adolescents, Neonatology and Pediatric Intensive Care, University Hospital Erlangen, Erlangen, Germany.
Front Pediatr. 2024 Mar 14;12:1382000. doi: 10.3389/fped.2024.1382000. eCollection 2024.
Centralization of neonatal surgical care for congenital malformations is already under discussion. Acute care of neonatal emergencies in perinatal centers with affiliated hospitals is not uniformly regulated in Germany.
Analyses are based on acute pediatric surgical care at four affiliated hospitals of a perinatal center. Epidemiologic data and outcome parameters "survival", "intracerebral hemorrhage", and "revision of surgical indication" are assessed. Comparison is made between patients receiving surgical treatment at affiliated hospitals (group A) and patients with transfer to the university center for therapy in case of surgical indication for gastrointestinal diseases (group B).
17 group A-patients are compared to 40 group B-patients. Comparison of epidemiological data reveals no significant differences. There is a survival advantage with transfer to the university center (mortality of 29% in group A vs. 2% in group B, = 0.007). Intracerebral hemorrhage occurred more frequently in externally treated patients (group A 24% vs. group B 2%, = 0.024). Surgical indication was revised in 30% of group B at the university center ( = 0.011) with consecutive successful conservative treatment.
Transfer of patients at the beginning of the acute phase of gastrointestinal diseases is key to optimize the quality of neonatal surgical care. However, larger population studies should confirm the presented results, discuss restricting factors of real care structures and should rule out bias in triage of patients.
先天性畸形新生儿外科护理的集中化已经在讨论之中。在德国，围产期中心及其附属医院对新生儿急症的急性护理尚无统一规定。
分析基于围产期中心四家附属医院的急性儿科外科护理情况。评估流行病学数据以及“生存”“脑出血”和“手术指征修订”等结局参数。对在附属医院接受手术治疗的患者（A组）和出现胃肠道疾病手术指征时转至大学中心接受治疗的患者（B组）进行比较。
将17例A组患者与40例B组患者进行比较。流行病学数据比较显示无显著差异。转至大学中心有生存优势（A组死亡率为29%，B组为2%，P = 0.007）。外部治疗的患者脑出血发生率更高（A组为24%，B组为2%，P = 0.024）。在大学中心，B组中有30%的患者手术指征得到修订（P = 0.011），随后保守治疗成功。
在胃肠道疾病急性期开始时转移患者是优化新生儿外科护理质量的关键。然而，更大规模的人群研究应证实所呈现的结果，讨论实际护理结构的限制因素，并排除患者分诊中的偏差。
