Singhal Graciaa, Ramakrishnan Rema, Goldacre Raph, Battersby Cheryl, Hall Nigel J, Gale Chris, Knight Marian, Lansdale Nick
Neonatal Medicine, School of Public Health, Imperial College London, London, UK.
National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Arch Dis Child Fetal Neonatal Ed. 2024 Dec 20;110(1):79-84. doi: 10.1136/archdischild-2024-327020.
The optimal time for neonatal stoma closure is unclear and there have been calls for a trial to compare early and late surgery. The feasibility of such a trial will depend on the population of eligible infants and acceptability to families and health professionals. In this study, we aimed to determine current UK practice and characteristics of those undergoing stoma surgery.
A retrospective cohort study of neonates who had undergone stoma surgery (excluding anorectal malformations and Hirschsprung's disease) using three national databases: the National Neonatal Research Database (NNRD, 2012-2019), British Association of Paediatric Surgeons Congenital Anomalies Surveillance System (BAPS-CASS, 2013-2014) and Hospital Episode Statistics-Admitted Patient Care (HES-APC, 2011-2018).
1830 eligible neonates were identified from NNRD, 163 from BAPS-CASS, 2477 from HES-APC. Median (IQR) duration of stoma in days was 57 (36-80) in NNRD, 63 (41-130) in BAPS-CASS and 78 (55-122) for neonates identified from HES-APC. At the time of closure, there were low rates of invasive ventilation (13%), inotrope use (5%) and recent steroids use (4%). Infants who underwent earlier closure (<9 weeks) were less preterm (median 28 weeks vs 25 weeks), have higher birth weight (median 986 g vs 764 g) and more likely to have stoma complications (29% vs 5%).
There are sufficient UK neonates undergoing stoma formation for a trial. Stoma closure is performed at around 2 months, with clinical stability, gestation, weight and stoma complications appearing to influence timing. The variation in practice we document indicates there is opportunity to optimise practice through a trial.
新生儿造口关闭的最佳时间尚不清楚，有人呼吁进行一项试验以比较早期手术和晚期手术。此类试验的可行性将取决于符合条件的婴儿群体以及家庭和卫生专业人员的接受程度。在本研究中，我们旨在确定英国目前的做法以及接受造口手术者的特征。
一项回顾性队列研究，利用三个国家数据库对接受造口手术的新生儿（不包括肛门直肠畸形和先天性巨结肠病）进行研究：国家新生儿研究数据库（NNRD，2012 - 2019年）、英国小儿外科医生协会先天性异常监测系统（BAPS - CASS，2013 - 2014年）以及医院事件统计 - 住院患者护理数据库（HES - APC，2011 - 2018年）。
从NNRD中识别出1830例符合条件的新生儿，从BAPS - CASS中识别出163例，从HES - APC中识别出2477例。NNRD中造口持续时间的中位数（四分位间距）以天计为57（36 - 80），BAPS - CASS中为63（41 - 130），从HES - APC中识别出的新生儿为78（55 - 122）。在关闭造口时，有创通气率（13%）、使用血管活性药物率（5%）和近期使用类固醇率（4%）较低。接受早期关闭（<9周）的婴儿早产程度较低（中位数28周对25周），出生体重较高（中位数986克对764克），且更有可能出现造口并发症（29%对5%）。
英国有足够数量的新生儿进行造口形成试验。造口关闭通常在2个月左右进行，临床稳定性、孕周、体重和造口并发症似乎会影响时间选择。我们记录的实践差异表明有机会通过试验优化实践。
