Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
J Perinatol. 2024 Dec;44(12):1746-1754. doi: 10.1038/s41372-024-02037-8. Epub 2024 Jul 12.
Determine short-term outcomes following peritoneal drain (PD), laparotomy (LAP) after PD (PD-LAP), and LAP in extremely low birth weight (ELBW) infants with spontaneous intestinal perforation (SIP).
ELBW infants with SIP were identified using the Children's Hospitals Neonatal Database. Mortality and length of stay (LOS) were compared among groups.
Of 729 SIP infants from 6/2010-12/2016, 383(53%) received PD, 61(8%) PD-LAP, and 285(39%) LAP. PD infants had lower GA at birth, at SIP diagnosis and upon admission than PD-LAP or LAP; and higher sepsis rates than LAP. Bivariate analysis and Kaplan-Meier survival estimates suggested PD had increased mortality vs. PD-LAP and LAP (27%, 11.5%, and 15.8% respectively, p < 0.001). However, surgical approach was not significantly associated with mortality in multivariable analysis accounting for GA and illness severity. LOS did not differ by surgical approach.
In ELBW infants with SIP, mortality, and LOS are independent of the initial surgical approach.
确定自发性肠穿孔（SIP）极低出生体重（ELBW）婴儿行腹腔引流（PD）、PD 后剖腹手术（PD-LAP）和剖腹手术（LAP）后的短期预后。
使用儿童医院新生儿数据库确定 SIP 患儿。比较各组死亡率和住院时间（LOS）。
2010 年 6 月至 2016 年 12 月期间，729 例 SIP 婴儿中，383 例行 PD（53%），61 例行 PD-LAP（8%），285 例行 LAP（39%）。与 PD-LAP 和 LAP 相比，PD 患儿出生时、SIP 诊断时和入院时的胎龄较小，且感染性休克发生率较高。双变量分析和 Kaplan-Meier 生存估计表明 PD 与 PD-LAP 和 LAP 相比死亡率更高（分别为 27%、11.5%和 15.8%，p<0.001）。然而，多变量分析考虑到胎龄和疾病严重程度后，手术方式与死亡率无显著相关性。手术方式对 LOS 无影响。
在 SIP 的 ELBW 婴儿中，死亡率和 LOS 与初始手术方式无关。
