Evila Yodya, Ekaputra Anthony, Widjanarko Nicolas Daniel, Ang Jessica Felicia
Department of Surgery, Pediatric Surgery Division, Padjajaran University, Bandung, Indonesia.
Department of General Medicine, Faculty of Medicine and Health Science, Atma Jaya University of Indonesia, Jakarta, Indonesia.
J Indian Assoc Pediatr Surg. 2024 Sep-Oct;29(5):454-464. doi: 10.4103/jiaps.jiaps_38_24. Epub 2024 Aug 23.
The early stages of life pose feeding challenges for infants with Congenital Diaphragmatic Hernia (CDH), necessitating feeding tube placement to prevent growth failure. Predicting the factors prompting this intervention has yielded inconclusive findings in prior research. Thus, this review explored prenatal, perinatal, and postnatal variables associated with feeding tube placement in CDH. Retrospective cohort or case-control reporting outcomes linked to prenatal, antenatal or postnatal predictors of feeding tube placement were included, following PRISMA 2020 guidelines. Reports, case series, conference abstracts, book sections, commentary, reviews, and editorials were excluded. Database searches were conducted in August 2023 encompassed Cochrane, MEDLINE, ProQuest, Wiley, and Google Scholar. Quality assessment using the Newcastle-Ottawa Scale and Review Manager 5.4 performed meta-analysis. Within eight studies, four exhibited a low risk of bias and the other was categorized as moderate. Analysis revealed significant effects for liver herniation (OR = 3.24, 95%CI 1.64-6.39, P = 0.0007), size of herniated defects classified as C or D (OR = 7.12, 95%CI 3.46-14.65, P < 0.00001), Extracorporeal Membrane Oxygenation treatment (ECMO) (OR = 6.05, 95%CI 4.51-8.12, P < 0.00001), and patch repair (OR = 5.07, 95%CI 3.89-6.62, P < 0.00001). ECMO treatment and patch repair surgery are robust predictors of feeding tube placement in CDH infants. Although liver herniation and size of herniated defect also showed associations, further studies are needed to address heterogeneity concerns. The review was registered in PROSPERO with the number CRD42023480109. No funding was received.
生命早期阶段给先天性膈疝（CDH）患儿带来了喂养挑战，因此需要放置喂食管以防止生长发育不良。此前的研究在预测促使采取这一干预措施的因素方面，结果并不明确。因此，本综述探讨了与CDH患儿放置喂食管相关的产前、围产期和产后变量。按照PRISMA 2020指南，纳入了与喂食管放置的产前、产时或产后预测因素相关的回顾性队列研究或病例对照研究报告结果。排除报告、病例系列、会议摘要、书籍章节、评论、综述和社论。2023年8月进行了数据库检索，涵盖Cochrane、MEDLINE、ProQuest、Wiley和谷歌学术。使用纽卡斯尔-渥太华量表和Review Manager 5.4进行质量评估并开展荟萃分析。在八项研究中，四项研究的偏倚风险较低，另一项研究的偏倚风险为中等。分析显示，肝脏疝出（OR = 3.24，95%CI 1.64 - 6.39，P = 0.0007）、分类为C或D的疝出缺损大小（OR = 7.12，95%CI 3.46 - 14.65，P < 0.00001）、体外膜肺氧合治疗（ECMO）（OR = 6.05，95%CI 4.51 - 8.12，P < 0.00001）和补片修补（OR = 5.07，95%CI 3.89 - 6.62，P < 0.00001）有显著影响。ECMO治疗和补片修补手术是CDH患儿放置喂食管的有力预测因素。虽然肝脏疝出和疝出缺损大小也显示出相关性，但需要进一步研究以解决异质性问题。该综述已在PROSPERO注册，注册号为CRD42023480109。未获得资金支持。
