Wang Jun-Li, Huang Run-Qi, Tang Chun-Yan, Wu Wen-Jie, Li Fei, Ren Tai, Wang Jun, Pan Wei-Hua
Developmental and Behavioral Pediatric Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China.
Child Primary Care Department & Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China.
World J Pediatr. 2024 Dec;20(12):1293-1305. doi: 10.1007/s12519-024-00850-x. Epub 2024 Nov 15.
Children undergoing surgical anastomosis for long-gap esophageal atresia (LGEA) often suffer from complications related to delayed oral feeding, which may impair their early development. Clinical swallow evaluation (CSE) is an effective technique to improve feeding outcomes. However, there are limited evidences on the application of CSE in these children.
Since 2020, serial CSEs have been consistently implemented for children undergoing anastomosis for LGEA in our hospital. We conducted a retrospective study comparing 19 children who received CSE with 31 historical controls who did not. Inverse probability of treatment weighting (IPTW) was applied to balance preoperative characteristics. We compared the time from surgery to full oral feeding and the rate of postoperative complications between the two groups. Growth curves for length-for-age Z score (LAZ) and weight-for-age Z score (WAZ) up to age 3 were fitted using generalized additive mixed models.
The median time to full oral feeding was 1.1 months [interquartile range (IQR), 0.8-2.4] in the CSE group and 1.5 months (IQR, 0.6-5.7) for controls. After IPTW, CSE was associated with a shorter time to full oral feeding, with a weighted hazard ratio of 2.26 [95% confidence interval (CI), 1.21 to 4.24]. LAZ growth curves significantly differed between groups (P = 0.001).
CSE was associated with the expedited achievement of full oral feeding and a more favorable growth pattern before 3 years of age.
接受长间隙食管闭锁（LGEA）手术吻合术的儿童经常遭受与经口喂养延迟相关的并发症，这可能会损害他们的早期发育。临床吞咽评估（CSE）是一种改善喂养结果的有效技术。然而，关于CSE在这些儿童中的应用证据有限。
自2020年以来，我院对接受LGEA吻合术的儿童持续进行了系列CSE。我们进行了一项回顾性研究，比较了19名接受CSE的儿童和31名未接受CSE的历史对照儿童。采用治疗权重逆概率（IPTW）来平衡术前特征。我们比较了两组从手术到完全经口喂养的时间以及术后并发症发生率。使用广义相加混合模型拟合了3岁前年龄别身长Z评分（LAZ）和年龄别体重Z评分（WAZ）的生长曲线。
CSE组完全经口喂养的中位时间为1.1个月[四分位间距（IQR），0.8 - 2.4]，对照组为1.5个月（IQR，0.6 - 5.7）。IPTW后，CSE与完全经口喂养时间缩短相关，加权风险比为2.26[95%置信区间（CI），1.21至4.24]。两组间LAZ生长曲线有显著差异（P = 0.001）。
CSE与更快实现完全经口喂养以及3岁前更有利的生长模式相关。
