Alzamrooni Ayah, Luques Lisandro, Sutthatarn Pattamon, Lapidus-Krol Eveline, Chiu Priscilla P L
Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatric Surgery, Hadassah Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Israel.
J Pediatr Surg. 2025 Apr;60(4):162219. doi: 10.1016/j.jpedsurg.2025.162219. Epub 2025 Jan 30.
Necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) lead to significant morbidity and mortality in extreme-low birth weight (ELBW) infants. This study examined surgical management and outcomes for these conditions.
A retrospective chart review of ELBW infants (birthweight <1000 g) who had laparotomy for NEC or SIP managed with primary anastomosis (PA) and stoma formation (SF) at a single high-volume center from 2000 to 2022 was performed. Patient data included demographics, pre-operative status, operative findings, post-operative complications, and outcomes at discharge and at 12 months. Statistical analyses were performed using Fisher's exact test and the Mann-Whitney test.
Of 132 patients included, 40 underwent PA and 92 underwent SF. SF patients had lower birth weights and older post-gestational age at surgery. SF patients exhibited higher pre-operative CRP and lower platelet counts. No significant differences were found in intra-operative findings. Post-operatively, SF patients had higher conjugated bilirubin levels, longer hospital stays, and longer times to full enteral feeds. Mortality rates were similar between groups. Nutritional outcomes at 12 months did not significantly differ. Micropreemies (weight <750 g at surgery) had higher mortality and more comorbidities, but no significant differences were observed between PA and SF management cohorts.
PA is a safe alternative to SF for managing NEC and SIP in ELBW infants with shorter hospital stays and faster progression to full feeds but the severity of pre-operative illness may influence surgical decision. Further studies are needed to refine patient selection criteria and optimize surgical outcomes.
Clinical Research.
Level III Retrospective Comparative Cohort Study.
坏死性小肠结肠炎（NEC）和自发性肠穿孔（SIP）在极低出生体重（ELBW）婴儿中会导致显著的发病率和死亡率。本研究探讨了这些病症的手术治疗及预后情况。
对2000年至2022年期间在一家大型中心接受剖腹手术治疗NEC或SIP并采用一期吻合术（PA）和造口术（SF）的ELBW婴儿（出生体重<1000g）进行回顾性病历审查。患者数据包括人口统计学资料、术前状况、手术发现、术后并发症以及出院时和12个月时的预后情况。使用Fisher精确检验和Mann-Whitney检验进行统计分析。
纳入的132例患者中，40例行PA，92例行SF。行SF的患者出生体重较低，手术时的孕龄较大。行SF的患者术前CRP较高，血小板计数较低。术中发现无显著差异。术后，行SF的患者结合胆红素水平较高，住院时间较长，完全经口喂养的时间较长。两组的死亡率相似。12个月时的营养结局无显著差异。超未成熟儿（手术时体重<750g）死亡率较高，合并症较多，但PA和SF治疗组之间未观察到显著差异。
对于ELBW婴儿的NEC和SIP，PA是SF的一种安全替代方法，住院时间较短，完全经口喂养进展较快，但术前疾病的严重程度可能会影响手术决策。需要进一步研究以完善患者选择标准并优化手术结局。
临床研究。
III级回顾性比较队列研究。
