Genet Emeric, Gounfle Erasti, Bonnard Arnaud, Jaby Olivier, Wang Xavier Xu, Jung Camille, Biran Valérie, Rideau Aline, Durrmeyer Xavier
Neonatal Intensive Care Unit, Centre Hospitalier Intercommunal de Créteil, 40 Avenue de Verdun, 94000, Créteil, France.
Clinical Research Center, Centre Hospitalier Intercommunal de Créteil, Créteil, France.
Eur J Pediatr. 2025 Feb 28;184(3):215. doi: 10.1007/s00431-025-06043-6.
The purpose of this study was to compare two initial surgical strategies for spontaneous intestinal perforation (SIP) in a bi-centric cohort of extremely preterm and/or extremely low birthweight infants. Observational, retrospective study including infants born before 28 weeks of gestation and/or with birthweight < 1000 g, born between 2010 and 2020, operated for SIP in two type 3 centers. Infants were attributed to groups according to the surgical technique of the first intervention: primary anastomosis or suturing (PAS) or enterostomy (ES). The primary endpoint was the duration of parenteral nutrition (PN) analyzed using multivariate Cox model. Secondary endpoints included total number of surgeries under general anesthesia, morbidity and mortality at discharge, and outcomes at 2 years. Among 65 included patients, those in the PAS group (n = 46) had a higher median [IQR] CRIB II score than those from the ES group (n = 19) (11.5 [10-13] vs 8 [4-10], p = 0.01) and were more frequently operated in Robert Debré (78% vs 21%, p < 0.001) but had comparable other clinical characteristics at birth and at the time of surgery. As compared to the ES group, infants from the PAS group had a significantly higher probability of NP weaning after adjustment (adjusted hazard ratio 3.05, 95% CI [1.43-6.49]) and a significantly lower median [IQR] number of general anesthesia (1 [1-1] vs 2 [2-2], p < 0.001). At discharge and at age 2, there was no significant difference in outcomes between groups. Conclusion: Initial one-stage surgery for SIP in extremely preterm infants was associated with shorter NP duration and fewer general anesthesia in this study.
本研究的目的是比较在一个双中心队列中，针对极早产儿和/或极低出生体重儿的自发性肠穿孔（SIP）的两种初始手术策略。这是一项观察性、回顾性研究，纳入了2010年至2020年间出生于两个三级中心、孕周小于28周和/或出生体重低于1000克、因SIP接受手术的婴儿。根据首次干预的手术技术，将婴儿分为两组：一期吻合或缝合（PAS）组和肠造口术（ES）组。主要终点是使用多变量Cox模型分析的肠外营养（PN）持续时间。次要终点包括全身麻醉下的手术总数、出院时的发病率和死亡率以及2岁时的结局。在纳入的65例患者中，PAS组（n = 46）的CRIB II评分中位数[四分位间距]高于ES组（n = 19）（11.5 [10 - 13] vs 8 [4 - 10]，p = 0.01），在罗伯特·德布雷医院接受手术的频率更高（78% vs 21%，p < 0.001），但在出生时和手术时具有可比的其他临床特征。与ES组相比，PAS组婴儿在调整后停止PN的可能性显著更高（调整后的风险比为3.05，95%置信区间[1.43 - 6.49]），全身麻醉的中位数[四分位间距]显著更低（1 [1 - 1] vs 2 [2 - 2]，p < 0.001）。在出院时和2岁时，两组之间的结局没有显著差异。结论：在本研究中，极早产儿SIP的初始一期手术与较短的PN持续时间和较少的全身麻醉相关。
