Jager Alexandra, Turnbull Joanne, Johnson Mark John, Hall Nigel J
University of Southampton, Southampton, UK
University of Southampton, Southampton, UK.
BMJ Paediatr Open. 2025 Mar 18;9(1):e003267. doi: 10.1136/bmjpo-2024-003267.
Despite evidence demonstrating clinical and cost benefits of transanastomotic tubes (TATs), following repair of congenital duodenal obstruction they are used in a minority of infants in the UK. Most infants are fed using parenteral nutrition (PN) (sometimes in combination with a TAT). This variation is unexplained by clinical or demographic factors. We aimed to understand why this is and the barriers to practice change.
UK-based clinicians (surgeons, neonatologists, dietitians and specialist nurses) completed an online mixed methods survey. Open-ended replies were summarised thematically. Data were analysed using descriptive and inferential statistics.
109 clinicians (24 neonatologists, 7 nurses, 3 dietitians, 75 surgeons) from all 25 UK neonatal surgical units completed the survey. 88% (n=96/109) stated TAT use was decided solely by surgeons, driven primarily by considerations of providing appropriate nutrition and risks; 36% of surgeons felt TATs should always be used where possible. Decisions about central venous catheters (CVCs) were made by neonatologists (28%, n=31/109), surgeons (17%, n=18/109), jointly (48%, n=52/109) or 'other' (7%, n=8/109). Neonatologists and surgeons prioritised providing appropriate nutrition and risks when deciding whether to use CVCs/PN; surgeons rated a lack of supporting research and TATs' risks as key barriers to TAT usage. Costs and parents' preferences had limited influence on TAT and PN usage.
Increased TAT usage requires surgeons to be persuaded of TATs' efficacy and safety, and neonatologist recognition that exclusive TAT feeding (ie, without CVCs/PN) can provide adequate nutrition. Further work is required to appreciate how best to achieve this.
尽管有证据表明经吻合口管（TAT）具有临床和成本效益，但在先天性十二指肠梗阻修复术后，英国少数婴儿使用了该管。大多数婴儿采用肠外营养（PN）喂养（有时与TAT联合使用）。这种差异无法用临床或人口统计学因素来解释。我们旨在了解其原因以及实践改变的障碍。
英国的临床医生（外科医生、新生儿科医生、营养师和专科护士）完成了一项在线混合方法调查。对开放式回复进行了主题总结。使用描述性和推断性统计分析数据。
来自英国所有25个新生儿外科单位的109名临床医生（24名新生儿科医生、7名护士、3名营养师、75名外科医生）完成了调查。88%（n = 96/109）表示TAT的使用完全由外科医生决定，主要是出于提供适当营养和风险的考虑；36%的外科医生认为在可能的情况下应始终使用TAT。关于中心静脉导管（CVC）的决策由新生儿科医生（28%，n = 31/109）、外科医生（17%，n = 18/109）共同做出（48%，n = 52/109）或“其他”（7%，n = 8/109）。新生儿科医生和外科医生在决定是否使用CVC/PN时优先考虑提供适当营养和风险；外科医生将缺乏支持性研究和TAT的风险视为TAT使用的关键障碍。成本和家长的偏好对TAT和PN的使用影响有限。
增加TAT的使用需要说服外科医生相信TAT的有效性和安全性，以及新生儿科医生认识到单纯TAT喂养（即不使用CVC/PN）可以提供足够的营养。需要进一步开展工作以了解如何最好地实现这一点。
