Neonatal short bowel syndrome outcomes after the establishment of the first Canadian multidisciplinary intestinal rehabilitation program: preliminary experience
Neonatal short bowel syndrome outcomes after the establishment of the first Canadian multidisciplinary intestinal rehabilitation program: preliminary experience
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DOI：
10.1016/j.jpedsurg.2006.12.033
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发表时间：
2007-05-01
影响因子：
2.4
通讯作者：
Wales, Paul W.
中科院分区：
文献类型：
--
作者：
Diamond, Ivan R.;de Silva, Nicole;Wales, Paul W.
背景：一个多学科的肠道康复团队已经在我们机构成立了3年。我们的目的是比较我们正式的肠功能改善和治疗小组（GIFT）建立之前和之后的短肠综合征新生儿的初步结局。方法：我们对我们的肠衰竭登记进行回顾性分析，比较GIFT前（1997-1999）和GIFT（2003-2005）的结果。结果：54例患者（平均胎龄= 33.5周）被纳入GIFT队列，40例患者（平均胎龄= 30.7周）被纳入GIFT前队列。两组的总死亡率（33.3% vs 37.5%, P = 0.84）相同，尽管在GIFT建立后死于肝功能衰竭的患者较少。在肝衰竭患者中，GIFT组的死亡率为9/10，而GIFT组的死亡率为6/13 （P = .03）。肝脏相关死亡的减少部分归因于早期转诊和移植存活率的提高（GIFT组为4例，而GIFT前组为0例）。结论：GIFT项目的初步结果分析表明，尽管采用了协调的护理方法，新生儿短肠综合征的自然史至今仍未改变。然而，与移植服务的沟通和整合的改善导致了更早的评估，移植率的增加和肝衰竭死亡率的降低。(C) 2007爱思唯尔公司版权所有。
Background: A multidisciplinary intestinal rehabilitation team has been in place at our institution for 3 years. Our goal was to compare the preliminary outcomes of neonates with short bowel syndrome before with those after the establishment of our formalized intestinal failure program (Group for the Improvement of Intestinal Function and Treatment [GIFT]).Methods: We conducted a retrospective analysis of our intestinal failure registry comparing preGIFT (1997-1999) with GIFT (2003-2005) outcomes.Results: Fifty-four patients (mean gestational age = 33.5 weeks) were included in the GIFT cohort, and 40 patients (mean gestational age = 30.7 weeks) formed the preGIFT cohort. Overall mortality rates (33.3% vs 37.5%, P = .84) were equivalent in the 2 cohorts, although fewer patients died of liver failure after the establishment of the GIFT. Among those with liver failure, the mortality in the preGIFT group was 9/10 as compared with that of 6/13 in the GIFT group (P = .03). The decrease in liver-related deaths was partly attributable to earlier referral for and increased survival to transplant (4 for the GIFT group vs 0 for the preGIFT group).Conclusions: Analysis of the preliminary outcomes of the GIFT program suggests that the natural history of neonatal short bowel syndrome remains unaltered to date despite a coordinated approach to care. However, improved communication and integration with the transplant service have resulted in earlier assessment, increased rates of transplantation, and decreased mortality from liver failure. (C) 2007 Elsevier Inc. All rights reserved.