Outcome of very premature infants with necrotising enterocolitis cared for in centres with or without on site surgical facilities
Outcome of very premature infants with necrotising enterocolitis cared for in centres with or without on site surgical facilities
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在有或没有现场手术设施的中心护理患有坏死性小肠结肠炎的极早产儿的结果
DOI：
10.1136/fn.85.2.f114
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发表时间：
2001-09-01
影响因子：
4.4
通讯作者：
Lui, K
中科院分区：
文献类型：
--
作者：
Loh, M;Osborn, DA;Lui, K
1992年至1997年，在新南威尔士州的七个围产期中心，605名婴儿在两个有内部手术设施的中心（第1组）和1195名婴儿在五个需要转移手术管理的中心（第2组）接受护理。肺透明膜病、气胸和NEC的发生率较高，死亡率相同（27%）。第1组中有52名（9%）婴儿和第2组中有72名（6%）婴儿的围产期特征和CRIB（婴儿临床风险指数）评分相似，经放射学或病理学证实为NEC。第1组中NEC婴儿的总体死亡率较低，但无统计学显著性（27% vs 35%）。第1组中有显著更多的NEC婴儿接受了手术（69%对39%）。第1组的术后死亡人数较少，第2组的非手术死亡人数较多。两组患者的呼吸和营养支持持续时间以及存活者的住院时间相似。在多变量分析中，较短的妊娠期是与NEC婴儿死亡率相关的唯一因素;在内部手术设施的存在是不是. Conclusions，有或没有现场手术设施的围产期中心与NEC早产儿管理的结果没有显着差异。应鼓励尽早转移。这一发现可能对新生儿护理设施的未来规划产生影响。
Objective-To determine if the presence of a neonatal surgical facility on site has any effect on mortality and morbidity of very premature infants with necrotising enterocolitis (NEC).Design and Setting-Retrospective review of infants of less than 29 weeks gestation cared for in the seven perinatal centres in New South Wales.Patients-Between 1992 and 1997, 605 infants were cared for in two centres with in house surgical facilities (group 1) and 1195 in five centres where transfers were required for surgical management (group 2).Results-Although use of antenatal steroids was significantly lower in group 1 centres than group 2 centres (74% v 85% respectively), and the incidence of hyaline membrane disease, pneumothorax, and NEC was higher, mortality was identical (27%). Fifty two (9%) infants in group 1 and 72 (6%) in group 2 of comparable perinatal characteristics and CRIB (Clinical Risk Index for Babies) scores developed radiologically or pathologically proven NEC. The overall mortality of infants with NEC in group 1 was lower but this was not statistically significant (27% v 35%). Significantly more infants with NEC in group 1 had surgery (69% v 39%). There were fewer postoperative deaths in group 1 and more deaths without surgery in group 2. The duration of respiratory and nutritional support and hospital stay for the survivors were similar in the two groups. In a multivariate analysis, shorter gestation was the only factor associated with mortality in infants with NEC; the presence of in house surgical facilities was not.Conclusions-There were no significant differences in outcome of premature infants with NEC managed in perinatal centres with or without on site surgical facilities. Early transfers should be encouraged. This finding may have implications for future planning of facilities for neonatal care.