Risk of Hospitalizations Following Gastrostomy in Children with Intellectual Disability
Risk of Hospitalizations Following Gastrostomy in Children with Intellectual Disability
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DOI：
10.1016/j.jpeds.2019.10.020
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发表时间：
2020-02-01
影响因子：
5.1
通讯作者：
Downs, Jenny
中科院分区：
文献类型：
--
作者：
Jacoby, Peter;Wong, Kingsley;Downs, Jenny
目的探讨重度智力障碍患儿胃造口术前后的住院率。研究设计我们使用来自西澳大利亚州（WA）和新南威尔士州（NSW）的相关健康管理和残疾数据进行了一项回顾性队列研究。纳入了2014年底（WA）和2015年底（NSW）前在西澳（WA）和新南威尔士州（NSW）分别于1983年至2009年和2002年至2010年期间出生并行胃造口术的儿童（n = 673 [WA, n = 325； NSW, n = 348]）。使用条件泊松回归模型评估胃造口术对急性全因住院、急性下呼吸道感染（LRTI）和癫痫入院的年龄调整影响。结果手术后5年全因住院率下降（西澳队列1983-2009：发病率比为0.70 [95% CI, 0.60-0.80]；西澳和新南威尔士州队列2002-2010：发病率比为0.63 [95% CI, 0.45-0.86]）。急性下呼吸道感染入院率在WA组中有所增加，在联合组中保持相似。在WA队列中，胃造口术后4年癫痫入院率下降，而在联合队列中，癫痫入院率普遍较低。在联合队列中，基金应用似乎降低了急性下呼吸道感染入院的相对发生率。结论胃造口术与健康益处相关，包括减少全因和癫痫住院治疗，但对急性下呼吸道感染没有保护作用。住院人数的减少可能反映了营养和药物供应的改善。
Objective To examine the frequency of hospital admissions before and after gastrostomy insertion in children with severe intellectual disability.Study design We conducted a retrospective cohort study using linked health administrative and disability data from Western Australia (WA) and New South Wales (NSW). Children born between 1983 and 2009 in WA and 2002 and 2010 in NSW who had a gastrostomy insertion performed (n = 673 [WA, n = 325; NSW, n = 348]) by the end of 2014 (WA) and 2015 (NSW) were included. Conditional Poisson regression models were used to evaluate the age-adjusted effect of gastrostomy insertion on acute hospitalizations for all-cause, acute lower respiratory tract infections (LRTI), and epilepsy admissions.Results The incidence of all-cause hospitalizations declined at 5 years after procedure (WA cohort 1983-2009: incidence rate ratio, 0.70 [95% CI, 0.60-0.80]; WA and NSW cohort 2002-2010: incidence rate ratio, 0.63 [95% CI, 0.45-0.86]). Admissions for acute LRTI increased in the WA cohort and remained similar in the combined cohort. Admissions for epilepsy decreased 4 years after gastrostomy in the WA cohort and were generally lower in the combined cohort. Fundoplication seemed to decrease the relative incidence of acute LRTI admissions in the combined cohort.Conclusions Gastrostomy was associated with health benefits including reduced all-cause and epilepsy hospitalizations, but was not protective against acute LRTI. These decreases in hospitalizations may reflect improved delivery of nutrition and medications.