Lin Tulian,Wu Qiang,Peng Yanfen,et al.Risk factors of high-output stoma after enterostomy in necrotizing enterocolitis[J].Journal of Clinical Pediatric Surgery,,21():310-314.[doi:10.3760/cma.j.cn101785-202201058-003]
Risk factors of high-output stoma after enterostomy in necrotizing enterocolitis
- Keywords:
- Enterocolitis; Necrotizing/SU; Enterostomy; Diarrhea; Postoperative Complications; Risk Factors; Infant; Newborn
- Abstract:
- ObjectiveTo explore the risk factors of high-output stoma(HOS)after enterostomy in infants with necrotizing enterocolitis(NEC).MethodsFrom July 1,2017 to June 30,2021,76 neonates undergoing enterostomy due to NEC were retrospectively reviewed.They were divided into two groups of HOS(n=25)and non-HOS(n=51)according to whether or not HOS occurred after enterostomy.General demographics,intraoperative findings and prognosis of two groups were compared.Univariate and multivariate Logistic regressions were utilized for examining the risk factors of HOS after enterostomy.ResultsUnivariate analysis indicated that birth weight,gestational age,preoperative need for respiratory support,NEC stages and subtypes,corrected gestational age,operative weight and residual length of proximal enterostomy were the relevant occurring factors for postoperative HOS(P<0.05).Logistic regression analysis showed that residual length of proximal enterostomy was an independent risk factor of HOS after enterostomy in NEC infants(OR=1.220,95%CI:1.108-1.343,P<0.05).Receiver operating characteristic(ROC)curve was plotted with residual length of proximal enterostomy.Area under the curve was 0.926(95%CI:0.849~1.000,P<0.05)while the sensitivity and specificity were 92% and 74%.When residual length of proximal enterostomy was 86.5 cm,the sensitivity and specificity were 84% and 96% of HOS,indicating that it was an excellent predictor for HOS in NEC infants.ConclusionHOS is prone to occur after enterostomy in NEC infants and residual length of proximal enterostomy is an independent risk factor and an excellent predictor for HOS in NEC infants after enterostomy.
References:
[1] Neu J,Walker WA.Necrotizing enterocolitis[J].N Engl J Med,2011,364(3):255-264.DOI:10.1056/NEJMra1005408.
[2] Carr BD,Gadepalli SK.Does surgical management alter outcome in necrotizing enterocolitis?[J].Clin Perinatol,2019,46(1):89-100.DOI:10.1016/j.clp.2018.09.008.
[3] 中华医学会小儿外科分会新生儿外科学组.新生儿坏死性小肠结肠炎外科手术治疗专家共识[J].中华小儿外科杂志,2016,37(10):724-728.DOI:10.3760/cma.j.issn.0253-3006.2016.10.002. Group of Neonatal Surgery,Branch of Pediatric Surgery,Chinese Medical Association:Expert Consensus on Surgical Treatment of Neonatal Necrotizing Enterocolitis[J].Chin J Pediatr Surg,2016,10(37):724-727.DOI:10.3760/cma.j.issn.0253-3006.2016.10.002.
[4] Bethell G,Kenny S,Corbett H.Enterostomy-related complications and growth following reversal in infants[J].Arch Dis Child Fetal Neonatal Ed,2017,102(3):F230-F234.DOI:10.1136/archdischild-2016-311126.
[5] Messaris E,Sehgal R,Deiling S,et al.Dehydration is the most common indication for readmission after diverting ileostomy creation[J].Dis Colon Rectum,2012,55(2):175-180.DOI:10.1097/DCR.0b013e31823d0ec5.
[6] Hayden DM,Pinzon MC,Francescatti AB,et al.Hospital readmission for fluid and electrolyte abnormalities following ileostomy construction:preventable or unpredictable?[J].J Gastrointest Surg,2013,17(2):298-303.DOI:10.1007/s11605-012-2073-5.
[7] Chong C,van Druten J,Briars G,et al.Neonates living with enterostomy following necrotising enterocolitis are at high risk of becoming severely underweight[J].Eur J Pediatr,2019,178(12):1875-1881.DOI:10.1007/s00431-019-03440-6.
[8] 彭艳芬,何秋明,郑海清,等.新生儿小肠造瘘术后营养状态及危险因素分析[J].中华新生儿科杂志,2018,33(5):350-353.DOI:10.3760/cma.j.issn.2096-2932.2018.05.007. Peng YF,He QM,Zheng HQ,et al.Nutritional outcomes and risk factors of neonatal enterostomy[J].Chin J Neonatology,2018,33(5):350-353.DOI:10.3760/cma.j.issn.2096-2932.2018.05.007.
[9] 中华医学会小儿外科学分会新生儿学组.新生儿坏死性小肠结肠炎小肠造瘘术后临床治疗专家共识[J].中华小儿外科杂志,2016,37(8):563-567.DOI:10.3760/cma.j.issn.0253-3006.2016.08.002. Group of Neonatal Surgery,Branch of Pediatric Surgery,Chinese Medical Association:Expert Consensus on Clinical Treatment of Neonatal Necrotizing Enterocolitis after Enterostomy[J].Chin J Pediatr Surg,2016,37(8):563-567.DOI:10.3760/cma.j.issn.0253-3006.2016.08.002.
[10] Canada NL,Mullins L,Pearo B,et al.Optimizing perioperative nutrition in pediatric populations[J].Nutr Clin Pract,2016,31(1):49-58.DOI:10.1177/0884533615622639.
[11] Crealey M,Walsh M,Awadalla S,et al.Managing newborn ileostomies[J].Ir Med J,2014,107(5):146-148.
[12] Samuels N,Ra VDG,Rcj DJ,et al.Risk factors for necrotizing enterocolitis in neonates:a systematic review of prognostic studies[J].Bmc Pediatrics,2017,17(1):105.DOI:10.1186/sl2887-0l7-0847-3.
[13] 赵绪稳,胡博,戴春娟,等.新生儿坏死性小肠结肠炎伴发肠穿孔的危险因素研究[J].临床小儿外科杂志,2021,20(11):1042-1047.DOI:10.12260/lcxewkzz.2021.11.009. Zhao XW,Hu B,Dai CJ,et al.Risk factors of intestinal perforation in neonatal necrotizing enterocolitis[J].J Clin Ped Sur,2021,20(11):1042-1047.DOI:10.12260/lcxewkzz.2021.11.009.
[14] Sparks EA,Khan FA,Fisher JG,et al.Necrotizing enterocolitis is associated with earlier achievement of enteral autonomy in children with short bowel syndrome[J].J Pediatr Surg,2016,51(1):92-95.DOI:10.1016/j.jpedsurg.2015.10.023.
[15] Blum JK,Rasmussen L,Qvist N,et al.Enterostomy complications in necrotizing enterocolitis (NEC) surgery,a retrospective chart review at Odense University Hospital[J].BMC Pediatr,2019,19(1):110.DOI:10.1186/s12887-019-1488-5.
[16] 彭艳芬,何秋明,林土连,等.新生儿坏死性小肠结肠炎不同关瘘时机并发症及营养状况分析[J].中华新生儿科杂志,2021,36(6):43-46.DOI:10.3760/cma.j.issn.2096-2932.2021.06.009. Peng YF,He QM,Lin TL,et al.Complications and nutritional status following different timings of post-enterostomy stoma reversal in necrotizing enterocolitis[J].Chin J Neonatology,2021,36(6):43-46.DOI:10.3760/cma.j.issn.2096-2932.2021.06.009.
[17] Kargl S,Wagner O,Pumberger W,et al.Ileostomy complications in infants less than 1500 grams-frequent but manageable[J].J Neonatal Surg,2017,6(1):4.DOI:10.21699/jns.v6i1.451.
[18] 王敏,朱海涛,沈淳.新生儿小肠造瘘术后肠内营养制剂作用观察[J].中华小儿外科杂志,2017,38(9):660-665.DOI:10.3760/cma.j.issn.0253-3006.2017.09.004. Wang M,Zhu HT,Shen C,et al.Effect of enteral nutrition on intestinal enterostomy in neonates[J].Chin J Pediatr Surg,2017,38(9):660-665.DOI:10.3760/cma.j.issn.0253-3006.2017.09.004.
[19] Jiang W,Zhang J,Lü X,et al.Continuous tube feeding versus intermittent oral feeding for intermediate position enterostomy in infants[J].Asia Pac J Clin Nutr,2018,27(2):313-317.DOI:10.6133/apjcn.032017.21.
Memo
收稿日期:2022-01-29
通讯作者:钟微,Email:zhongwei@gwcmc.org