| Přispěvatelé: |
University of Helsinki, Faculty of Medicine, Doctoral Program in Clinical Research, Helsingin yliopisto, lääketieteellinen tiedekunta, Kliininen tohtoriohjelma, Helsingfors universitet, medicinska fakulteten, Doktorandprogrammet i klinisk forskning, Bjornland, Kristin, Koivusalo, Antti |
| Popis: |
Background. Among the gastrointestinal diseases of preterm infants, necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) cause the highest morbidity and mortality rates. Aim of the study. Retrospective assessment of outcome in NEC and SIP of morbidity, mortality, intestinal failure associated cholestasis (IFAC), late abdominal surgical interventions, and the effects of patients´ characteristics. Patients and methods. Data was obtained by review of hospital records with institutional ethical consent. The setting was Finnish university hospital centres: two in studies I-II and one in studies III-IV. Included were 225 surgical NEC and SIP patients from 1986 to 2014 (I-II), 93 surgical NEC and SIP patients and 20 medical NEC patients from 2002 to 2019 (III), and 165 surgical NEC and SIP patients from 1986 to 2019 (IV). The main outcome measures were mortality (I, II, III), development of IFAC (II), and late reoperations (IV). Secondary outcome measures were loss of small intestine and duration of parenteral nutrition (PN) (III). Survival statistics were assessed with LogRank (Mantel-Cox) test and risk levels with logistic regression analysis. Results. Overall three-month survival in surgical NEC and SIP was 74 %. From 1986-2000 to 2001-2014, overall three-month survival improved from 69% to 81 % (p=0.04), in NEC from 69% to 77% (p=0.30) and in SIP from 69% to 89% (p=0.04). Independent risk factors of overall three-month survival (1986-2014) were admittance to the newborn intensive care unit (NICU), birth weight (BW), gestational age (GA), respiratory distress syndrome (RDS), and septicaemias: RR=1.6-3.3 (95%CI= 1.1-8.6), p=0.005-0.01. The strongest overall predictor was the admittance to the NICU: RR=2.8 (95% CI = 1.4-5.3), p=0.003 (I). IFAC developed in 41% of patients (NEC 48%, SIP 31%, p=0.04) and was predicted by septicaemias (p=0.001) and abdominal reoperations (p |
