新生儿坏死性小肠结肠炎要点课件

NECROTIZING ENTEROCOLITIS Gadassi Noa MD. MPH. NEC - Incidence o1%-8% of all NICUs admissions oMortality rate 10%-50% oMainly affects preterm infants (90%) o 10% in term infants oIncidence increases as gestational and birth weight decrease oNo gender, seasonal, socioeconomic association NEC - onset of disease oEndemic versus epidemic appearance oMedian days of onset at term: 2 days oMedian age at onset Term infants (10%). Term infants develop NEC much earlier than preterm. Laparotomy versus peritoneal drainage for necrotizing entercolitis and perforation Moss et al. NEJM, May 2006 Multicenter randomized trial 1500 g, 34 wks Outcome measures: Survival at 90 days postoperatively Dependence on TPN 90 days postoperatively and length of hospital stay Lapaotomy vs. peritoneal drainage in NEC, 1500 g, Moss et al. NEJM, May 2006 238 assessed for eligibility 117 randomly assigned to treatment 63 declined to participate 58 for other reasons 62 laparotomy55 peritoneal drainage No lost to follow-up No discontinuation of intervention 238 assessed for eligibility238 assessed for eligibility 63 declined to participate 58 for other reasons 238 assessed for eligibility 117 randomly assigned to treatment 63 declined to participate 58 for other reasons 238 assessed for eligibility 117 randomly assigned to treatment 63 declined to participate 58 for other reasons 238 assessed for eligibility 117 randomly assigned to treatment 63 declined to participate 58 for other reasons 238 assessed for eligibility 55 peritoneal drainage 117 randomly assigned to treatment 63 declined to participate 58 for other reasons 238 assessed for eligibility 62 laparotomy55 peritoneal drainage 117 randomly assigned to treatment 63 declined to participate 58 for other reasons 238 assessed for eligibility 62 laparotomy55 peritoneal drainage 117 randomly assigned to treatment 238 assessed for eligibility 62 laparotomy55 peritoneal drainage 117 randomly assigned to treatment 63 declined to participate 58 for other reasons 238 assessed for eligibility 62 laparotomy55 peritoneal drainage 117 randomly assigned to treatment 63 declined to participate 58 for other reasons 238 assessed for eligibility 62 laparotomy55 peritoneal drainage 117 randomly assigned to treatment 63 declined to participate 58 for other reasons 238 assessed for eligibility 62 laparotomy55 peritoneal drainage 117 randomly assigned to treatment 63 declined to participate 58 for other reasons 238 assessed for eligibility 62 laparotomy55 peritoneal drainage 117 randomly assigned to treatment 63 declined to participate 58 for other reasons 238 assessed for eligibility 62 laparotomy55 peritoneal drainage 117 randomly assigned to treatment 62 laparotomy55 peritoneal drainage 117 randomly assigned to treatment 62 laparotomy 238 assessed for eligibility 55 peritoneal drainage 117 randomly assigned to treatment 62 laparotomy 63 declined to participate 58 for other reasons 238 assessed for eligibility 55 peritoneal drainage 117 randomly assigned to treatment 62 laparotomy Moss et al. NEJM, May 2006 Results: PD LAP P Deaths (at 90 days post-op) 19/55 (34.5%) 22/62 (35.5%) 0.92 TPN dependence 17/36 (47.5%) 16/40 (40%) 0.53 58 11656 0.43Hospital stay (days) 126 Subgroup analyses Extensive pneumatosis intestinalis, gestational age 25 wks, acidosis: No significant advantage of either treatment in any group. Copyright 2006 American Academy of Pediatri