Risk factors for prolonged mechanical ventilation in neonates following gastrointestinal surgery.
Gastrointestinal surgery
anastomotic leak
mechanical ventilation
neonates
Journal
Translational pediatrics
ISSN: 2224-4344
Titre abrégé: Transl Pediatr
Pays: China
ID NLM: 101649179
Informations de publication
Date de publication:
May 2022
May 2022
Historique:
received:
08
01
2022
accepted:
02
03
2022
entrez:
10
6
2022
pubmed:
11
6
2022
medline:
11
6
2022
Statut:
ppublish
Résumé
Prolonged mechanical ventilation (MV) should be avoided in neonates. Noninvasive ventilation (NIV) can facilitate weaning from MV but has risks for patients immediately following foregut surgery due to the potential risk of anastomotic leak. We evaluated the risk factors for prolonged MV following intestinal surgery in neonates. We retrospectively reviewed 253 neonates undergoing intestinal surgery in 2017-2018 to identify risk factors for prolonged MV, and determine the correlation between NIV and anastomotic leak in a tertiary neonatal intensive care unit that performs the greatest number of neonatal surgeries in Ontario. The most common diagnoses were necrotizing enterocolitis/spontaneous intestinal perforation (NEC/SIP) 21%, intestinal atresia 16%, esophageal atresia/tracheoesophageal fistula 14%, ano-rectal malformation 13%, malrotation/volvulus 11%, gastroschisis 9% and omphalocele 4%. The median (IQR) duration of MV post-surgery was 3 (1-8) days with 25.7 % (n=65) of neonates on MV for >7 days. Compared to infants on MV post-surgery for ≤7 days, those with MV>7 days were of lower gestational age, birth weight and weight at surgery, but a higher proportion underwent stoma creation, had a longer duration of opioid administration and higher rates of moderate to severe bronchopulmonary dysplasia (BPD) and mortality (P<0.05). Generalized linear regression analysis showed lower gestational age (GA) and longer opioid administration were associated with longer duration of MV (P<0.001), but indication for surgery, weight at surgery and stoma creation didn't correlate with longer duration of MV (P>0.05). Of the 122 patients handled by one-stage resection with primary anastomosis, 22.1% (n=27) received NIV with 74.1% (n=20) commenced on NIV after 7 days post-surgery, anastomotic leak was detected in 2.5 % (3/122) patients and didn't correlate with NIV. Lower GA and longer opioid administration were risk factors for prolonged MV in neonates following intestinal surgery. Further research is needed to investigate modifiable practices around pain assessment/ventilation in these patients, and the correlation between NIV and anastomotic leak.
Sections du résumé
Background
UNASSIGNED
Prolonged mechanical ventilation (MV) should be avoided in neonates. Noninvasive ventilation (NIV) can facilitate weaning from MV but has risks for patients immediately following foregut surgery due to the potential risk of anastomotic leak. We evaluated the risk factors for prolonged MV following intestinal surgery in neonates.
Methods
UNASSIGNED
We retrospectively reviewed 253 neonates undergoing intestinal surgery in 2017-2018 to identify risk factors for prolonged MV, and determine the correlation between NIV and anastomotic leak in a tertiary neonatal intensive care unit that performs the greatest number of neonatal surgeries in Ontario.
Results
UNASSIGNED
The most common diagnoses were necrotizing enterocolitis/spontaneous intestinal perforation (NEC/SIP) 21%, intestinal atresia 16%, esophageal atresia/tracheoesophageal fistula 14%, ano-rectal malformation 13%, malrotation/volvulus 11%, gastroschisis 9% and omphalocele 4%. The median (IQR) duration of MV post-surgery was 3 (1-8) days with 25.7 % (n=65) of neonates on MV for >7 days. Compared to infants on MV post-surgery for ≤7 days, those with MV>7 days were of lower gestational age, birth weight and weight at surgery, but a higher proportion underwent stoma creation, had a longer duration of opioid administration and higher rates of moderate to severe bronchopulmonary dysplasia (BPD) and mortality (P<0.05). Generalized linear regression analysis showed lower gestational age (GA) and longer opioid administration were associated with longer duration of MV (P<0.001), but indication for surgery, weight at surgery and stoma creation didn't correlate with longer duration of MV (P>0.05). Of the 122 patients handled by one-stage resection with primary anastomosis, 22.1% (n=27) received NIV with 74.1% (n=20) commenced on NIV after 7 days post-surgery, anastomotic leak was detected in 2.5 % (3/122) patients and didn't correlate with NIV.
Conclusions
UNASSIGNED
Lower GA and longer opioid administration were risk factors for prolonged MV in neonates following intestinal surgery. Further research is needed to investigate modifiable practices around pain assessment/ventilation in these patients, and the correlation between NIV and anastomotic leak.
Identifiants
pubmed: 35685067
doi: 10.21037/tp-22-14
pii: tp-11-05-617
pmc: PMC9173873
doi:
Types de publication
Journal Article
Langues
eng
Pagination
617-624Commentaires et corrections
Type : CommentIn
Informations de copyright
2022 Translational Pediatrics. All rights reserved.
Déclaration de conflit d'intérêts
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tp.amegroups.com/article/view/10.21037/tp-22-14/coif). The authors have no conflicts of interest to declare.
Références
Arch Dis Child Fetal Neonatal Ed. 2004 Nov;89(6):F537-41
pubmed: 15499150
J Pediatr. 2017 Jan;180:99-104.e1
pubmed: 27522446
Intensive Care Med. 2002 Jun;28(6):752-7
pubmed: 12107682
J Pediatr. 2018 Mar;194:34-39.e3
pubmed: 29198532
Cochrane Database Syst Rev. 2014 Aug 01;(8):CD008930
pubmed: 25081420
Pediatrics. 1996 Sep;98(3 Pt 1):357-61
pubmed: 8784356
Pediatr Pulmonol. 2013 May;48(5):443-8
pubmed: 22811341
Clin J Pain. 2010 Nov-Dec;26(9):813-30
pubmed: 20717010
Arch Dis Child Educ Pract Ed. 2017 Oct;102(5):254-256
pubmed: 28724533
Cochrane Database Syst Rev. 2015 Oct 05;(10):CD009134
pubmed: 26436599
Zhongguo Dang Dai Er Ke Za Zhi. 2018 Jan;20(1):5-11
pubmed: 29335074
J Neonatal Perinatal Med. 2019;12(2):135-141
pubmed: 30614810
J Paediatr Child Health. 2016 Jul;52(7):710-4
pubmed: 27228265
Am J Perinatol. 2014 Dec;31(12):1063-72
pubmed: 24683068
Arch Dis Child Fetal Neonatal Ed. 2008 Jul;93(4):F305-6
pubmed: 18192327
Laryngoscope. 2011 Mar;121(3):596-600
pubmed: 21344442
Am J Respir Crit Care Med. 2011 Aug 15;184(4):430-7
pubmed: 21616997
Semin Perinatol. 2018 Nov;42(7):444-452
pubmed: 30343941
J Pediatr Surg. 2019 May;54(5):945-948
pubmed: 30814037
Pediatrics. 2006 Oct;118(4):e992-1000
pubmed: 17015519
Am J Respir Crit Care Med. 2001 Jun;163(7):1723-9
pubmed: 11401896
JAMA Pediatr. 2015 Nov;169(11):1011-7
pubmed: 26414549
Pediatrics. 2013 Nov;132(5):e1351-60
pubmed: 24144716
Crit Care. 2004 Oct;8(5):R322-7
pubmed: 15469575
Paediatr Anaesth. 2006 Mar;16(3):258-65
pubmed: 16490089
J Hosp Infect. 2005 Dec;61(4):300-11
pubmed: 16221510
Neonatology. 2013;103(3):161-5
pubmed: 23258368
N Engl J Med. 2013 Aug 15;369(7):611-20
pubmed: 23944299
Pediatr Crit Care Med. 2005 May;6(3):312-8
pubmed: 15857531
Chest. 1997 Jul;112(1):186-92
pubmed: 9228375
Eur J Pediatr. 2014 Apr;173(4):427-34
pubmed: 24522325
Lancet. 2008 Jan 12;371(9607):126-34
pubmed: 18191684
Cochrane Database Syst Rev. 2017 Feb 01;2:CD003212
pubmed: 28146296
Crit Care Med. 2011 Dec;39(12):2612-8
pubmed: 21765357
Respir Care. 2017 May;62(5):641-642
pubmed: 28442592
Acta Paediatr. 2017 Aug;106(8):1248-1259
pubmed: 28257153
J Neonatal Perinatal Med. 2015;8(2):91-7
pubmed: 26410431
Neonatology. 2016;109(4):258-64
pubmed: 26859512