RESUMO
OBJECTIVE: To determine risk factors for intestinal failure (IF) in infants undergoing surgery for necrotizing enterocolitis (NEC). STUDY DESIGN: Infants were enrolled in a multicenter prospective cohort study. IF was defined as the requirement for parenteral nutrition for >or= 90 days. Logistic regression was used to identify predictors of IF. RESULTS: Among 473 patients enrolled, 129 had surgery and had adequate follow-up data, and of these patients, 54 (42%) developed IF. Of the 265 patients who did not require surgery, 6 (2%) developed IF (OR 31.1, 95% CI, 12.9 - 75.1, P < .001). Multivariate analysis identified the following risk factors for IF: use of parenteral antibiotics on the day of NEC diagnosis (OR = 16.61, P = .022); birth weight < 750 grams, (OR = 9.09, P < .001); requirement for mechanical ventilation on the day of NEC diagnosis (OR = 6.16, P = .009); exposure to enteral feeding before NEC diagnosis (OR=4.05, P = .048); and percentage of small bowel resected (OR = 1.85 per 10 percentage point greater resection, P = .031). CONCLUSION: The incidence of IF among infants undergoing surgical treatment for NEC is high. Variables characteristic of severe NEC (low birth weight, antibiotic use, ventilator use, and greater extent of bowel resection) were associated with the development of IF.
Assuntos
Enterocolite Necrosante/complicações , Enterocolite Necrosante/diagnóstico , Síndrome do Intestino Curto/complicações , Síndrome do Intestino Curto/diagnóstico , Peso ao Nascer , Estudos de Coortes , Enterocolite Necrosante/cirurgia , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Análise Multivariada , Razão de Chances , Pediatria/métodos , Gravidez , Estudos Prospectivos , Fatores de Risco , Síndrome do Intestino Curto/cirurgiaRESUMO
OBJECTIVE: To evaluate time trend of gastroschisis and examine the epidemiological risk factors for gastroschisis. STUDY DESIGN: This population-based study analyzed the active surveillance data from the California Birth Defects Monitoring Program from 1987 to 2003. RESULTS: The overall birth prevalence of gastroschisis was 2.6 cases per 10,000 births (908 cases in >3.5 million births). In the adjusted analysis, by using the age of 25 to 29 years as the reference, mothers aged 12 to 15 years had a 4.2-times greater birth prevalence (95% CI, 2.5-7.0), and fathers aged 16 to 19 years and 20 to 24 years had 1.6- and 1.5-times greater birth prevalence (95% CI, 1.1-2.1 and 1.2-1.8), respectively. Compared with non-Hispanic whites and US-born Hispanic, both foreign-born Hispanics and blacks had adjusted prevalence ratio of 0.6 (95% CI, 0.5-0.7 and 0.4-0.9, respectively). In addition, nulliparity was also associated with gastroschisis. Independent of maternal age, paternal age, and maternal ethnicity, the birth prevalence increased 3.2-fold (95% CI, 2.3-4.3) during the 17-year study period. CONCLUSIONS: The birth prevalence of gastroschisis continues to increase in California, and young, nulliparous women are at the greatest risk of having a child with gastroschisis.
Assuntos
Gastrosquise/epidemiologia , California/epidemiologia , Feminino , Humanos , Recém-Nascido , Masculino , Idade Materna , Idade Paterna , Prevalência , Fatores de RiscoRESUMO
We report a case of syringocystadenoma papilliferum, a rare cutaneous adnexal neoplasm, occurring synchronously in two distinct unusual locations in a 22-month-old child with lesions on the lower leg and back.