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Yang M, Xie Y, Zhuang Y, Chen Y, Lin X, Liu Z, Zhang P, Xiao W, Chen Y, Chen C, Zheng L, Duan S. Risk factors and predictive models for early recurrent intussusception in children: a retrospective cohort study. Transl Pediatr 2023; 12:1800-1809. [PMID: 37969126 PMCID: PMC10644014 DOI: 10.21037/tp-23-269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 08/18/2023] [Indexed: 11/17/2023] Open
Abstract
Background Early recurrent intussusception (ERI) in children is common and seriously affects the physical and mental health of the children. There are few reports discussing risk factors for ERI in children, and this study aims to identify risk factors for ERI in children and build predictive models. Methods We conducted a retrospective study of 787 children with no relapse intussusception (NRI) and 82 children with ERI between January 2011 and December 2021. Univariate and multifactorial stepwise logistic regression analysis was used to analyze the correlation between 11 factors and ERI, to determine the independent risk factors for ERI in children. The prediction model was established by independent risk factors and then verified. Results Age, vomiting, bloody stools, and monocyte ratios were independently correlated with the composite endpoint (P<0.05). A nomogram was constructed and a calibration curve was plotted, using independent risk factors. Based on the disease's diagnostic score, the predictive model's performance was validated by using logistic regression receiver operating characteristic (ROC) curve detection, with area under the curve (AUC) value of 0.883 [95% confidence interval (CI): 0.846-0.920], and the calibration curve was close to the ideal diagonal line. In addition, the decision curve analysis (DCA) showed that the model had significant net benefits. Conclusions Independent risk factors for ERI in children are age, vomiting, bloody stool, and monocyte ratio. Children older than 1 year in age, who lacked vomiting and bloody stool symptoms, and who exhibited an elevated ratio of monocytes were more likely to relapse early. The predictive model constructed herein can predict the early recurrence of children with ERI, providing a reference for clinicians' individualized judgments.
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Affiliation(s)
- Min Yang
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Yao Xie
- Department of Radiology, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Yangmu Zhuang
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Yiyi Chen
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Xiaobin Lin
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Zhijun Liu
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Peijian Zhang
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Wang Xiao
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Yingchun Chen
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Chunxia Chen
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Lian Zheng
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Shouxing Duan
- Department of Pediatric Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital (Nanshan Hospital), Shenzhen, China
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3
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Miholjcic TBS, Baud O, Iranmanesh P, Wildhaber BE. Risk Factors for Dehiscence of Operative Incisions in Newborns after Laparotomy. Eur J Pediatr Surg 2023. [PMID: 37816380 DOI: 10.1055/s-0043-1771223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
BACKGROUND Surgical wound dehiscence (SWD) in neonates is a life-threatening complication. The aim was to define risk factors of postoperative incision dehiscence in this population. METHODS Data of 144 patients from 2010 to 2020 were analyzed retrospectively. All full-term newborns or preterm newborns up to 42 weeks of amenorrhea (adjusted) who had a laparotomy within 30 days were included. Descriptive patient information and perioperative data were collected. SWD was defined as any separation of cutaneous edges of postoperative wounds. RESULTS Overall, SWD occurred in 16/144 (11%) patients, with a significantly increased incidence in preterm newborns (13/59, 22%) compared with full-term newborns (3/85, 4%; p < 0.001). SWD was significantly associated with exposure to postnatal steroids (60% vs. 4%, p < 0.001) and nonsteroidal anti-inflammatory drugs (25% vs. 4%, p < 0.01), invasive ventilation duration before surgery (median at 10 vs. 0 days, p < 0.001), preoperative low hemoglobin concentration (115 vs. 147 g/L, p < 0.001) and platelet counts (127 vs. 295 G/L, p < 0.001), nonabsorbable suture material (43% vs. 8%, p < 0.001), the presence of ostomies (69% vs. 18%, p < 0.001), positive bacteriological wound cultures (50% vs. 6%, p < 0.001), and relaparotomy (25% vs. 3%, p < 0.01). Thirteen of 16 patients with SWD presented necrotizing enterocolitis/intestinal perforations (81%, p < 0.001). CONCLUSION This study identified prematurity and a number of other factors linked to the child's general condition as risk factors for SWD. Some of these can help physicians recognize and respond to at-risk patients and provide better counseling for parents.
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Affiliation(s)
- Tina B S Miholjcic
- Division of Child and Adolescent Surgery, Department of Pediatrics, Gynecology, and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Olivier Baud
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Neonatal and Pediatric Intensive Care, Department of Pediatrics, Gynecology, and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - Pouya Iranmanesh
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Barbara E Wildhaber
- Division of Child and Adolescent Surgery, Department of Pediatrics, Gynecology, and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
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4
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Xu X, Zhou Y, Huang Y, Le Q, Lin L, Yu Z. Nursing Management of Abdominal Wound Dehiscence of an Infant With Severe Undernutrition and Peristomal Moisture-Associated Dermatitis After Ileostomy Closure: A Case Study. J Wound Ostomy Continence Nurs 2023; 50:331-336. [PMID: 37467414 DOI: 10.1097/won.0000000000000987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
BACKGROUND Abdominal wound dehiscence (AWD) is a costly postoperative complication; its management is particularly challenging for WOC nurses when it occurs secondary to an ostomy closure. CASE We present a case of AWD secondary to ileostomy closure in Baby Q, a 9-month 19-day-old female infant. A silver wound contact dressing was used on her dehisced wound followed by negative pressure wound therapy and adhesive tape to pull the wound edge together and promote granulation. We used a combination of enteral nutrition, parenteral nutrition, total parenteral nutrition, and total enteral nutrition adjusting the feeding plan stepwise according to her nutritional status. CONCLUSIONS Malnutrition and severe peristomal skin complications may contribute to the risk of AWD in infants undergoing reversal of a temporary ostomy. Assessing and treating nutritional status and peristomal skin is imperative before performing ostomy closure.
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Affiliation(s)
- Xiaofeng Xu
- Xiaofeng Xu, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Yiwen Zhou, MSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Ying Huang, MD, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Qian Le, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Lili Lin, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Zhuowen Yu, RN, MSN, WON, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Yiwen Zhou
- Xiaofeng Xu, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Yiwen Zhou, MSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Ying Huang, MD, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Qian Le, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Lili Lin, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Zhuowen Yu, RN, MSN, WON, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Ying Huang
- Xiaofeng Xu, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Yiwen Zhou, MSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Ying Huang, MD, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Qian Le, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Lili Lin, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Zhuowen Yu, RN, MSN, WON, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Qian Le
- Xiaofeng Xu, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Yiwen Zhou, MSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Ying Huang, MD, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Qian Le, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Lili Lin, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Zhuowen Yu, RN, MSN, WON, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Lili Lin
- Xiaofeng Xu, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Yiwen Zhou, MSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Ying Huang, MD, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Qian Le, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Lili Lin, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Zhuowen Yu, RN, MSN, WON, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Zhuowen Yu
- Xiaofeng Xu, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Yiwen Zhou, MSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Ying Huang, MD, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Qian Le, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Lili Lin, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Zhuowen Yu, RN, MSN, WON, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
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5
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Fu M, chen Y, Li J, Zhang X, Jiang X, Ou W, Chen K, Xiao W, Xie Y, Zhuang Y, Yang M, Shouxing D. Prediction values of a novel prognostic index hypoproteinemia combined with contaminated wounds for wound dehiscence after abdominal surgery in neonates.. [DOI: 10.21203/rs.3.rs-2517931/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Abstract
Background
Abdominal Wound Dehiscence (AWD), occupying a large proportion of neonatal surgery is an essential complication of abdominal surgery, which can leads to severe consequences, including life-threatening. This study aims at exploring prediction value for AWD with potential joint factors of hypoproteinemia and incision type.
Method
The Cox proportional-hazards model (the Cox model) was applied to analyze clinical data came from 453 patients underwent neonatal laparotomy from June 2009 to June 2020. According to application of the random numbers, 453 cases were divided into two separate models randomly involving training set with 318 observations (70%) and validation set with 135 observations (30%), and then the models trained were validated based on the validation set. Investigation in the connection between hypoproteinemia, incision type, combined factors and AWD, were used for comparing those prediction values for AWD.
Results
With a median follow-up of 15 months, the incidence of neonatal AWD was 6.0% (27/453). Based on the univariate and multivariate Analysis using the Cox Regression Analysis, hypoproteinemia(HR = 7.005, P = 0.001) and joint factor༈HR = 6.901, P < 0.001༉were both the independent risk factors for neonatal AWD in training set. Meanwhile, hypoproteinemia and joint factor༈HR = 5.497, P = 0.045༉were both also the independent risk factors for neonatal AWD in validation models, which indicated that joint factor was the independent risk factor in both models. The summary ROC curve was estimated, and the area under the ROC curve (AUC) was calculated as a criterion for validating the models trained. The findings illustrated that AUC of joint prediction factor for AWD was higher than either that of hypoproteinemia༈0.759 vs. 0.638) or incision type factor ༈0.759 vs. 0.671༉singly.
Conclusion
The contribution of hypoproteinemia and incision type combined factor for predicting AWD is superior than that of them individually, resulting in a significant promotion in prediction efficiency and accuracy of predicting neonatal AWD.
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Affiliation(s)
- Maxian Fu
- Huazhong university of science and technology union shenzhen hospital (Nanshan Hospital)
| | | | - Jianhong Li
- The Second Affiliated Hospital of Shantou University Medical College
| | - Xuan Zhang
- Pingshan District Maternal & Child Healthcare Hospital of Shenzhen, Pingshan General Hospital of Southern Medical University
| | - Xuewu Jiang
- Pingshan District Maternal & Child Healthcare Hospital of Shenzhen, Pingshan General Hospital of Southern Medical University
| | - Wenhui Ou
- The Second Affiliated Hospital of Shantou University Medical College
| | - Kaihong Chen
- The Second Affiliated Hospital of Shantou University Medical College
| | - Wenfeng Xiao
- The Second Affiliated Hospital of Shantou University Medical College
| | - Yao Xie
- Cancer Hospital of Shantou University Medical College
| | | | - Min Yang
- Shantou University Medical College
| | - Duan Shouxing
- Huazhong university of science and technology union shenzhen hospital (Nanshan Hospital)
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