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Risk factors for perioperative hypothermia and infectious outcomes in gastroschisis patients
Christina M Bence1, Rachel M Landisch1, Ruizhe Wu2
1Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, 999 North 92nd Street, Suite CCC 320, Milwaukee, WI 53226, United States.
Insights
Infants with gastroschisis (a birth defect) are at high risk for hypothermia and infections. This study found perioperative hypothermia (low body temperature) was not linked to increased infectious complications in these infants.
Area of Science:
- Neonatal surgery
- Pediatric surgery
- Surgical critical care
Background:
- Infants with gastroschisis face significant risks of hypothermia and infectious complications (ICs).
- Understanding the relationship between perioperative hypothermia (PH) and ICs is crucial for improving outcomes in gastroschisis management.
- This study investigates the association between PH and ICs in a multi-institutional cohort of infants with gastroschisis.
Purpose of the Study:
- To evaluate the association between perioperative hypothermia (PH) and infectious complications (ICs) in neonates with gastroschisis.
- To identify factors associated with PH and surgical site infections (SSIs) in this patient population.
Main Methods:
- A retrospective review was conducted on infants with gastroschisis who underwent abdominal closure between 2013 and 2017 across seven children's hospitals.
- Infectious complications (any-IC and SSI) were analyzed in relation to the presence or absence of PH.
- Multivariable logistic regression was used to determine perioperative characteristics associated with PH and SSI.
Main Results:
- Of 256 neonates, 42% experienced PH, with varying degrees of severity.
- No significant association was found between PH and any IC (p=0.7) or SSI (p=0.98).
- Pulmonary comorbidities and primary abdominal closure were associated with PH, while silo placement and prosthetic patch closure were linked to SSI.
Conclusions:
- Perioperative hypothermia was not associated with an increased risk of infectious complications in infants with gastroschisis.
- Primary abdominal closure and pulmonary comorbidities are risk factors for PH.
- Silo placement and prosthetic patch closure are independent risk factors for surgical site infections in gastroschisis.
Introduction:
Prior data suggest that infants with gastroschisis are at high risk for hypothermia and infectious complications (ICs). This study evaluated the associations between perioperative hypothermia (PH) and ICs in gastroschisis using a multi-institutional cohort.
Methods:
Retrospective review of infants with gastroschisis who underwent abdominal closure from 2013-2017 was performed at 7 children's hospitals. Any-IC and surgical site infection (SSI) were stratified against the presence or absence of PH, and perioperative characteristics associated with PH and SSI were determined using multivariable logistic regression.
Results:
Of 256 gastroschisis neonates, 42% developed PH, with 18% classified as mild hypothermia (35.5-35.9 °C), 10.5% as moderate (35.0-35.4 °C), and 13% severe (<35 °C). There were 82 (32%) ICs with 50 (19.5%) being SSIs. No associations between PH and any-IC (p = 0.7) or SSI (p = 0.98) were found. Pulmonary comorbidities (odds ratio (OR)=3.76, 95%CI:1.42-10, p = 0.008) and primary closure (OR=0.21, 95%CI:0.12-0.39, p<0.001) were associated with PH, while silo placement (OR=2.62, 95%CI:1.1-6.3, p = 0.03) and prosthetic patch (OR=3.42, 95%CI:1.4-8.3, p = 0.007) were associated with SSI on multivariable logistic regression.
Conclusions:
Primary abdominal closure and pulmonary comorbidities are associated with PH in gastroschisis, however PH was not associated with increased risk of ICs. Independent risk factors for SSI include silo placement and prosthetic patch closure.
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