2024/12/31 by BenRabehTrabelsi, R., Boukthir S, Brini I +3
#Newborns #endoscopie digestive haute #facteurs pré- dictifs #gastrointestinalendoscopy #hémorragie digestive haute #nouveau-né #predictivefactors #upper gastrointestinal bleeding
paper · doi:10.71566/pist-rmp-194925
Background:Uppergastrointestinalbleeding(UGIB)isacommonemergencyintheneonatalperiodespe- ciallyincriticallyillneonates. Theoccurrenceofseveremucosallesions(SML)ofUGItractisrelativelyfre- quent. Esophago-gastro-duodenalendoscopy(OGDE)isthefirstexaminationtoidentifymucosallesions. Howeveritisaninvasiveprocedureandisunavailableinmanydigestiveendoscopyunitsinourcountry. ThereforeitwouldbeusefultoidentifypredictivefactorsofSMLtoavoidunnecessaryinvasiveexamination in neonates and to allow better management of OGDE in this age group. Aim :Describe endoscopic findings infull-term neonateswithUGIBandidentifyclinicalfactorsas- sociated with the presence of SML. Methods: Retrospective study including full-term newbornswithUGIBwhounderwentOGDE,car- ried out in pediatric endoscopy unit of Tunis Child- ren’s Hospital from January 2007 to December 2013. Hemostasisdisorderswereexcluded. SML were erosive and ulcerative lesions, ulcers, tumors and stigmata of recent hemorrhage such as an ad- herentclotoranarterialbleeding. Univariateand multivariateanalysiswereperformedtoidentify predictive factors of SML. Results:86 full-term newborns wereincluded. Themeanagewas10±9. 4days. Thepresentation ofUGIBwashaematemesisinallcases. Wefound a clinically significant bleeding (CSB) in 28 cases (32. 6%). We found mucosal lesions in 77 cases (89. 5%):69casesofneonatalesogastroduodenitis (80. 2%),sixcasesofpepticesophagitis(7%),one case of gastric angioma and one case of gastric tumor(teratoma). SMLwere reported in 45 cases (52. 3%). Univariate analysis foundthat SMLwere significantly associated with pathological perina- talandneonatalhistory(p=0. 011),caesareansec- tiondelivery(p=0. 002),poorweightgain(p=0. 011), CSB (p=0. 001), rebleeding (p=0. 001), tachycar- dia(p<0. 001)anddecreasingofhemoglobinlevel (p<0. 001) Multivariate logistic regression found four clinical and laboratory predictive factors of SML:CSB(AdjustedOR:4. 3,CI95%[1-26. 4]),re-bleeding(AdjOR:4. 5[1-33. 6]),tachycardia(AdjOR:4 [1-21. 7]) and decreasing ofhemoglobin level (Ad- jOR: 7. 2 [1-84. 4]). Conclusion:These factors mayallowneonatologist toidentifyneonateswhomayrequireendoscopic examination and therefore better management of OGDE in this age group. These results are interes- tingbutprospectivestudyisrequiredtovalidate and improve our results.