PDF(Pubmed)
Abstract：
BACKGROUND: Partial or complete thymectomy is routinely performed in paediatric open-heart surgeries when treating congenital heart defects. Whether or not thymectomised children require systematic immunological monitoring later in life is unknown. The objective of this study was to investigate the effects of preoperatively and postoperatively used antibiotics, hospitalisation and surgical complications on self-reported immunological vulnerability in paediatric patients with early thymectomy to better recognise the patients who could benefit from immunological follow-up in the future.
METHODS: We conducted a retrospective cohort study, including 98 children and adolescents aged 1-15 years, who had undergone an open-heart surgery and thymectomy in infancy and who had previously answered a survey regarding different immune-mediated symptoms and diagnoses. We performed a comprehensive chart review of preoperative and postoperative factors from 1 year preceding and 1 year following the open-heart surgery and compared the participants who had self-reported symptoms of immunological vulnerability to those who had not.
RESULTS: The median age at primary open-heart surgery and thymectomy was 19.5 days in the overall study population (60% men, n=56) and thymectomies mainly partial (80%, n=78). Broad-spectrum antibiotics were more frequently used preoperatively in participants with self-reported immunological vulnerability (OR=3.05; 95% CI 1.01 to 9.23). This group also had greater overall use of antibiotics postoperatively (OR=3.21; 95% CI 1.33 to 7.76). These findings were more pronounced in the subgroup of neonatally operated children. There was no statistically significant difference in the duration of intensive care unit stay, hospitalisation time, prevalence of severe infections, surgical complications or glucocorticoid use between the main study groups.
CONCLUSIONS: Antimicrobial agents were more frequently used both preoperatively and postoperatively in thymectomised children with self-reported immunological vulnerability after thymectomy. Substantial use of antimicrobial agents early in life should be considered a potential risk factor for increased immunological vulnerability when evaluating the significance of immune-mediated symptom occurrence in thymectomised paediatric patients.
METHODS: We conducted a retrospective cohort study, including 98 children and adolescents aged 1-15 years, who had undergone an open-heart surgery and thymectomy in infancy and who had previously answered a survey regarding different immune-mediated symptoms and diagnoses. We performed a comprehensive chart review of preoperative and postoperative factors from 1 year preceding and 1 year following the open-heart surgery and compared the participants who had self-reported symptoms of immunological vulnerability to those who had not.
RESULTS: The median age at primary open-heart surgery and thymectomy was 19.5 days in the overall study population (60% men, n=56) and thymectomies mainly partial (80%, n=78). Broad-spectrum antibiotics were more frequently used preoperatively in participants with self-reported immunological vulnerability (OR=3.05; 95% CI 1.01 to 9.23). This group also had greater overall use of antibiotics postoperatively (OR=3.21; 95% CI 1.33 to 7.76). These findings were more pronounced in the subgroup of neonatally operated children. There was no statistically significant difference in the duration of intensive care unit stay, hospitalisation time, prevalence of severe infections, surgical complications or glucocorticoid use between the main study groups.
CONCLUSIONS: Antimicrobial agents were more frequently used both preoperatively and postoperatively in thymectomised children with self-reported immunological vulnerability after thymectomy. Substantial use of antimicrobial agents early in life should be considered a potential risk factor for increased immunological vulnerability when evaluating the significance of immune-mediated symptom occurrence in thymectomised paediatric patients.
摘要：
背景：在小儿心脏直视手术中，当治疗先天性心脏缺陷时，常规进行部分或完全胸腺切除术。尚不清楚胸腺切除儿童在以后的生活中是否需要进行系统的免疫学监测。这项研究的目的是调查术前和术后使用抗生素的效果，早期胸腺切除术的儿科患者自我报告的免疫脆弱性的住院和手术并发症，以更好地识别将来可能从免疫随访中受益的患者。
方法：我们进行了一项回顾性队列研究，包括98名1-15岁的儿童和青少年，他在婴儿期接受了心脏直视手术和胸腺切除术，并且以前回答了关于不同免疫介导症状和诊断的调查。我们对心脏直视手术前1年和术后1年的术前和术后因素进行了全面的图表回顾，并将自我报告有免疫脆弱性症状的参与者与未报告的参与者进行了比较。
结果：在整个研究人群中，初次心脏直视手术和胸腺切除术的中位年龄为19.5天（60％的男性，n=56)和胸腺切除术主要是部分(80%，n=78）。在自我报告免疫易损性的参与者中，术前使用广谱抗生素的频率更高（OR=3.05；95％CI1.01至9.23）。该组术后抗生素的总体使用也更多（OR=3.21；95％CI1.33至7.76）。这些发现在新生儿手术儿童的亚组中更为明显。重症监护病房住院时间差异无统计学意义,住院时间,严重感染的患病率，主要研究组之间的手术并发症或糖皮质激素使用。
结论：在胸腺切除术后自我报告免疫易损性的胸腺切除患儿中，在术前和术后使用抗菌药物更为频繁。在评估胸腺切除的儿科患者中免疫介导的症状发生的重要性时，应将生命早期大量使用抗菌药物视为增加免疫脆弱性的潜在风险因素。
方法：我们进行了一项回顾性队列研究，包括98名1-15岁的儿童和青少年，他在婴儿期接受了心脏直视手术和胸腺切除术，并且以前回答了关于不同免疫介导症状和诊断的调查。我们对心脏直视手术前1年和术后1年的术前和术后因素进行了全面的图表回顾，并将自我报告有免疫脆弱性症状的参与者与未报告的参与者进行了比较。
结果：在整个研究人群中，初次心脏直视手术和胸腺切除术的中位年龄为19.5天（60％的男性，n=56)和胸腺切除术主要是部分(80%，n=78）。在自我报告免疫易损性的参与者中，术前使用广谱抗生素的频率更高（OR=3.05；95％CI1.01至9.23）。该组术后抗生素的总体使用也更多（OR=3.21；95％CI1.33至7.76）。这些发现在新生儿手术儿童的亚组中更为明显。重症监护病房住院时间差异无统计学意义,住院时间,严重感染的患病率，主要研究组之间的手术并发症或糖皮质激素使用。
结论：在胸腺切除术后自我报告免疫易损性的胸腺切除患儿中，在术前和术后使用抗菌药物更为频繁。在评估胸腺切除的儿科患者中免疫介导的症状发生的重要性时，应将生命早期大量使用抗菌药物视为增加免疫脆弱性的潜在风险因素。
