title: Peritoneal drainage as primary management in necrotizing enterocolitis: a prospective study.
abstract: OBJECTIVE
  The use of peritoneal drainage (PD) in neonates with necrotizing enterocolitis (NEC) is controversial. The authors began to perform it successfully in infants with pneumoperitoneum, and subsequently they extended its use to infants with peritonitis and advanced NEC before radiologic evidence of peritoneal free air. To analyze the efficacy of PD they began a prospective study.
  
  
  METHODS
  A prospective study was conducted in 6 neonatal intensive care units (NICU) in Spain: neonates with pneumoperitoneum or peritonitis and advanced NEC were all included, whatever the birth weight and gestational age (GA).
  
  
  RESULTS
  PD was performed in 47 infants, but 3 of them were excluded because pneumoperitoneum was caused by pathologies other than NEC. In a cohort of 44 infants, 86% improved after PD, and 64% survived after only PD. After PD, 54% of infants needed delayed surgery. Overall survival rate was 82%; 57% infants with birth weight under 1,000 g, and 95% in infants over 1,000 g at birth. The main cause of mortality was massive NEC in the tiniest babies. Only one infant had a short bowel syndrome.
  
  
  CONCLUSIONS
  From the authors' point of view, PD is the first step in treating neonates with pneumoperitoneum or overwhelming NEC, regardless of birth weight and GA. Laparotomy, if it is necessary, always must be performed after clinical stability is achieved. Mortality rates remain higher in the tiniest babies because of massive NEC.
authors.affiliation: Hospital de Barcelona, SCIAS, Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Demestre
authors.forename: Gemma
authors.initials: G
authors.lastname: Ginovart
authors.forename: Josep
authors.initials: J
authors.lastname: Figueras-Aloy
authors.forename: Roser
authors.initials: R
authors.lastname: Porta
authors.forename: Xavier
authors.initials: X
authors.lastname: Krauel
authors.forename: Alfredo
authors.initials: A
authors.lastname: Garcia-Alix
authors.forename: Frederic
authors.initials: F
authors.lastname: Raspall
mesh_terms: D001724:Birth Weight; D004322:Drainage / Q000379:methods*; D020345:Enterocolitis, Necrotizing / Q000150:complications / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D007813:Laparotomy; D010538:Peritonitis / Q000209:etiology / Q000628:therapy; D011027:Pneumoperitoneum / Q000209:etiology / Q000628:therapy; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome