Peritoneal needle suction for intestinal perforation in the preterm neonate.
A few years ago, most intestinal perforations in the premature newborn appeared within the clinical context of necrotising enterocolitis (NEC). Since then, we have observed an increase in the number of isolated perforations appearing outside typical NEC. The fact that the perforations are more often isolated, and the healing capabilities of the premature intestine, led us to propose peritoneal needle suction (PNS) alone as first treatment for intestinal perforations in the premature neonate.


METHODS
The charts of 6 consecutive premature infants presenting with intestinal perforations treated initially by PNS alone were reviewed.


RESULTS
The patients' median birth weight was 1030 g, with a median gestational age of 27 weeks. In 5 out of 6 infants (83 %), PNS achieved complete exsufflation without recurrence of the pneumoperitoneum and complete intestinal healing, allowing complete enteral feeding 30 to 71 days after perforation. One infant with recurrent pneumoperitoneum after 3 PNS and peritoneal drainage was operated. All infants survived.


CONCLUSIONS
We believe that for early perforations of the premature neonate, the poor diffusion of the infection and the frequent capacity of the perforation to close and subsequently heal without scars, favour a minimally invasive management using PNS.
Michel
J L
JL
Department of Paediatric Surgery, Felix Guyon Hospital, Saint-Denis, Reunion Island, France. jl-michel.@chd-fguyon.fr
Harper
L
L
Alessandri
J L
JL
Jacquemot
L
L
De Napoli-Cocci
S
S
Pilorget
H
H
Samperiz
S
S
D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007416:Intestinal Perforation / Q000150:complications / Q000628:therapy*; D009339:Needles; D010529:Peritoneal Cavity / Q000000981:diagnostic imaging; D011027:Pneumoperitoneum / Q000150:complications / Q000628:therapy*; D011859:Radiography; D013396:Suction / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome