[Role of peritoneal drainage in very low birth weight with enterocolitis].
Peritoneal drainage (PD) has been proposed as a temporizing procedure for perforated necrotizing enterocolitis (NEC) in very low birth weight neonates. This operation was designed for patients considered too unstable to undergo laparotomy (LAP). Since the introduction of PD some investigators have suggested that it may serve as a definitive therapy. The aim of our study is to determine the efficacy of PD for the stabilization of patients with complicated NEC and its utility as a definitive surgical treatment.


METHODS
We review the clinical records from all the patients treated in our unit because of NEC that required surgical therapy. We analyze the mean blood pressure, cardiac and respiratory rate, inspired oxygen concentration, mean airway pressure, diuresis, and arterial blood gases measured 6 and 12 hours after the initial surgical treatment. We divide patients in two different groups according to the initial surgical procedure, peritoneal drainage (PD) or laparotomy group (LAP). Data is shown as media +/- standard deviation, statistical analyses were performed using analysis of variance (ANOVA) for repeated measures and Mann-Withney test.


RESULTS
From January 1997 to January 2001 we treated 13 patients with necrotizing enterocolitis that required surgical treatment. Among this group 6 patients were managed initially with PD and 7 with LAP. The gestational age media was 29.07 +/- 3.81 weeks and the birth weight mean 1199.76 +/- 521 gr., without any significant differences between the two groups DP and LAP. All patients improved haemodynamically and respiratory 6 and 12 hours after the surgical treatment. Nevertheless, the mean blood pressure improved even more in the DP group (p<0.005). The DP group showed an improvement in all parameters 6 hours after the drainage was placed, but this effect wasn't maintained for the next 12 hours onwards. From the 12 hours after PD all patients suffered a steady worsening that required further surgical procedures. The overall mortality was 3 patients (23%), without differences between the two groups. The surgical techniques performed (bowel resection, diversion) were similar for both groups.


CONCLUSIONS
DP allows the stabilization for very critically ill patients with complicated NEC. However, this stabilization is temporary. This improvement lasts for a few hours providing a better status for the definitive surgical treatment for the perforated NEC. In our experience DP could not be considered as a definitive surgical treatment.
Romero
R M
RM
Servicio de Cirugía Pediátrica, Unidad de Cuidados Intensivos Neonatales, Hospital Infantil Universitario Gregorio Marañón. romero_online@mac.com
García-Casillas
M A
MA
Matute
J A
JA
Barrientos
G
G
Zamora
E
E
Megías
A
A
Cerdá
J
J
Sánchez
R
R
Franco
M L
ML
Molina
E
E
Vázquez
J A
JA
D002675:Child, Preschool; D004760:Enterocolitis / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D013396:Suction / Q000379:methods*