title: Treatment of intestinal perforation in extremely low-birthweight infants.
abstract: BACKGROUND
  The mortality of intestinal perforation in extremely low-birthweight infants (ELBWI) is high. It still remains to be determined whether peritoneal drainage is a definitive treatment instead of laparotomy. The authors used bedside peritoneal drainage (BSPD) as the diagnostic procedure, and exchange transfusion (ET) as the preparatory procedure for invasive stress of laparotomy. The treatment protocol is composed primarily of laparotomy combined with BSPD and ET.
  
  
  METHODS
  ELBWI who developed intestinal perforation during hospitalization between 1993 and 2000 were treated according to the aforementioned protocol. Their medical records were examined retrospectively.
  
  
  RESULTS
  Eight ELBWI were identified. The subjects' birthweights ranged from 553 to 892 g and the gestational age ranged from 23 to 26 weeks. The subjects consisted of five cases with idiopathic intestinal perforation, two cases with necrotizing enterocolitis, and one case with meconium plug syndrome. Laparotomy was performed in all cases, and BSPD was performed in seven cases. Intestinal perforation was definitively diagnosed by X-ray only in three cases, while by stool-like drainage in BSPD in the other five cases. Seven (87.5%) cases survived.
  
  
  CONCLUSIONS
  In this limited experience, the treatment mainly composed of laparotomy combined with BSPD and ET appeared beneficial.
authors.affiliation: Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan. kawakamiakihiro@kantoh.rofuku.go.jp
authors.forename: Akihiro
authors.initials: A
authors.lastname: Kawakami
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Shirakawa
authors.forename: Akira
authors.initials: A
authors.lastname: Shirahata
authors.forename: Kouichi
authors.initials: K
authors.lastname: Yano
authors.forename: Masaru
authors.initials: M
authors.lastname: Morita
authors.forename: Kimimasa
authors.initials: K
authors.lastname: Yasumoto
mesh_terms: D004322:Drainage; D005078:Exchange Transfusion, Whole Blood; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000628:therapy*; D019102:Infant, Very Low Birth Weight; D007416:Intestinal Perforation / Q000628:therapy*; D008297:Male; D012189:Retrospective Studies