To drain or not to drain: a single institution experience with neonatal intestinal perforation.
OBJECTIVE
The optimal surgical treatment for extremely-low-birth-weight (ELBW) neonates with pneumoperitoneum is controversial. This study aimed to identify clinical factors associated with two known causes of pneumoperitoneum-necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP), and assesses the treatment outcome with primary peritoneal drainage (PPD) vs. laparotomy.


METHODS
We reviewed and analyzed clinical characteristics and outcome from records of neonates with pneumoperitoneum treated at our institution from January 1999 to January 2003.


RESULTS
Forty-six neonates (31 NEC, 15 SIP) were treated with either PPD (20 with NEC, 13 with SIP) or laparotomy (11 with NEC, 2 with SIP). In neonates who underwent PPD, those with NEC (vs. SIP) were less likely to have a patent ductus arteriosus, but were more likely to have been fed, have drains placed later in life, have a subsequent laparotomy, a longer total parental nutrition course, a higher 30-day mortality, and to take more days to begin enteral feeds.


CONCLUSIONS
The etiology of pneumoperitoneum (NEC vs. SIP) in ELBW neonates can usually be determined preoperatively. Neonates with SIP should have a drain placed while those with NEC should undergo laparotomy.
Chiu
Bill
B
Children's Memorial Hospital, 2300 Children's Plaza, Box 63, Chicago, IL 60614, USA.
Pillai
Srikumar B
SB
Almond
P Stephen
PS
Beth Madonna
Mary
M
Reynolds
Marleta
M
Luck
Susan R
SR
Arensman
Robert M
RM
D004322:Drainage; D020345:Enterocolitis, Necrotizing / Q000150:complications / Q000601:surgery / Q000628:therapy; D006801:Humans; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007416:Intestinal Perforation / Q000150:complications / Q000601:surgery / Q000628:therapy*; D007813:Laparotomy; D011027:Pneumoperitoneum / Q000209:etiology / Q000601:surgery / Q000628:therapy*