Peritoneal drainage does not stabilize extremely low birth weight infants with perforated bowel: data from the NET Trial.
BACKGROUND
Proponents of peritoneal drainage (PD) hypothesize that it allows stabilization before laparotomy. We examined this hypothesis by comparing clinical status before and after either PD or primary laparotomy (LAP).


METHODS
In an ethically approved, international, prospective randomized controlled trial (2002-2006), extremely low birth weight (<1000 g) infants with pneumoperitoneum received primary PD (n = 35) or LAP (n = 34). Physiologic data were collected prospectively and organ failure scores calculated and compared between preprocedure and day 1 after procedure. Data, expressed as mean +/- SD or median (range), were analyzed using appropriate statistical tests.


RESULTS
There was no postprocedure improvement in either PD or LAP group comparing heart rate (PD, P = 1.0; LAP, P = .6), blood pressure (PD, P = .6; LAP, P = .8), inotrope requirement (PD, P = .2; LAP, P = .3), or Arterial partial pressure of oxygen/fraction of inspired oxygen ratio (PD, P = .1; LAP, P = .5). Infants managed with PD had a worsening cardiovascular status (P = .05). There were no differences in total organ failure score in either group (PD, P = .5; LAP, P = 1). Only 4 infants survived with PD alone with no difference between preprocedure and postprocedure organ failure score (P = .4).


CONCLUSIONS
Peritoneal drainage does not immediately improve clinical status in extremely low birth weight infants with bowel perforation. The use of PD as a stabilizing or temporizing measure is not supported by these results.
Department of Pediatric Surgery, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, London WC1N 1EH, United Kingdom.
Clare M
CM
Rees
Simon
S
Eaton
A Kate
AK
Khoo
Edward M
EM
Kiely
Agostino
A
Pierro
D004322:Drainage / Q000379:methods*; D020345:Enterocolitis, Necrotizing / Q000601:surgery*; D006801:Humans; D052577:Infant, Extremely Low Birth Weight / Q000502:physiology; D007231:Infant, Newborn; D007234:Infant, Premature; D007416:Intestinal Perforation / Q000601:surgery*; D007813:Laparotomy / Q000379:methods*; D009102:Multiple Organ Failure / Q000175:diagnosis / Q000453:epidemiology; D010537:Peritoneum / Q000601:surgery; D011027:Pneumoperitoneum / Q000601:surgery; D011182:Postoperative Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011300:Preoperative Care; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome