title: Peritoneal drainage versus laparotomy for perforated necrotising enterocolitis or spontaneous intestinal perforation: a retrospective cohort study.
abstract: OBJECTIVE
  Perforated necrotising enterocolitis (NEC) and spontaneous intestinal perforation (SIP) in preterm infants are associated with high morbidity and mortality. The optimum surgical management during the acute stage remains unclear. The aim of the study was to compare the outcomes of preterm infants (gestational age at birth <30 weeks) with perforated NEC or SIP undergoing primary peritoneal drainage (PD) versus laparotomy.
  
  
  METHODS
  This was a retrospective cohort study (January 2004 to February 2010). Initial search of hospital database followed by a review of the medical records was performed to identify eligible infants. Thirty-nine infants were included in the study. Information regarding the baseline characteristics and outcomes of interest were recorded using the medical charts, radiology and laboratory databases. NEC was differentiated from SIP based on radiological, operative and clinical findings retrospectively for this study.
  
  
  RESULTS
  Among 39 infants, 19 underwent primary PD while 20 had primary laparotomy. Gestational age and birthweight were similar between the two groups. The composite outcome of mortality before discharge or hospital stay longer than 3 months post-term was significantly worse in PD group (74% vs. 40%, P= 0.038).
  
  
  CONCLUSIONS
  Preterm infants undergoing PD for NEC/SIP appeared to have increased risk of adverse outcome compared with laparotomy. More randomised controlled trials are necessary to confirm these findings.
authors: Telethon Institute for Child Health Research, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.
authors: Abhijeet
authors: A
authors: Rakshasbhuvankar
authors: Shripada
authors: S
authors: Rao
authors: Corrado
authors: C
authors: Minutillo
authors: Ian
authors: I
authors: Gollow
authors: Satish
authors: S
authors: Kolar
mesh_terms: D015331:Cohort Studies; D016208:Databases, Factual; D004322:Drainage; D020345:Enterocolitis, Necrotizing / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D007416:Intestinal Perforation / Q000601:surgery*; D008297:Male; D008485:Medical Audit; D010537:Peritoneum / Q000601:surgery; D012189:Retrospective Studies; D012422:Rupture, Spontaneous; D013514:Surgical Procedures, Operative / Q000379:methods*