title: Surgical management of extremely low birth weight infants with neonatal bowel perforation: a single-center experience and a review of the literature.
abstract: BACKGROUND
  Necrotizing enterocolitis (NEC) and focal intestinal perforation (FIP) are major causes of morbidity in infants with extremely low birth weight (ELBW).
  
  
  OBJECTIVE
  To evaluate the surgical procedures applied, and the survival and long-term outcome of ELBW infants with NEC and FIP in a single-center study.
  
  
  METHODS
  Inborn and outborn ELBW infants (<1000 g) with NEC and FIP were analyzed retrospectively from 2002 to 2007. Data collected include surgical procedures, survival as well as complications, length of partial parenteral nutrition and hospital stay. The short-term and long-term outcomes after 2-7 years were assessed and compared with a matched control group.
  
  
  RESULTS
  Out of 280 ELBW infants, 28 underwent surgery, 19 because of FIP and 9 for NEC. Fourteen infants in the FIP group were treated with primary laparotomy and 5 with peritoneal drainage (PD). In the NEC group, only 1 infant was treated with PD. PD was used for unstable patients and was always followed by secondary laparotomy after stabilization. Five of 28 (18%) surgically treated ELBW infants and 4 (14%) matched controls died. The following complications occurred in the surgical group: complete (n = 1) or minor wound dehiscence (n = 4), stoma prolapse (n = 5), parastomal hernia (n = 2), stoma fistula (n = 1), and wound infection (n = 2). Dependency on parenteral nutrition was significantly shorter in infants with FIP, while there were no differences in time to stoma closure and length of hospital stay between those with FIP and those with NEC. Eleven of 23 (47.8%) surviving patients with FIP or NEC showed developmental delay, compared with 9 of 24 (37.5%) in the controls.
  
  
  CONCLUSIONS
  The management of EBLW infants with NEC and FIP remains challenging. Our treatment approach was associated with low mortality. Developmental delay seems to be caused by extreme prematurity rather than NEC- or FIP-related bowel perforation.
authors.affiliation: Department of Pediatric Surgery and Urology, University Children's Hospital, Tübingen, Germany. carmen.eicher@med.uni-tuebingen.de
authors.forename: Carmen
authors.initials: C
authors.lastname: Eicher
authors.forename: Guido
authors.initials: G
authors.lastname: Seitz
authors.forename: Andrea
authors.initials: A
authors.lastname: Bevot
authors.forename: Monika
authors.initials: M
authors.lastname: Moll
authors.forename: Rangmar
authors.initials: R
authors.lastname: Goelz
authors.forename: Joerg
authors.initials: J
authors.lastname: Arand
authors.forename: Christian
authors.initials: C
authors.lastname: Poets
authors.forename: Joerg
authors.initials: J
authors.lastname: Fuchs
mesh_terms: D000465:Algorithms; D020345:Enterocolitis, Necrotizing / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D007416:Intestinal Perforation / Q000150:complications / Q000151:congenital* / Q000401:mortality / Q000601:surgery*; D008297:Male; D012107:Research Design; D012189:Retrospective Studies