title: [Role of peritoneal drainage in necrotizing enterocolitis in critical infants with extremely low birth weight].
abstract: BACKGROUND
  Peritoneal drainage is one of the options for treatment in necrotizing enterocolitis (NEC). Currently its role is controversial as an alternative to laparotomy in low birthweight and mortality associated with both procedures is high (35-55%).
  
  
  METHODS
  We reviewed 30 low-weight premature (< 1000 g) with NEC treated surgically. We evaluate the hemodynamic, respiratory and metabolic status of the patients, as well as multi-organ involvement and the need for inotropic drugs. These data were analyzed previos to surgery and at 6 and 12 hours. We divided the sample into two groups: those who underwent peritoneal drainage (PD) input or laparotomy (LAP).
  
  
  RESULTS
  In the series the average birth weight was 754 +/- 156 g and gestational age was 26.1 +/- 2.1 weeks. We carry on 10 peritoneal drainage and 20 laparotomies. The DP group before the intervention showed increased heart rate, FiO2 and acidosis (p < 0.05). The needs of dopamine were similar in both groups. Following the peritoneal drainage, we found breathing improvement (adequate ventilation and oxygenation, decreased FiO2) and hemodynamic improvement (blood pressure maintained, reduced heart rate, reduced requirements for dopamine) at 6 and 12 h. DP was not the definitive treatment in any of the patiens, and all survivors (80%) of this group required further laparotomy. 62% of them died. Overall mortality was 47% (70% DP and 35% LAP, p = 0.07).
  
  
  CONCLUSIONS
  Peritoneal drainage allowed the stabilization of low-weight premature in critical condition. The hemodynamic and respiratory stabilization was transient and did not prevent the definitive surgical treatment, although it improved the conditions for doing so. In our series, the peritoneal drainage did not improve long-term survival, questioning its role as an alternative to surgery for NEC.
authors.affiliation: Servicio Cirugía Pediátrica, Hospital Infantil Gregorio Marañón, Madrid. mariazornoza@gmail.com
authors.forename: M
authors.initials: M
authors.lastname: Zornoza
authors.forename: D
authors.initials: D
authors.lastname: Peláez
authors.forename: R
authors.initials: R
authors.lastname: Romero
authors.forename: C
authors.initials: C
authors.lastname: Corona
authors.forename: A
authors.initials: A
authors.lastname: Tardáguila
authors.forename: R
authors.initials: R
authors.lastname: Rojo
authors.forename: N
authors.initials: N
authors.lastname: Carrera
authors.forename: A
authors.initials: A
authors.lastname: Cañizo
authors.forename: E
authors.initials: E
authors.lastname: Molina
authors.forename: M A
authors.initials: MA
authors.lastname: García-Casillas
authors.forename: J
authors.initials: J
authors.lastname: Cerdá
mesh_terms: D016638:Critical Illness; D003663:Decision Trees; D004322:Drainage / Q000379:methods*; D020345:Enterocolitis, Necrotizing / Q000601:surgery*; D006801:Humans; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D010537:Peritoneum; D012189:Retrospective Studies