title: Peritoneal drainage as the initial management of intestinal perforation in premature infants.
abstract: Complicated necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) are major causes of mortality. We hypothesized that peritoneal drainage (PD) is more efficacious in SIP. Newborn infants with intestinal perforation treated with PD at our institution between 2007 and 2012 were divided into two groups: Group 1, infants with complicated NEC (n = 19), and Group 2, infants with SIP (n = 15). In Group 1, median birth weight was 705 g; median gestational age was 25.9 weeks. Median age at PD was 24 days. Six required laparotomy. Median time from PD to enteral feeds was 22.5 days. In Group 2, median birth weight was 685 g; median gestational age was 25.3 weeks. Median age at PD was 5 days. Two required laparotomy. Median time from PD to enteral feeds was 16 days. In Group 1, eight patients survived to discharge; median length of hospital stay (LOS) was 104.5 days. In Group 2, eight survived; median LOS was 109.5 days. Neither outcome was statistically significant (P = 0.73 and 0.878, respectively). Management of premature infants with intestinal perforation remains challenging. Mortality is high. Between our cohorts, there were no differences in regard to PD as definitive therapy, survival, and LOS.
authors.affiliation: Department of Surgery, Division of Pediatric Surgery, University of Kentucky, Lexington, Kentucky, USA.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Stokes
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Iocono
authors.forename: John M
authors.initials: JM
authors.lastname: Draus
mesh_terms: D004322:Drainage / Q000379:methods*; D020345:Enterocolitis, Necrotizing / Q000401:mortality / Q000628:therapy; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000628:therapy*; D007416:Intestinal Perforation / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D007813:Laparotomy; D008297:Male; D010529:Peritoneal Cavity; D011027:Pneumoperitoneum / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome