title: Intestinal perforation in premature neonates: The need for subsequent laparotomy after placement of peritoneal drains.
abstract: OBJECTIVE
  In view of recent studies questioning the usefulness of peritoneal drainage (PD) in premature neonates with pneumoperitoneum, suggesting approximately 75% of those treated with PD needed delayed laparotomy, we reviewed the requirement for laparotomy after initial PD at our institution.
  
  
  METHODS
  Retrospective cohort of all premature infants with a diagnosis of intestinal perforation (ICD Code P78.0) from 1995 to 2012. Inclusion criteria were pneumoperitoneum on x-ray (isolated perforation or necrotising enterocolitis), birthweight <1800 g and gestational age <33 weeks.
  
  
  RESULTS
  Fifty patients met the criteria (38 PD, 12 primary laparotomy). Thirty-two per cent (95% CI 18-49%) received secondary laparotomy after initial PD. There was no significant difference when stratified according to isolated perforation (24%) versus necrotising enterocolitis (56%, P = 0.11). There was no significant difference between PD and primary laparotomy for time to full enteral nutrition, hazard ratio (HR) 0.99 (95% CI 0.48-2.04) or mortality, HR 2.15 (95% CI 0.48-9.63). The HR for mortality was partly confounded by birthweight, birthweight-adjusted HR 1.52 (95% CI 0.32-7.23).
  
  
  CONCLUSIONS
  Thirty-two per cent of neonates treated with primary PD received secondary laparotomy, with no significant difference in key outcomes. Primary PD still appears to be of benefit for those without features of necrotising enterocolitis.
authors.affiliation: Paediatric Surgery, Wellington Regional Hospital, Wellington, New Zealand.
authors.forename: Prabal
authors.initials: P
authors.lastname: Mishra
authors.affiliation: Paediatrics, Wellington Regional Hospital, Wellington, New Zealand.
authors.forename: David
authors.initials: D
authors.lastname: Foley
authors.affiliation: Department of Public Health, University of Otago, Wellington, New Zealand.
authors.forename: Gordon
authors.initials: G
authors.lastname: Purdie
authors.affiliation: Department of Obstetrics and Gynaecology, University of Otago, Wellington, New Zealand.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Pringle
mesh_terms: D015331:Cohort Studies; D003131:Combined Modality Therapy; D016001:Confidence Intervals; D016208:Databases, Factual; D004322:Drainage / Q000379:methods* / Q000401:mortality; D020345:Enterocolitis, Necrotizing / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D007416:Intestinal Perforation / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D007813:Laparotomy / Q000379:methods* / Q000401:mortality; D008297:Male; D020380:Needs Assessment; D009520:New Zealand; D011027:Pneumoperitoneum / Q000175:diagnosis / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome
keywords: intestinal perforation; necrotising enterocolitis; neonatal surgery; neonatology