title: Octreotide in a Critically Ill Extremely Preterm Infant With Perforated Necrotizing Enterocolitis.
abstract: Necrotizing enterocolitis (NEC) is the most severe gastrointestinal complication of prematurity. Surgery, either peritoneal drainage placement or laparotomy with resection of the intestinal necrotic tracts, is the definitive treatment of perforated NEC; however, when clinical conditions contraindicate surgical approaches, little is known about medical treatments adjuvant or alternative to surgery. Octreotide is a synthetic somatostatin analog that inhibits pancreatic secretion and leads to splanchnic vasoconstriction. In preterm neonates, it is mainly used off-label for chylothorax and congenital hyperinsulinism, whereas gastrointestinal indications are limited. We describe the case of a critically ill extremely low birth weight infant with perforated NEC, who had unsuccessfully undergone peritoneal drainage placement and laparotomy. Her unstable condition contraindicated a further laparotomy, thus off-label treatment with octreotide was attempted. No adverse events occurred. The infant's condition gradually improved and progressive reduction of peritoneal outputs and successful resolution of pneumoperitoneum were achieved, with no relapse after octreotide discontinuation.
authors.affiliation: Departments of Medical and Surgical Sciences, Neonatal Intensive Care Unit, and silvia.martini4@gmail.com.
authors.forename: Silvia
authors.initials: S
authors.lastname: Martini
authors.affiliation: Departments of Medical and Surgical Sciences, Neonatal Intensive Care Unit, and.
authors.forename: Arianna
authors.initials: A
authors.lastname: Aceti
authors.affiliation: Paediatric Surgery, St Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Lima
authors.affiliation: Paediatric Surgery, St Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Maffi
authors.affiliation: Departments of Medical and Surgical Sciences, Neonatal Intensive Care Unit, and.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Faldella
authors.affiliation: Departments of Medical and Surgical Sciences, Neonatal Intensive Care Unit, and.
authors.forename: Luigi
authors.initials: L
authors.lastname: Corvaglia
mesh_terms: D016638:Critical Illness; D020345:Enterocolitis, Necrotizing / Q000150:complications / Q000188:drug therapy*; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007416:Intestinal Perforation / Q000150:complications / Q000188:drug therapy*; D007813:Laparotomy; D015282:Octreotide / Q000627:therapeutic use*; D012074:Remission Induction
chemical_list: D005765:Gastrointestinal Agents; D015282:Octreotide