Outcome of primary peritoneal drainage in perforated necrotizing enterocolitis: an experience with 96 infants
DOI:
https://doi.org/10.18203/2349-2902.isj20211914Keywords:
Necrotizing enterocolitis, Pneumatosis intestinalis, Primary peritoneal drainageAbstract
Background: Necrotizing enterocolitis is a life-threatening inflammation of neonatal intestine of multifactorial etiology. In early stages, medical management is considered; while as a transmural disease with pneumatosis or perforation needs surgical attention. Primary peritoneal drainage has evolved as an alternative to classic exploratory laparotomy especially in sick preterm and very low birth weight infants.
Methods: In our study, we tried to employ primary peritoneal drainage as an initial intervention in all surgical necrotizing enterocolitis patients and analyzed the results and final outcome in terms of total days in neonatal intensive care unit, total parenteral nutrition days, days to start oral feeds, need for laparotomy, mortality and other complications.
Results: Around one-third patients were either very low or extremely low birth weight and 80% patients were preterm. Primary peritoneal drainage was successful without need for laparotomy in around 65% of patients. In the rest 34 patients, 24 were subjected to rescue laparotomy, while 10 could not be stabilized for major surgery. Overall mortality was 29.16%.
Conclusions: Early bedside primary peritoneal drainage can be employed in all cases of NEC with perforation with rescue laparotomy to be determined by subsequent monitoring. This strategy seems to be safe and cost-effective in a resource challenged set up and lifesaving in sick and extremely low birth weight infants.
References
Fitzgibbons SC, Ching Y, Yu D, Jaksic T. Mortality of necrotizing enterocolitis expressed by low-birth-weight categories. J Pediatr Surg. 2009;44:1072-5.
Warner BB, Deych E, Zhou Y, Hall-Moore C, Weinstock GM, Sodergren E, et al. Gut bacteria dysbiosis and necrotising enterocolitis in very low birthweight infants: a prospective case-control study. Lancet. 2016;387(10031):1928-36.
Xiong T, Maheshwari A, Neu J. An Overview of Systematic Reviews of Randomized-Controlled Trials for Preventing Necrotizing Enterocolitis in Preterm Infants. Neonatology. 2020;117:46-56.
Nino D, Sodhi C, Hackam D. Necrotizing enterocolitis: new insights into pathogenesis and mechanisms. Nat Rev Gastroenterol Hepatol. 2016;13:590-600.
Moss RL, Dimmitt RA, Barnhart DC. Laparotomy versus Peritoneal Drainage for Necrotizing Enterocolitis and Perforation. N Engl J Med. 2006;354:2225-34.
Ein SH, Shandling B, Wesson D. A 13-year experience with peritoneal drainage under local anaesthesia for necrotizing enterocolitis. J Pediatr Surg. 1990;25:1034-7.
Cheu HW, Sukarochana K, Lloyd DA. Peritoneal drainage for necrotizing enterocolitis. J Pediatr Surg. 1988;23:557-61.
Demestre X, Ginovert G, Figueras-Aloy J, Porta R, Krauel X, Garcia-Alix A et al. Peritoneal drainage as primary management in necrotizing enterocolitis. A prospective study. J Pediatr Surg. 2002;37(11):1543-39.
Azarow KS, Ein SH, Shandling B, Wesson D, Superina R, Filler RM. Laparotomy or drain for perforated necrotizing enterocolitis: who gets what and why? Pediatr Surg Int. 1997;12:137-9.
Ehrlich PF, Sato TT, Short BL, Hartman GE. Outcome of perforated necrotizing enterocolitis in the very low-birth weight neonate may be independent of the type of surgical treatment. Am Surg. 2001;67:752-6.
Blakely ML, Lally KP, McDonald S. Postoperative outcomes of extremely low birth-weight infants with necrotizing enterocolitis or isolated intestinal perforation: a prospective cohort study by the NICHD Neonatal Research Network. Ann Surg. 2005;241:984-9.
Moschopoulos C, Kratimenos P, Koutroulis I. The Neurodevelopemental Perspective of Surgical Necrotizing Enterocolitis: The role of GUT-Brain Axis. Mediators Inflamm 2018;11;2018:7456857.
Gorra AS, Howard N, Azarow KS. Long-term neurodevelopmental outcomes in children born with gastroschisis: the tiebreaker. J Pediatr Surg. 2012;47:125-9.
Goyal A, Manalang LR, Donnell SC. Primary peritoneal drainage in necrotising enterocolitis: an 18-year experience. Ped Surgery Int. 2006;22:449-52.
