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Intestinal perforation in premature neonates: The need for subsequent laparotomy after placement of peritoneal drains
Author(s) -
Mishra Prabal,
Foley David,
Purdie Gordon,
Pringle Kevin C
Publication year - 2016
Publication title -
journal of paediatrics and child health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.631
H-Index - 76
eISSN - 1440-1754
pISSN - 1034-4810
DOI - 10.1111/jpc.13013
Subject(s) - medicine , laparotomy , necrotizing enterocolitis , pneumoperitoneum , perforation , gestational age , surgery , retrospective cohort study , enteral administration , parenteral nutrition , pediatrics , laparoscopy , pregnancy , materials science , genetics , biology , punching , metallurgy
Aim 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% C I 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.