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Peritoneal drainage as definitive management of intestinal perforation in extremely low-birth-weight infants

Gerald Gollin1, Aaron Abarbanell, Joanne E Baerg

  • 1Division of Pediatric Surgery, Loma Linda University School of Medicine and Children's Hospital, Loma Linda, CA 92354, USA.

Journal of Pediatric Surgery
|December 11, 2003
PubMed

Insights

Peritoneal drainage (PD) for extremely low-birth-weight (ELBW) infants with intestinal perforation offers comparable survival to laparotomy. However, this approach leads to delayed enteral feeding and significant infectious complications and cholestasis.

Area of Science:

  • Neonatal Surgery
  • Pediatric Gastroenterology
  • Critical Care Medicine

Background:

  • Intestinal perforation in extremely low-birth-weight (ELBW) infants presents management challenges.
  • Optimal therapeutic strategies for ELBW infants with intestinal perforation are not well-defined.

Purpose of the Study:

  • To evaluate the outcomes of peritoneal drainage (PD) as definitive therapy for intestinal perforation in ELBW neonates.
  • To compare PD outcomes with those of immediate laparotomy and resection.

Main Methods:

  • Retrospective review of 29 consecutive ELBW infants undergoing PD for intestinal perforation.
  • Assessment of survival rates, need for secondary abdominal procedures, time to enteral feeding, and incidence of cholestasis and infectious complications.
  • Analysis of variables associated with nonsurvival.

Main Results:

  • Overall survival rate was 66%.
  • 24% of infants required a second abdominal procedure.
  • Full enteral feeding was achieved at a mean of 69 days.
  • 63% of survivors experienced extra-abdominal infectious complications; 57% had elevated direct bilirubin at 2 months.

Conclusions:

  • Peritoneal drainage (PD) as definitive treatment for intestinal perforation in ELBW infants yields survival rates comparable to laparotomy.
  • PD requires few secondary abdominal procedures but is associated with prolonged time to full enteral nutrition.
  • A substantial incidence of non-abdominal infectious complications and cholestasis was observed.
Abstract

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