Peritoneal drainage or laparotomy for neonatal bowel perforation? A randomized controlled trial

Area of Science:

• Neonatal surgery
• Pediatric surgery
• Critical care medicine

Background:

• Optimal surgical management for intestinal perforation in extremely low birth weight (ELBW) infants remains unclear.
• Intestinal perforation is a serious condition requiring timely and effective intervention in neonates.

Purpose of the Study:

• To evaluate if primary peritoneal drainage improves survival and outcomes in ELBW infants diagnosed with intestinal perforation.
• To compare the efficacy of primary peritoneal drainage versus immediate laparotomy.

Main Methods:

• An international multicenter randomized controlled trial involving ELBW infants with pneumoperitoneum.
• Patients were randomized to receive either primary peritoneal drainage or immediate laparotomy.
• A delayed laparotomy was permitted for the drainage group if clinical improvement was not observed within 12 hours.

Main Results:

• Six-month survival rates were similar between the drain group (51.4%) and the laparotomy group (63.6%), with no statistically significant difference.
• A significant majority (74%) of infants in the drainage group ultimately required a delayed laparotomy.
• Primary peritoneal drainage was rarely effective as a definitive treatment, with only 11% of survivors treated solely with drainage.

Conclusions:

• Primary peritoneal drainage is not an effective primary treatment or temporizing measure for intestinal perforation in ELBW infants.
• Delayed laparotomy did not improve survival outcomes compared to primary laparotomy.
• Consideration should be given to a timely "rescue" laparotomy if peritoneal drainage is initially employed.