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Peritoneal drainage as the initial management of intestinal perforation in premature infants

Sean M Stokes1, Joseph A Iocono, John M Draus

  • 1Department of Surgery, Division of Pediatric Surgery, University of Kentucky, Lexington, Kentucky, USA.

The American Surgeon
|September 9, 2014
PubMed

Insights

Peritoneal drainage (PD) for intestinal perforation in newborns showed similar survival and hospital stay for complicated necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP). This suggests PD may not be more effective for SIP than for NEC.

Area of Science:

  • Neonatal surgery
  • Pediatric gastroenterology
  • Critical care medicine

Background:

  • Complicated necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) are leading causes of mortality in neonates.
  • Intestinal perforation in premature infants presents significant management challenges and high mortality rates.

Purpose of the Study:

  • To evaluate the efficacy of peritoneal drainage (PD) as a primary treatment for intestinal perforation in neonates.
  • To compare outcomes between infants with complicated NEC and SIP treated with PD.

Main Methods:

  • A retrospective review of newborn infants treated with PD for intestinal perforation between 2007 and 2012.
  • Infants were divided into two groups: complicated NEC (n=19) and SIP (n=15).
  • Outcomes analyzed included need for laparotomy, time to enteral feeds, survival, and length of hospital stay (LOS).

Main Results:

  • Infants with SIP required laparotomy less frequently (2 vs. 6) and reached enteral feeds sooner (16 vs. 22.5 days) compared to those with complicated NEC.
  • Survival rates were similar between groups (8/19 for NEC vs. 8/15 for SIP).
  • Median length of hospital stay was comparable (104.5 days for NEC vs. 109.5 days for SIP), with no statistically significant differences.

Conclusions:

  • Peritoneal drainage (PD) did not demonstrate statistically significant differences in efficacy, survival, or length of hospital stay between complicated NEC and SIP cohorts.
  • Management of intestinal perforation in premature infants remains challenging, with high mortality regardless of the underlying diagnosis.
  • Further research is needed to optimize treatment strategies for neonatal intestinal perforation.

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