Intestinal perforation in premature neonates: The need for subsequent laparotomy after placement of peritoneal drains

Area of Science:

• Neonatal surgery
• Pediatric gastroenterology
• Surgical critical care

Background:

• Peritoneal drainage (PD) is a treatment for pneumoperitoneum in premature neonates.
• Recent studies question the efficacy of PD, with high rates of subsequent laparotomy.
• This study evaluates the need for laparotomy after initial PD in premature infants.

Purpose of the Study:

• To review the requirement for laparotomy after initial peritoneal drainage (PD) in premature neonates with pneumoperitoneum.
• To compare outcomes between initial PD and primary laparotomy.
• To assess the utility of PD based on underlying diagnosis (isolated perforation vs. necrotising enterocolitis).

Main Methods:

• Retrospective cohort study of premature infants (<1800g, <33 weeks gestation) with intestinal perforation (ICD Code P78.0) from 1995-2012.
• Inclusion criteria: pneumoperitoneum on x-ray (isolated perforation or necrotising enterocolitis).
• Data analyzed included rates of secondary laparotomy, time to full enteral nutrition, and mortality.

Main Results:

• Fifty patients met criteria: 38 received PD, 12 had primary laparotomy.
• 32% of neonates treated with initial PD required secondary laparotomy.
• No significant differences in time to full enteral nutrition or mortality between PD and primary laparotomy groups.

Conclusions:

• 32% of neonates treated with primary PD required secondary laparotomy.
• Initial PD did not significantly impact key outcomes compared to primary laparotomy.
• PD remains beneficial for premature neonates with pneumoperitoneum but without features of necrotising enterocolitis.