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Peritoneal drainage for necrotizing enterocolitis.

H W Cheu1, K Sukarochana, D A Lloyd

  • 1Division of Pediatric Surgery, University of Pittsburgh School of Medicine, PA.

Journal of Pediatric Surgery
|June 1, 1988
PubMed
Summary
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Primary peritoneal drainage (PPD) aids critically ill neonates with necrotizing enterocolitis (NEC), especially premature infants under 1,000g with intestinal perforation. However, PPD is not a substitute for laparotomy, which remains crucial for optimal NEC management.

Area of Science:

  • Neonatal surgery
  • Pediatric gastroenterology
  • Critical care medicine

Background:

  • Necrotizing enterocolitis (NEC) is a severe gastrointestinal emergency in neonates.
  • Surgical intervention is often required for definite NEC.
  • Primary peritoneal drainage (PPD) is a less invasive option explored for critically ill infants.

Purpose of the Study:

  • To evaluate the efficacy and outcomes of primary peritoneal drainage (PPD) versus primary laparotomy in managing neonatal necrotizing enterocolitis (NEC).
  • To assess the role of PPD as an adjunct or alternative to immediate laparotomy in specific neonatal populations with NEC.

Main Methods:

  • Retrospective analysis of 169 neonates with definite NEC.
  • Comparison of outcomes between infants undergoing primary laparotomy (41) and primary peritoneal drainage (PPD) (51).

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  • Analysis of operative survival, late survival, and risk factors including birth weight and gestational age.

    • Main Results:

    • PPD was used in 55% of operated NEC cases, with 33% requiring subsequent laparotomy.
    • Operative survival was lower for PPD (53%) compared to primary laparotomy (83%).
    • For infants <1000g, survival was similar (PPD 52% vs. laparotomy 57%), despite higher risk factors in PPD group. For infants >1000g, laparotomy survival (86%) was higher than PPD (62%).

    Conclusions:

    • Primary peritoneal drainage (PPD) can be a useful adjunct for resuscitation in critically ill neonates with complicated NEC, particularly premature infants (<1000g) with intestinal perforation.
    • PPD is not a substitute for laparotomy, which is recommended for NEC management once optimal clinical response is achieved.
    • Late survival rates were significantly lower after PPD, with many late deaths unrelated to NEC, highlighting population differences.