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Peritoneal drainage as definitive treatment for intestinal perforation in infants with extremely low birth weight
M S Lessin1, F I Luks, C W Wesselhoeft
1Division of Pediatric Surgery, Brown University School of Medicine and Hasbro Children's Hospital, Providence, Rhode Island, USA.
Insights
Peritoneal drainage alone offers a high survival rate for intestinal perforation in extremely premature infants. This approach avoids surgery and complications like strictures, enabling full feeding post-recovery.
Area of Science:
- Neonatal surgery
- Pediatric gastroenterology
- Critical care medicine
Background:
- Neonatal intensive care has improved survival for extremely premature infants.
- Intestinal perforation remains a major cause of mortality in infants under 25 weeks' gestational age.
Purpose of the Study:
- To evaluate the efficacy of peritoneal drainage as a sole treatment for intestinal perforation in extremely low birth weight infants.
Main Methods:
- Nine infants weighing less than 750g with intestinal perforation were treated with peritoneal drainage.
- Drains were removed upon clinical improvement and cessation of drainage.
Main Results:
- Seven of nine infants (78%) survived the initial drainage procedure.
- Six long-term survivors tolerated full enteral feeds without strictures or abscesses; none required further surgery.
Conclusions:
- Peritoneal drainage alone can be considered definitive therapy for intestinal perforation in most micropremature infants.
- This minimally invasive approach demonstrates significant success and avoids complications associated with celiotomy.
Background:
Advances in neonatal intensive care have improved the survival of the extremely premature infant. However, survival at less than 25 weeks' gestational age remains tenuous, with intestinal perforation presenting a significant mortality.
Methods:
During an 18-month period from 1995 to 1996, nine patients weighing less than 750 g (range, 485 to 740 g; mean, 615 g) presented with intestinal perforation. All patients were treated with peritoneal drainage. Drains were removed after clinical improvement and the cessation of peritoneal drainage.
Results:
Seven patients survived the initial drainage procedure (78%). At a mean follow-up of 12 months, the six long-term survivors are all tolerating full enteral feeds, and none developed intestinal strictures or intraabdominal abscess. No patient required subsequent celiotomy. Peritoneal drainage has previously been considered in some centers as temporary therapy in extremely ill neonates deemed unlikely to survive operation. The authors have adopted drainage as the sole treatment in selected patients.
Conclusion:
Peritoneal drainage alone may be considered definitive therapy for intestinal perforation in the majority of micropremature infants.