Abstract
Primary peritoneal drainage (PPD) was initially introduced as a method for the pre-operative resuscitation of critically ill infants with complicated necrotising enterocolitis (NEC). Some have recommended it as definitive strategy for a select group of extremely low birth weight babies. The role of laparotomy in neonates who do not respond to initial PPD has also been challenged. With this background, we analysed our experience with the use of PPD in babies with NEC over an 18-year period. We retrospectively reviewed all patients with NEC who had PPD as their initial surgical management over an 18-year period. A total of 122 babies with NEC were treated surgically, of whom 42 had PPD as the initial procedure. There were 28 survivors (67%) in the PPD group, of whom 7 recovered without laparotomy. Twenty-nine infants (69%) had a good clinical response to PPD with 80% (23/29) survival, compared to a 27% survival (3/11) in those who did not respond to drainage. Six patients underwent rescue laparotomy after a poor response to PPD and three of these survived. Six of the 28 pts who underwent laparotomy had isolated intestinal perforation and their clinical characteristics were no different from those with typical NEC. PPD is a useful option in the management of complicated NEC. It is difficult to recognise with certainty those infants who will not require a subsequent laparotomy and therefore we do not support the concept of PPD solely as a definitive strategy. The response to PPD is a good prognostic indicator for ultimate survival. Despite a low salvage rate of 27% in non-responders compared to 80% in responders, there is a role for early laparotomy for those infants who do not respond to PPD.
Similar content being viewed by others
References
Ein SH, Marshall DG, Girvan D (1977) Peritoneal drainage under local anesthesia for perforations from necrotizing enterocolitis. J Pediatr Surg 12(6):963–967
Cheu HW, Sukarochana K, Lloyd DA (1988) Peritoneal drainage for necrotizing enterocolitis. J Pediatr Surg 23(6):557–561
Lessin MS, Luks FI, Wesselhoeft CW, Gilchrist BF, Iannitti D, DeLuca FG (1998) Peritoneal drainage as definitive treatment for intestinal perforation in infants with extremely low birth weight (<750 g). J Pediatr Surg 33(2):370–372
Gollin G, Abarbanell A, Baerg JE (2003) Peritoneal drainage as definitive management of intestinal perforation in extremely low-birth-weight infants. J Pediatr Surg 38(12):1814–1817
Dimmitt RA, Meier AH, Skarsgard ED, Halamek LP, Smith BM, Moss RL (2000) Salvage laparotomy for failure of peritoneal drainage in necrotizing enterocolitis in infants with extremely low birth weight. J Pediatr Surg 35(6):856–859
Ein SH, Shandling B, Wesson D, Filler RM (1990) A 13-year experience with peritoneal drainage under local anesthesia for necrotizing enterocolitis perforation. J Pediatr Surg 25(10):1034–1036; discussion 1036–1037
Morgan LJ, Shochat SJ, Hartman GE (1994) Peritoneal drainage as primary management of perforated NEC in the very low birth weight infant. J Pediatr Surg 29(2):310–314; discussion 314–315
Rovin JD, Rodgers BM, Burns PC, McGahren ED (1999) The role of peritoneal drainage for intestinal perforation in infants with and without necrotizing enterocolitis. J Pediatr Surg 34(1):143–147
Cass DL, Brandt ML, Patel DL, Nuchtern JG, Minifee PK, Wesson DE (2000) Peritoneal drainage as definitive treatment for neonates with isolated intestinal perforation. J Pediatr Surg 35(11):1531–1536
Tam Al, Camberos A, Applebaum H (2002) Surgical decision making in necrotising enterocolitis and focal intestinal perforation: predictive value of radiologic findings. J Pediatr Surg 37(12):1688–1691
Sharma R, Tepas JJ III, Mollitt DL, Pieper P, Wludyka P (2004) Surgical management of bowel perforations and outcome in very low-birth-weight infants (< or =1,200 g). J Pediatr Surg 39(2):190–194
Moss RL, Dimmitt RA, Henry MC, Geraghty N, Efron B (2001) A meta-analysis of peritoneal drainage versus laparotomy for perforated necrotizing enterocolitis. J Pediatr Surg 36(8):1210–1213
Pierro A: Necrotising enterocolitis trial. http://www.nettrial.net
Acknowledgements
We thank the Consultant Paediatric Surgeons at Alder Hey Hospital and the Consultant Neonatologists at Liverpool Women’s Hospital for allowing us to review their patients, and Prof. R.W.I. Cooke and Dr. Bill Yoxall for their help and guidance with the data collection.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Goyal, A., Manalang, L.R., Donnell, S.C. et al. Primary peritoneal drainage in necrotising enterocolitis: an 18-year experience. Ped Surgery Int 22, 449–452 (2006). https://doi.org/10.1007/s00383-006-1670-3
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00383-006-1670-3