Coming full circle: an evidence-based definition of the timing and type of surgical management of very low-birth-weight (<1000 g) infants with signs of acute intestinal perforation
Section snippets
Methods
The neonatal research database at the University of Florida Health Science Center, Jacksonville, has been accruing clinical patient information continuously since its inception in 1991. Every neonatology patient's data is entered concurrent with care under the supervision of a single neonatologist (RS). The intensive care nursery is a regional perinatal critical care referral facility where a single, multidisciplinary faculty provides care to all admitted babies. With appropriate institutional
Results
Between October 1991 and December 2003, 65 VLBW infants with suspected gut disruption were referred for surgical care. Exclusion of the 9 babies who received both PD and LAP allowed comparison of 56 infants who received either PD or LAP as initial surgical care. Peritoneal drainage and LAP infants had similar BW and GA (Table 2). Logistic regression demonstrated MD to be the best predictor of mortality, which significantly increased with the time interval from diagnosis to surgical intervention
Discussion
Physiological stress, commonly seen in the high-risk newborn, will cause shunting of blood from the splanchnic circulation. This may produce at least transient hypoperfusion of the intestine, increasing intestinal permeability [11], [12]. This then allows bacterial translocation, which can stimulate multiple organ dysfunction. Recognizing that inappropriate operative intervention may impose additive stress and that ineffective debridement may accentuate sepsis, the decision between PD and LAP
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Cited by (32)
Incidence of spontaneous intestinal perforations exceeds necrotizing enterocolitis in extremely low birth weight infants fed an exclusive human milk-based diet: A single center experience
2021, Journal of Pediatric SurgeryCitation Excerpt :Literature suggests that human milk's immunoprotective and gut-maturational properties may help to reduce the incidence of NEC [6,7,9,10]. In addition, standardized feeding protocols are associated with a decrease in NEC [31]. As the clinical presentation of SIP and NEC can be difficult to differentiate, this new relative incidence is an important finding for physicians to keep in mind as they try to identify a definitive diagnosis.
Does Surgical Management Alter Outcome in Necrotizing Enterocolitis?
2019, Clinics in PerinatologyCitation Excerpt :This strategy gained traction over the ensuing decades, although it is not in universal use (15% to 95% of surgeons use PD, depending on the practice context).31–33 Dozens of retrospective studies over the past three decades have reported variable results; some showed comparable survival between PD and laparotomy,39,45–47 some showed higher mortality in the PD group,48–50 and others posited that severity of disease and metabolic derangement determined outcome.34,35 Over the past 20 years, several systematic reviews, meta-analyses, and prospective multicenter cohort studies have indicated that PD is associated with increased mortality,9,12,13,51,52 with the exception of a propensity-matched Kids Inpatient Database study that showed a 47% survival with PD compared with 37% survival with laparotomy as initial treatment.53
Mortality associated with laparotomy-confirmed neonatal spontaneous intestinal perforation: A prospective 5-year multicenter analysis
2014, Journal of Pediatric SurgeryCurrent concepts in the surgical approach to necrotizing enterocolitis
2014, PathophysiologyA Clinical Perspective of Necrotizing Enterocolitis: Past, Present, and Future
2013, Clinics in Perinatology
Presented at the 52nd Annual Congress of British Association of Paediatric Surgeons, Dublin, Ireland, July 12-15, 2005.