Perforated necrotizing enterocolitis is a major cause of morbidity and mortality in premature infants, and the optimal treatment is uncertain.
Dr Lawrence Moss and colleagues designed a multicenter randomized trial to compare peritoneal drainage with laparotomy and bowel resection.
The research team assessed these techniques in preterm infants with perforated necrotizing enterocolitis.
The team included 117 preterm infants, delivered before 34 weeks of gestation, with birth weights less than 1500g and perforated necrotizing enterocolitis.
Primary peritoneal drainage or laparotomy with bowel resection was undertaken at 15 pediatric centres.
|36% assigned to laparotomy died 90 days postoperatively|
|New England Journal of Medicine|
The researchers standardized postoperative care.
The primary outcome was survival at 90 days postoperatively.
Secondary outcomes included dependence on parenteral nutrition 90 days postoperatively, and length of hospital stay.
At 90 days postoperatively, 35% of infants assigned to primary peritoneal drainage had died.
The team found that 36% of infants assigned to laparotomy had died 90 days postoperatively.
About 47% of infants in the peritoneal-drainage group depended on total parenteral nutrition.
In comparison, the researchers noted that only 40% in the laparotomy group depended on total parenteral nutrition.
The mean length of hospitalization for the 76 infants who were alive 90 days after operation was similar in the primary peritoneal-drainage and laparotomy groups.
Subgroup analyses were stratified according to the presence or absence of radiographic evidence of extensive necrotizing enterocolitis.
The team also stratified for gestational age of less than 25 weeks, and serum pH less than 7.3 at presentation.
These analyses showed no significant advantage of either treatment in any group.
Dr Moss' team concluded, “The type of operation performed for perforated necrotizing enterocolitis does not influence survival or other clinically important early outcomes in preterm infants.”