NECROTIZING ENTEROCOLITIS IN PREMATURE BABIES;

LAPAROTOMY VERSUS PERITIONEAL DRAINAGE

Abstract

.. Premature infants with necrotizing enterocolitis (NEC) or intestinal perforation (IP) are treated either
surgically with laprotomy or peritoneal drain placement. Objective: (1) To develop a hypothesis about the relative effect
of these 2 therapies on risk adjusted outcomes through 18 months in premature infants. (2) To obtain data that would
be useful in designing and conducting a successful trial of this hypothesis. Design: A prospective, observational study.
Setting: In pediatric surgical departments of Military Hospital Rawalpindi & Combined Military Hospital Rawalpindi.
Period: From Nov 2005 to April 2007. Materials & Methods: To assist in risk adjustment, the attending pediatric
surgeon recorded the preoperative diagnosis and intraoperative diagnosis and identified infants who were considered
to be too ill for laprotomy. Results: Severe NEC or IP in 156 of 2987 premature infants; 80 were treated with initial
drainage and 76 were treated with initial laprotomy. By 16 months, 76 (50%) had died; outcome remained worse in
subgroup with NEC. Laprotomy was not performed in 76% (28 of 36) of drain treated survivors. Conclusions:
Drainage was commonly used , and outcome was poor. Our findings, particularly the risk adjusted odds ratio favoring
laparotomy, indicate the need for a large, multicenter clinical trial to assess the effect of initial surgery therapy on out
come at >16 months.