Factors Associated with Definitive Peritoneal Drainage for Spontaneous Intestinal Perforation in Extremely Low Birth Weight Neonates

Abstract

Peritoneal drainage for spontaneous intestinal perforation in ELBW neonates is more likely to be definitive in the absence of bandemia and vasopressor requirement. These may be important factors in deciding whether to proceed to laparotomy.

Definitive peritoneal drainage in the extremely low birth weight infant with spontaneous intestinal perforation: predictors and hospital outcomes

“…This percentage is higher than the studies by Moss et al 27 and Rees et al, 28 who showed definitive PD rates of 62 and 26%, respectively. When comparing our study to a recent and similar (although smaller sample size) study looking at SIP patients treated with PD by Emil et al, 26 the difference is striking. Their rate of definitive PD was only 31% (5/16).…”

“…Numerous variables can and will influence the success rate of PD, including the preferences and biases of attending pediatric surgeons and neonatologists. Some groups or practices will have a low threshold for reoperation as in the studies by Rees et al 28 and Emil et al, 26 whereas others will wait longer to intervene. At our institution, when a peritoneal drain is placed in an infant suspected to have SIP, it is done with the hope that it will be a definitive therapy.…”

“…Tepas et al 39 found that the presence of 'metabolic derangement' was associated with better outcomes following laparotomy rather than PD. Emil et al 26 revealed that infants requiring a laparotomy in addition to PD more often needed vasopressor support at presentation and in the 48 h following PD and had a higher percentage of bands in the white blood cell count. Owing to the retrospective nature of our study, precise review of postoperative vital signs was limited.…”

“…One previous small study (n = 16) showed that extremely low birth weight infants with SIP who failed PD had a significantly higher percentage of bands in the white blood cell count prior to drain placement and more frequently required vasopressor therapy at the time of presentation and during the 48 h following peritoneal drain placement. 26 In our retrospective cohort study, we aimed to identify preoperative and perioperative characteristics, which could identify those infants who succeed with PD alone and those who are at risk of PD failure in our patient population. In addition, we compared hospital outcomes between infants with definitive PD and infants requiring salvage laparotomy.…”

Response to Swanson et al.

“…In patients treated solely with a drain, the diagnosis of SIP is challenging for some investigators. 5 It should also be noted that only 37% of infants in the study had pneumatosis intestinalis and 27% of the 'progressors' who were 2 weeks old or less never received enteral nutrition. Both features suggest that a significant portion of this population might have had SIP with pneumoperitoneum (unfortunately these data are not provided).…”