Laparotomy versus Peritoneal Drainage for Necrotizing Enterocolitis and Perforation

Moss, Richard L.; Dimmitt, Reed A.; Barnhart, Douglas C.; Sylvester, Karl G.; Brown, Rebeccah L.; Powell, David; Islam, Saleem; Langer, Jacob C.; Sato, Thomas T.; Brandt, Mary L.; Lee, Hanmin; Blakely, Martin L.; Lazar, Eric L.; Hirschl, Ronald B.; Kenney, Brian D.; Hackam, David J.; Zelterman, Daniel; Silverman, Bonnie L.

doi:10.1056/nejmoa054605

Cited by 375 publications

(233 citation statements)

References 25 publications

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“…Laparotomy with excision of necrotic bowel and primary peritoneal drainage (PPD) are the two most commonly used surgical treatments for NEC. A recently completed randomized trial that compared mortality, gastrointestinal morbidity, and length of hospital stay in infants receiving laparotomy or PPD for NEC found no significant difference in these short-term outcomes (1). These findings might lead to an increase in the use of PPD because this procedure is perceived to be less invasive and produces results similar to laparotomy in the sickest, weakest patients.…”

Section: Session I: Predictors and Outcomesmentioning

confidence: 99%

New Therapies and Preventive Approaches for Necrotizing Enterocolitis: Report of a Research Planning Workshop

et al. 2007

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Section: Session I: Predictors and Outcomesmentioning

confidence: 99%

New Therapies and Preventive Approaches for Necrotizing Enterocolitis: Report of a Research Planning Workshop

et al. 2007

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“…1 In part, this is explained by the capability of modern neonatology to sustain ever-smaller and more immature neonates, since NEC is more common among these patients. 2 However, in part, this failure is due to the lack of successful NEC prevention strategies.…”

Section: Introductionmentioning

confidence: 99%

Necrotizing enterocolitis during the first week of life: a multicentered case–control and cohort comparison study

et al. 2008

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Objective: Necrotizing enterocolitis (NEC) is rare during the first week of life; most cases occur after 2 to 4 weeks. We hypothesized that when NEC develops in the first week, certain predisposing factors and feeding practices are identifiable. To test this, we sought to identify every case of NEC diagnosed during the first week within the Intermountain Healthcare system during the most recent 6-year period.Study Design: Data were collected from neonates admitted to any Intermountain Healthcare neonatal intensive care unit (NICU) with a date of birth from 1 January 2001 through 31 December 2006. Electronic and paper records were obtained for all with a diagnosis of NEC (Bell stage XII) within the first 168 h. X-rays, physician notes, nursing records, laboratory reports and operative reports were subjected to critical review to reexamine the diagnosis of NEC. Among those with confirmed NEC, we recorded underlying conditions and every feeding given prior to the diagnosis of NEC. Comparisons were made with patients that did not develop NEC, yet were cared for in the same NICUs, during the same period of time, and of the same gestational ages.Result: A total of 28 neonates were identified electronically as having NEC during the first week. Critical review confirmed this in 21, but 5 were determined at laparotomy to have had spontaneous intestinal perforation, and 2 others were found on surgical reports to have had a congenital infarction of the colon. Total 20 of the 21 confirmed cases developed NEC while in a NICU being treated for another condition. The exception was a small-for-gestational-age neonate in a well baby nursery. Compared to 6100 controls, the 21 with early NEC were more likely to have had a meconium-positive test for illicit drug exposure (P<0.005), early onset sepsis (P<0.034) and respiratory distress (P<0.039). They were less likely than case-controls to have been fed human milk (P ¼ 0.003) and were more likely to have been fed formula exclusively (P ¼ 0.019).None who were fed human milk exclusively developed early NEC. Twelve of the twenty-one were fed (by gavage or bottle) amounts exceeding the upper limit of volumes taken by breastfed neonates. Conclusion:We speculate that the prevalence of NEC during the first week could be reduced by identifying at-risk patients, feeding them human milk exclusively for the first week and using feeding volumes that do not exceed that taken by healthy breastfed neonates.

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“…The largest surgical trial evaluating laparotomy versus peritoneal drainage suffered greatly by combining these varied disease entities. 7,8 Other multicenter studies continued to use this umbrella definition of NEC, typically focusing on two elements (perforation and pneumoperitoneum) to the exclusion of other factors. [9][10][11][12] The Vermont Oxford Network, neonatology's largest clinical database, continues to define focal intestinal perforation (or SIP) only at surgery or postmortem examination.…”

mentioning

confidence: 99%

Surgical necrotizing enterocolitis defined

Swanson

2014

J Perinatol

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Laparotomy versus Peritoneal Drainage for Necrotizing Enterocolitis and Perforation

Abstract: The type of operation performed for perforated necrotizing enterocolitis does not influence survival or other clinically important early outcomes in preterm infants. (ClinicalTrials.gov number, NCT00252681.).

Cited by 375 publications

References 25 publications

New Therapies and Preventive Approaches for Necrotizing Enterocolitis: Report of a Research Planning Workshop

New Therapies and Preventive Approaches for Necrotizing Enterocolitis: Report of a Research Planning Workshop

Necrotizing enterocolitis during the first week of life: a multicentered case–control and cohort comparison study

Surgical necrotizing enterocolitis defined

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