Multicenter retrospective comparison of spontaneous intestinal perforation outcomes between primary peritoneal drain and primary laparotomy

Ahle, Samantha L.; Badru, Faidah; Damle, Rachelle N.; Osei, Hector; Muñoz-Abraham, Armando Salim; Bajinting, Adam; Barbian, Maria E.; Bhatia, Amina; Gingalewski, Cindy; Greenspon, José; Hamilton, Nicholas A.; Stitelman, David H.; Strand, Marya; Warner, Brad W.; Villalona, Gustavo A.

doi:10.1016/j.jpedsurg.2019.07.007

Cited by 12 publications

(8 citation statements)

References 29 publications

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“…The optimal surgical treatment of SIP is still controversial. Both randomized controlled trials ( 35 - 37 ) and observational studies ( 29 , 32 , 38 , 39 ) have demonstrated the type of initial operation has no impact on survival among preterm infants with intestinal perforation, similar to our findings. However, most studies mentioned above did not distinguish SIP from NEC and did not separately report the outcomes for SIP.…”

Section: Discussionsupporting

confidence: 89%

“…Among VPIs with SIP who received surgery, more than half received laparotomy only and about three quarters of infants initially treated with peritoneal drainage received secondary laparotomy, indicating that laparotomy was the most commonly used surgical intervention for SIP in China. In the literature, however, peritoneal drainage was performed in the majority (64.3–89.3%) of SIP infants with a varied proportion (24.1–68.8%) of infants subsequently requiring laparotomy ( 29 - 34 ). Considering that peritoneal drainage is allowed to be performed at the bedside and avoids surgical complications, it is generally conducted as an alternative treatment for SIP, temporarily or definitively, especially in infants who are too unstable to tolerate laparotomy.…”

Section: Discussionmentioning

confidence: 99%

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Spontaneous intestinal perforation among very preterm infants in China: a multicenter cohort study

Mao,

Jiang,

Shen

et al. 2024

Transl Pediatr

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Background Spontaneous intestinal perforation (SIP) is one of the most serious surgical bowel conditions affecting preterm infants. There are limited data on the mortality and morbidities of very preterm infants [VPIs, <32 weeks’ gestational age (GA)] with SIP in China. The study aimed to describe the prevalence, treatment, and outcomes of SIP among VPIs in China. Methods This retrospective cohort study included all infants born at 24 +0 –31 +6 weeks GA from January 1, 2019, to December 31, 2020, and admitted within seven days after birth to the neonatal intensive care units in the Chinese Neonatal Network. The primary outcome was survival without major morbidities. The association between SIP and neonatal outcomes was evaluated using multivariate logistic regression controlling for possible confounders. Results Out of the 15,814 enrolled infants, 150 (1.0%) developed SIP with a median onset age of four (IQR 2–6) days. Infants with GA 24 +0 –25 +6 weeks had the highest incidence of SIP (13/532, 2.4%), followed by those with GA 26 +0 –27 +6 weeks (22/2,005, 1.1%), 28 +0 –29 +6 weeks (44/5,269, 0.8%) and 30 +0 –31 +6 weeks (71/8,008, 0.9%). Ten SIP cases were lost to follow-up with unknown survival status and 41 (29.3%) of the remaining 140 infants with SIP died during hospitalization. Only 29.3% of infants with SIP survived without major morbidities, significantly lower than those without SIP (59.2%; P<0.01). Multivariate analysis revealed SIP was associated with a higher risk of overall death (adjusted OR 3.36; 95% CI: 1.85 to 6.08), late-onset sepsis (adjusted OR 2.10; 95% CI: 1.02 to 4.31), and bronchopulmonary dysplasia (adjusted OR 2.49; 95% CI: 1.44 to 4.30). Among all infants with SIP, 28 (18.7%) did not receive any surgical intervention. Laparotomy was provided to 113 (92.6%) of the remaining 122 infants, solely (84/122, 68.9%) or following peritoneal drainage (29/122, 23.8%), while nine (7.4%) infants underwent peritoneal drainage only. Conclusions Around 1% of VPIs in China developed SIP, associated with increased risk of mortality and morbidities. Over 90% of VPIs with SIP underwent laparotomy as initial or subsequent surgical treatment. Effective and evidence-based strategies are needed for the prevention and management of SIP.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Spontaneous intestinal perforation among very preterm infants in China: a multicenter cohort study

Mao,

Jiang,

Shen

et al. 2024

Transl Pediatr

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“…Although not statistically significant, peritoneal drainage was employed more frequently in PT patients (22.4%) than in the TC group (4.4%). This likely reflects a practice pattern at our institution where patients are approached differently based on their gestational age and weight at the time of diagnosis, which is similar to the strategy utilized at other centers (18)(19)(20).…”

Section: Discussionmentioning

confidence: 87%

Comparison of Necrotizing Enterocolitis in Pre-mature Infants vs. Term-Born Infants With Congenital Heart Disease

et al. 2021

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Purpose: Necrotizing enterocolitis (NEC) is a serious illness that occurs among premature infants and term-born infants with congenital heart disease (CHD). Prior studies have suggested these two groups may experience different disease entities. We sought to evaluate if there are differences in disease characteristics between these two populations.Materials and Methods: A retrospective chart review of infants treated for Bells stage 2-3 NEC from 2011 to 2020 was performed. Demographic information, CHD diagnoses and clinical data were recorded. Prior to data analysis, patients were divided into two groups: term-born patients with CHD (TC) and premature patients without CHD (PT).Results: 99 patients were analyzed−23 TC patients and 76 PT patients. Platelet counts (222.7 ± 176.1 vs. 310.2 ± 174.5 cells/uL, P = 0.03) and C-reactive protein (CRP) levels (53.6 ± 81.7 vs. 117.6 ± 90.4 mg/L, P < 0.001) were significantly higher among the PT group. In addition, PT patients were more likely to develop pneumatosis (30.4 vs. 68.4%, P = 0.002) than TC patients. NEC-specific mortality was similar between both groups of patients.Conclusions: When compared to TC patients, PT patients had higher CRP levels, higher platelet counts and more commonly developed pneumatosis. These factors may point toward a difference in disease pathophysiology regarding NEC development in premature patients vs. term-born patients with CHD.

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“…The diagnosis typically occurs in the first week of life when affected infants present with abdominal distension, with or without clinical instability, and free air in the abdomen (pneumoperitoneum) evident on radiographs ( 12 ). The current standard of care is surgical intervention (drain into abdomen or resection of compromised tissue), cessation of enteral nutrition, and a course of antibiotics ( 13 , 14 ). This is the same treatment utilized when there is an intestinal perforation in NEC.…”

Section: Introductionmentioning

confidence: 99%

Single cell analysis via mass cytometry of spontaneous intestinal perforation reveals alterations in small intestinal innate and adaptive mucosal immunity

Olaloye

Eke²,

Jolteus³

et al. 2023

Front. Immunol.

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IntroductionSpontaneous intestinal perforation (SIP) is a poorly understood severe gastrointestinal complications of prematurity which is poorly understood. Extremely premature infants born prior to 28 weeks’ gestation develop a localized perforation of the terminal ileum during the first week of life and therapy involves surgery and cessation of enteral feeds. Little is known regardj g the impact of mucosal immune dysfunction on disease pathogenesis.MethodsWe performed mass cytometry time of flight (CyTOF) of small intestinal mucosa of patients with SIP (Gestational age (GA) 24 – 27 weeks, n=8) compared to patients who had surgery for non-SIP conditions (neonatal (GA >36 weeks, n=5 ) and fetal intestine from elective terminations (GA 18-21 weeks, n=4). CyTOF analysis after stimulation of T cells with PMA/Ionomycin was also performed.ResultsWe noted changes in innate and adaptive mucosal immunity in SIP. SIP mucosa had an expansion of ckit+ neutrophils, an influx of naïve CD4 and CD8 T cells and a reduction of effector memory T cells. SIP T cells were characterized by reduced CCR6 and CXCR3 expression and increased interferon gamma expression after stimulation.DiscussionThese findings suggest that previously unrecognized immune dysregulation is associated with SIP and should be explored in future studies.

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Multicenter retrospective comparison of spontaneous intestinal perforation outcomes between primary peritoneal drain and primary laparotomy

Cited by 12 publications

References 29 publications

Spontaneous intestinal perforation among very preterm infants in China: a multicenter cohort study

Spontaneous intestinal perforation among very preterm infants in China: a multicenter cohort study

Comparison of Necrotizing Enterocolitis in Pre-mature Infants vs. Term-Born Infants With Congenital Heart Disease

Single cell analysis via mass cytometry of spontaneous intestinal perforation reveals alterations in small intestinal innate and adaptive mucosal immunity

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