Neonatal surgery: Towards evidence-based practice and management

Rintala, Risto; Pakarinen, Mikko P.; Koivusalo, Antti

doi:10.1053/j.sempedsurg.2014.09.012

Cited by 7 publications

(4 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The lack of statistical power and the clinical heterogeneity makes it challenging to extract clinically relevant conclusions from the results of the three trials. Although some of the studies and commentaries propose that a better response to the research question may be obtained with larger, adequately powered RCTs, the truth is that those are especially difficult to conduct for surgical interventions in sNEC or SIP in preterm neonatal populations [69], and it is not clear that a larger randomized study might be feasible at the moment. The commonly encountered barriers to designing such trials include difficulties with research ethic board's approval, challenges with informed consent and low incidence of sNEC and SIP in preterm neonates.…”

Section: Discussionmentioning

confidence: 99%

Laparotomy versus Peritoneal Drainage as Primary Treatment for Surgical Necrotizing Enterocolitis or Spontaneous Intestinal Perforation in Preterm Neonates: A Systematic Review and Meta-Analysis

2023

View full text Add to dashboard Cite

Aim: to systematically review and meta-analyze the impact on morbidity and mortality of peritoneal drainage (PD) compared to laparotomy (LAP) in preterm neonates with surgical NEC (sNEC) or spontaneous intestinal perforation (SIP). Methods: Medical databases were searched until June 2022 for studies comparing PD and LAP as primary surgical treatment of preterm neonates with sNEC or SIP. The primary outcome was survival during hospitalization; predefined secondary outcomes included need for parenteral nutrition at 90 days, time to reach full enteral feeds, need for subsequent laparotomy, duration of hospitalization and complications. Results: Three RCTs (N = 493) and 49 observational studies (N = 19,447) were included. No differences were found in the primary outcome for RCTs, but pooled observational data showed that, compared to LAP, infants with sNEC/SIP who underwent PD had lower survival [48 studies; N = 19,416; RR 0.85; 95% CI 0.79–0.90; GRADE: low]. Observational studies also showed that the subgroup of infants with sNEC had increased survival in the LAP group (30 studies; N = 9370; RR = 0.82; 95% CI 0.72–0.91; GRADE: low). Conclusions: Compared to LAP, PD as primary surgical treatment for sNEC or SIP has similar survival rates when analyzing data from RCTs. PD was associated with lower survival rates in observational studies.

show abstract

Section: Discussionmentioning

confidence: 99%

Laparotomy versus Peritoneal Drainage as Primary Treatment for Surgical Necrotizing Enterocolitis or Spontaneous Intestinal Perforation in Preterm Neonates: A Systematic Review and Meta-Analysis

2023

View full text Add to dashboard Cite

show abstract

“…6 Department of Neonatology, King Edward Memorial Hospital, Subiaco, WA, Australia. 7 Department of Neonatology, Perth Children's Hospital, Nedlands, WA, Australia.…”

Section: Fundingmentioning

confidence: 99%

“…Term and late preterm infants (≥34 weeks of gestation) may suffer from conditions that predispose them to critical illness needing admission to Neonatal Intensive Care Units (NICU). These include persistent pulmonary hypertension of the newborn (PPHN) [ 1 ], meconium aspiration syndrome [ 2 ], hypoxic-ischaemic encephalopathy (HIE) [ 3 ], sepsis [ 4 ], critical congenital heart disease [ 5 ], congenital diaphragmatic hernia [ 6 ], and other major surgical conditions [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Early versus late parenteral nutrition in term and late preterm infants: study protocol for a randomised controlled trial

et al. 2022

View full text Add to dashboard Cite

Background Despite the wide use of parenteral nutrition (PN) in neonatal intensive care units (NICU), there is limited evidence regarding the optimal time to commence PN in term and late preterm infants. The recommendations from the recently published ESPGHAN/ESPEN/ESPR/CPEN and NICE guidelines are substantially different in this area, and surveys have reported variations in clinical practice. The aim of this randomised controlled trial (RCT) is to evaluate the benefits and risks of early versus late PN in term and late preterm infants. Methods/design This study is a single-centre, non-blinded RCT in the NICU of Perth Children’s Hospital, Western Australia.A total of 60 infants born ≥34 weeks of gestation who have a high likelihood of intolerance to enteral nutrition (EN) for at least 3-5 days will be randomised to early (day 1 or day 2 of admission) or late commencement (day 6 of admission) of PN after informed parental consent. In both groups, EN will be commenced as early as clinically feasible. Primary outcomes are plasma phenylalanine and plasma F2-isoprostane levels on Day 4 and Day 8 of admission. Secondary outcomes are total and individual plasma amino acid profiles, plasma and red blood cell fatty acid profiles, in-hospital all-cause mortality, hospital-acquired infections, length of hospital/NICU stay, z scores and changes in z scores at discharge for weight, height and head circumference, time to full EN, duration of respiratory (mechanical, non-invasive) support, duration of inotropic support, the incidence of hyper and hypoglycaemia, incidence of metabolic acidosis, liver function, blood urea nitrogen, and C-reactive protein (CRP). Discussion This RCT will examine the effects of early versus late PN in term and late preterm infants by comparing key biochemical and clinical outcomes and has the potential to identify underlying pathways for beneficial or harmful effects related to the timing of commencement of PN in such infants. Trial registration ANZCTR; ACTRN12620000324910 (3rd March 2020)

show abstract

“…Term and late preterm infants may su er from various conditions that predispose them to critical illness. These include persistent pulmonary hypertension of the newborn (Jain 2015), meconium aspiration syndrome (Chettri 2016), hypoxic-ischaemic encephalopathy (Douglas-Escobar 2015), sepsis (Dong 2017;Schrag 2016), critical congenital heart disease (Strobel 2015), congenital diaphragmatic hernia (Leeuwen 2014), and other surgical conditions (Rintala 2014).…”

Section: Description Of the Conditionmentioning

confidence: 99%

Early versus late parenteral nutrition for critically ill term and late preterm infants

Moon

Athalye-Jape

Rao

et al. 2018

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

show abstract

Neonatal surgery: Towards evidence-based practice and management

Cited by 7 publications

References 34 publications

Laparotomy versus Peritoneal Drainage as Primary Treatment for Surgical Necrotizing Enterocolitis or Spontaneous Intestinal Perforation in Preterm Neonates: A Systematic Review and Meta-Analysis

Laparotomy versus Peritoneal Drainage as Primary Treatment for Surgical Necrotizing Enterocolitis or Spontaneous Intestinal Perforation in Preterm Neonates: A Systematic Review and Meta-Analysis

Early versus late parenteral nutrition in term and late preterm infants: study protocol for a randomised controlled trial

Early versus late parenteral nutrition for critically ill term and late preterm infants

Contact Info

Product

Resources

About