Peritoneal drainage versus laparotomy as initial surgical treatment for perforated necrotizing enterocolitis or spontaneous intestinal perforation in preterm low birth weight infants

Rao, Shripada; Basani, Laxman; Simmer, Karen; Samnakay, Naeem; Deshpande, Girish

doi:10.1002/14651858.cd006182.pub2

Cited by 82 publications

(62 citation statements)

References 57 publications

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“…This second surgical procedure was performed for more than one-half of the patients in this data set, which is consistent with the range reported in the literature (22%-74%). [15][16][17]19,24,29,30 The known drivers of surgical costs in infants who underwent peritoneal drainage followed by laparotomy include increased length of stay 19 and postdrainage clinical decompensation. 15,31 The present study was limited by the administrative nature of the data set.…”

Section: Discussionmentioning

confidence: 99%

Outcomes and Costs of Surgical Treatments of Necrotizing Enterocolitis

et al. 2015

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BACKGROUND AND OBJECTIVES: Despite previous studies demonstrating no difference in mortality or morbidity, the various surgical approaches for necrotizing enterocolitis (NEC) in infants have not been evaluated economically. Our goal was to compare total in-hospital cost and mortality by using propensity score-matched infants treated with peritoneal drainage alone, peritoneal drainage followed by laparotomy, or laparotomy alone for surgical NEC. RESULTS: Successful propensity score matching was performed with 699 infants (peritoneal drainage, n = 101; peritoneal drainage followed by laparotomy, n = 172; and laparotomy, n = 426). Average adjusted cost for peritoneal drainage followed by laparotomy was $ CONCLUSIONS: Propensity score-matched analysis of surgical NEC treatment found that peritoneal drainage followed by laparotomy was associated with decreased mortality compared with peritoneal drainage alone but at significantly increased costs. WHAT'S KNOWN ON THIS SUBJECT:Mortality rates and health care expenditures are high among infants requiring surgery for necrotizing enterocolitis. The impact of different surgical managements on mortality remains equivocal. Adjusted economic differences for various surgical treatments may exist but have not been elucidated. WHAT THIS STUDY ADDS:After performing a relatively large-scale, adjusted analysis of cost and mortality for surgical managements currently used for treating necrotizing enterocolitis, a costbenefit for a particular surgical approach was demonstrated while accounting for comorbidities and group assignment bias.

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Section: Discussionmentioning

confidence: 99%

Outcomes and Costs of Surgical Treatments of Necrotizing Enterocolitis

et al. 2015

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“…A recent Cochrane review on this topic concluded that there was no difference in mortality, hospital stay, or dependence on total parenteral nutrition. 97 However, there is some suggestion that infants who undergo laparotomy instead of primary peritoneal drainage have a better neurodevelopmental outcome at 18 months of age. 98 A multicenter trial in the US is currently recruiting patients to compare the effectiveness of laparotomy versus primary peritoneal drainage in NEC.…”

Section: Managementmentioning

confidence: 99%

Necrotizing enterocolitis: current perspectives

Yajamanyam

Rasiah²,

Ewer³

2014

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Necrotizing enterocolitis is the most common gastrointestinal emergency in neonates, particularly in those born very preterm. It is a leading cause of morbidity and mortality, especially in extremely low birth weight infants. Despite extensive research, the pathophysiology of necrotizing enterocolitis remains unclear and therapeutic options are limited. Multiple risk factors have been reported, but most are associated with prematurity and its complications. This makes management very challenging in vulnerable preterm infants. In this review, we focus on the risk factors and some of the current research in this area, particularly studies aimed at early detection and potential preventive measures for this potentially lethal condition.

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“…Exploratory laparotomy with the resection of the bowel or primary peritoneal drainage (PPD) are the traditional approach. In a previous study, PPD and exploratory laparotomy were compared in the newborns diagnosed with either SIP or NEC, and no difference was found in mortality or prognosis between the two groups (11). In our case, we used exploratory laparotomy with bowel resection in addition to ileostomy and colostomy.…”

Section: Discussionmentioning

confidence: 93%