Bedside peritoneal drainage:A primary treatment for perforated necrotizing enterocolitis

Abstract

Background and purpose: Necrotizing enterocolitis is one of the leading causes of morbidity and mortality in neonatal intensive care units particularly in places without neonatal surgical facilities. The best treatment for perforated necrotizing enterocolitis is uncertain. Bedside peritoneal drainage has been used as primary treatment in the management of perforated necrotizing enterocolitis. This study aimed to compare outcomes of bedside peritoneal drainage done by general surgeons as a primary procedure for the treatment of preterm and/or low birth weight neonates with perforated necrotizing enterocolitis to outcomes of early laparotomy performed by pediatric surgeons as regards effectiveness of the procedure as a definitive treatment, the need for delayed laparotomy and mortality rate. Patients and methods: Fifty cases of preterm and/or low birth weight neonates with perforated necrotizing enterocolitis were randomly assigned to one of two groups. Group I was managed by bedside peritoneal drainage done by general surgeon while laparotomy was reserved for non responding cases. Group II was managed by early laparotomy done by pediatric surgeon. Data collected from all cases included birth weight (g), gestational age (weeks), gender, age at operation (bedside peritoneal drainage or early laparotomy). Delayed laparotomy was performed for infants who developed persistent fecal.fistula or suffered late intestinal stricture as well as for closure of enterostomy. Outcomes of bedside peritoneal drainage and early laparotomy were recorded and statistically compared regarding the effectiveness of procedure as a definitive treatment, need for delayed laparotomy and mortality. Results: 16 cases (64%) showed clinical improvement after bedside peritoneal drainage. Bedside peritoneal drainage in Group I and early laparotomy in Group II were effective as a definitive treatment in 10 cases (40%) and 15 cases (60%) respectively. Delayed laparotomy was indicated in 7 cases(28%) in Group I and 8 cases (32%) in Group II.Mortality was recorded in 8 patients (32%) in BPD group and in 9 patients (36%) in laparotomy group. Conclusion: According to this study, outcomes of bedside peritoneal drainage as a primary treatment for low birth weight and/or preterm neonates with perforated necrotizing enterocolitis showed no significant statistical difference as regards the need for delayed laparotomy and mortality rate when compared to the outcomes of early laparotomy as a primary treatment for the same conditions. Bedside peritoneal drainage provides a useful primary procedure for the management of preterm and low birth weight neonates with perforated necrotizing enterocolitis particularly in healthcare facilities without neonatal surgery capacity.