Abstract
Objective: Focal intestinal perforation (FIP), which is characterized by the lack of inflammatory infiltration peripheral to the perforation, develops with few premonitory symptoms. The treatment typically involves laparotomy for drainage or percutaneous drain insertion. We retrospectively investigated the efficacy and risks associated with laparotomy-assisted drainage and peritoneal drainage (PD) for FIP. StudyDesign: This was a retrospective, comparative study.Results: We retrospectively evaluated seven infants with FIP who were admitted to the neonatal intensive care unit between April 2007 and March 2017. Five infants were administered indomethacin and six were administered steroids. The PD group had significantly higher birth weight, higher C-reactive protein (CRP) levels, and shorter operating times. In addition, they gained weight postoperatively but often required adjuvant therapy for bowel function. There was no significant difference between the groups regarding the time to post-operative full feeding, and all infants showed improved physical appearance.Conclusions: PD under local anesthesia can be considered for treating infants with FIP who have elevated CRP levels and poor general condition. We think management of this condition is still challenging in our experience, and it is necessary to continue in the future.
Highlights
With recent advances in perinatal care, there has been an increase in the number of low birth weight infants who suffer from neonatal diseases
We found no significant difference in the time to post-operative full feeding between the peritoneal drainage (PD) and laparotomy and enterostomy (Lap+Ent) groups, which was consistent with previously reported findings
PD is effective for treating Focal intestinal perforation (FIP) in LBWIs
Summary
With recent advances in perinatal care, there has been an increase in the number of low birth weight infants who suffer from neonatal diseases. Due to their prematurity, extremely low birth weight infants (ELBWIs) have a high incidence of complications that are known to affect their lifetime prognosis. In Japan, the mortality rate of neonates with gastrointestinal perforation was 18.9% in 2013, exceeding the rate of 16.9% in 2008, which is said to be due to increased birth and survival rates of ELBWIs, coupled with a simultaneous increase in the incidence of gastrointestinal perforation [1]. Gastrointestinal perforations that occur during the neonatal period include necrotizing enterocolitis (NEC) and focal intestinal perforation (FIP) without necrotic changes [2]. FIP is alternatively called as intestinal perforation, local intestinal perforation, isolated intestinal perforation [3,4], or spontaneous intestinal perforation [5]
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