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Necrotizing Enterocolitis with Perforation in Neonates: Primary Peritoneal Drainage Irrespective of Birth Weight Resulting in Improved Survival

Tanvir Roshan Khan, Assistant Professor, Department of Pediatric Surgery, King George’s Medical University (KGMU), Lucknow, Uttar Pradesh-226003. , Tanvir Roshan Khan* , Madhukar Maletha** , J.D. Rawat*** , Ashish Wakhlu*** , S.N. Kureel***

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New Indian Journal of Surgery 8(2):p 144-147, April - June 2017. | DOI: https://dx.doi.org/10.21088/nijs.0976.4747.8217.23

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Abstract

Background: Necrotizing enterocolitis (NEC) is the most common life threatening emergency of the gastrointestinal tract in newborn period. Despite aggressive medical management many patients develop complications which require surgical intervention. There is controversy regarding the optimal timing and type of surgical intervention in these high risk patients. This paper presents our experience of peritoneal drainage as the primary treatment in all patients of NEC with bowel perforation and its effect on the overall survival of these patients.

Method: Total 142 patients of NEC with perforation were admitted in the study period of 5 years. These patients were prospectively analysed. Patients were divided in two groups according to their body weight to judge the clinical improvement by the peritoneal drainage (Group 1- birth weight< 1500 grams, and group 2- birth weight > 1500 grams). All these patients of NEC (irrespective of their weight and gestational age) with perforation were subjected to primary peritoneal drainage.

Results: Primary peritoneal drainage (PPD) provided a cure in more than half of these high risk babies. Out of 142, 80 patients required no other operative procedure and they were considered cured by PPD only. The survival was 61.7% in group 1 while group 2 had a survival rate of 68.9%.

Conclusion: The study shows that, though the primary peritoneal drainage is not a definitive cure in patients of NEC with perforation, but it definitively reduces the number of laparotomies and also helps in improving the general condition of the patients who need surgery later on. Primary peritoneal drainage (PPD) reduces the mortality in these high risk neonates.

 

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DOI: https://dx.doi.org/10.21088/nijs.0976.4747.8217.23

Keywords

Necrotizing Enterocolitis; Primary Peritoneal Drainage; Laparotomy; Mortality; High Risk. 

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