Peritoneal drainage effective for spontaneous intestinal perforation in infants

Last Updated: 2015-05-04

By Will Boggs MD

NEW YORK (Reuters Health) - Peritoneal drainage is effective initial therapy for most extremely low birth weight (ELBW) infants with spontaneous intestinal perforation, according to a chart review.

"I believe that peritoneal drainage (PD) is a good initial approach for extremely low birth weight (<1000 grams) neonates with spontaneous intestinal perforation (SIP)," Dr. John M. Draus Jr., from Kentucky Children's Hospital, Lexington, who was not involved in this study, told Reuters Health by email. "In a previous study from my group, we found that 40% of SIP patients were successfully managed with PD alone. This study had a larger patient cohort and had even better results."

About 3% of ELBW infants develop SIP, which can be associated with feeding difficulties, prolonged hospitalization, and long-term neurodevelopmental impairment.

Dr. Brett M. Jakaitis and Dr. Amina M. Bhatia, from Emory University School of Medicine, Atlanta, Georgia, report the outcomes of 89 ELBW infants who underwent definitive PD or salvage laparotomy for SIP between 2003 and 2012.

About three quarters of the infants were treated with definitive PD, and about a quarter required salvage laparotomy, according to the April 9 Journal of Perinatology online report.

The two groups did not differ in 30-day survival (82% for PD, 95% for salvage laparotomy). Infants who presented before or at seven days of life were 2.7 times more likely to go on to need a salvage laparotomy.

The presence of stool in the peritoneal drainage increased the likelihood of eventually requiring laparotomy, while the presence of serous fluid in the abdomen decreased the likelihood, though neither of these differences reached statistical significance.

PD failure within the first 10 days was usually due to sepsis or persistent pneumoperitoneum. Later PD failure usually resulted from recurrent pneumoperitoneum or enterocutaneous fistula.

Times to begin and achieve full enteral feeds were significantly longer for infants who required salvage laparotomy, but days spent on mechanical ventilation and hospital stays did not differ significantly between the groups.

"Our data indicate that there may be a subset of patients among those diagnosed with SIP who have a specific type of perforation amenable to PD," the authors conclude. "Larger, prospective trials would be needed to confirm our findings."

"The management of extremely low birth weight neonates with SIP is challenging," Dr. Draus said. "This study supports the use of PD as the initial treatment choice. PD should be performed by a pediatric surgeon, and the surgeon should remain involved in the management of these patients. Salvage laparotomy will be required in a significant percentage of these babies."

Dr. Bhatia did not respond to a request for comments.

The authors reported no funding or conflict of interest.

SOURCE: http://bit.ly/1Ea6nRY

J Perinatol 2015.