BACKGROUND: Perforated necrotizing enterocolitis is a major cause of morbidity and mortality in premature infants, and the optimal treatment is uncertain. We designed this multicenter randomized trial to compare outco...BACKGROUND: Perforated necrotizing enterocolitis is a major cause of morbidity and mortality in premature infants, and the optimal treatment is uncertain. We designed this multicenter randomized trial to compare outcomes of primary peritoneal drainage with laparotomy and bowel resection in preterm infants with perforated necrotizing enterocolitis. METHODS: We randomly assigned 117 preterm infants (delivered before 34 weeks of gestation) with birth weights less than 1500 g and perforated necrotizing enterocolitis at 15 pediatric centers to undergo primary peritoneal drainage or laparotomy with bowel resection. Postoperative care was standardized. The primary outcome was survival at 90 days postoperatively. Secondary outcomes included dependence on parenteral nutrition 90 days postoperatively and length of hospital stay. RESULTS: At 90 days postoperatively, 19 of 55 infants assigned to primary peritoneal drainage had died (34.5 percent), as compared with 22 of 62 infants assigned to laparotomy (35.5 percent, P = 0.92). The percentages of infants who depended on total parenteral nutrition were 17 of 36 (47.2 percent) in the peritoneal-drainage group and 16 of 40 (40.0 percent) in the laparotomy group (P = 0.53). The mean (±SD) length of hospitalization for the 76 infants who were alive 90 days after operation was similar in the primary peritoneal-drainage and laparotomy groups (126±58 days and 116±56 days, respectively; P = 0.43). Subgroup analyses stratified according to the presence or absence of radiographic evidence of extensive necrotizing enterocolitis (pneumatosis intestinalis), gestational age of less than 25 weeks, and serum pH less than 7.30 at presentation showed no significant advantage of either treatment in any group. CONCLUSIONS: The type of operation performed for perforated necrotizing enterocolitis does not influence survival or other clinically important early outcomes in preterm infants.展开更多
Background:Traditionally,a stoma is established after resection of perforated or necrotic intestine for isolated intestinal perforation (IIP) and necrotizing enterocolitis (NEC).We compared the outcome of resection an...Background:Traditionally,a stoma is established after resection of perforated or necrotic intestine for isolated intestinal perforation (IIP) and necrotizing enterocolitis (NEC).We compared the outcome of resection and anastomosis (RA) with stoma formation (RS). Methods:Sixty-eight neonates undergoing laparotomy for IIP (n=20),NEC(n=43),and indeterminate cause (n=5) were reviewed retrospectively. Intestinal resection was followed by either anastomosis or stoma. The primary outcome measure was the frequency of anastomosis-and stoma-related complications. Results:The median gestational age (GA) was 28.5 weeks and birth weight (BW)-was 940 g. Thirty-seven neonates had RA (NEC 22,IIP 14,1 unknown),28 RS (NEC 21,IIP 6,1 unknown),and 3 laparotomy only. Twenty-five neonates died postoperatively. The mean ± SD GA of those who survived was 30 ± 4.5 weeks and those who died was 27.2 ± 3.5 weeks (P=0.008). The mean BW for those that survived was 1440.5 ± 865.1 g and those who died was 827.7 ± 385.1 g (P=0.002). There was no statistically significant difference between the RA and RS groups for GA (P=0.93),BW(P=0.4),general complications (P=0.96),anastomosis and stoma complications (P=0.48),and deaths (P=0.42). Conclusions:RA,rather than stoma,is an acceptable option in the surgical management of preterm neonates with IIP or NEC.展开更多
文摘BACKGROUND: Perforated necrotizing enterocolitis is a major cause of morbidity and mortality in premature infants, and the optimal treatment is uncertain. We designed this multicenter randomized trial to compare outcomes of primary peritoneal drainage with laparotomy and bowel resection in preterm infants with perforated necrotizing enterocolitis. METHODS: We randomly assigned 117 preterm infants (delivered before 34 weeks of gestation) with birth weights less than 1500 g and perforated necrotizing enterocolitis at 15 pediatric centers to undergo primary peritoneal drainage or laparotomy with bowel resection. Postoperative care was standardized. The primary outcome was survival at 90 days postoperatively. Secondary outcomes included dependence on parenteral nutrition 90 days postoperatively and length of hospital stay. RESULTS: At 90 days postoperatively, 19 of 55 infants assigned to primary peritoneal drainage had died (34.5 percent), as compared with 22 of 62 infants assigned to laparotomy (35.5 percent, P = 0.92). The percentages of infants who depended on total parenteral nutrition were 17 of 36 (47.2 percent) in the peritoneal-drainage group and 16 of 40 (40.0 percent) in the laparotomy group (P = 0.53). The mean (±SD) length of hospitalization for the 76 infants who were alive 90 days after operation was similar in the primary peritoneal-drainage and laparotomy groups (126±58 days and 116±56 days, respectively; P = 0.43). Subgroup analyses stratified according to the presence or absence of radiographic evidence of extensive necrotizing enterocolitis (pneumatosis intestinalis), gestational age of less than 25 weeks, and serum pH less than 7.30 at presentation showed no significant advantage of either treatment in any group. CONCLUSIONS: The type of operation performed for perforated necrotizing enterocolitis does not influence survival or other clinically important early outcomes in preterm infants.
文摘Background:Traditionally,a stoma is established after resection of perforated or necrotic intestine for isolated intestinal perforation (IIP) and necrotizing enterocolitis (NEC).We compared the outcome of resection and anastomosis (RA) with stoma formation (RS). Methods:Sixty-eight neonates undergoing laparotomy for IIP (n=20),NEC(n=43),and indeterminate cause (n=5) were reviewed retrospectively. Intestinal resection was followed by either anastomosis or stoma. The primary outcome measure was the frequency of anastomosis-and stoma-related complications. Results:The median gestational age (GA) was 28.5 weeks and birth weight (BW)-was 940 g. Thirty-seven neonates had RA (NEC 22,IIP 14,1 unknown),28 RS (NEC 21,IIP 6,1 unknown),and 3 laparotomy only. Twenty-five neonates died postoperatively. The mean ± SD GA of those who survived was 30 ± 4.5 weeks and those who died was 27.2 ± 3.5 weeks (P=0.008). The mean BW for those that survived was 1440.5 ± 865.1 g and those who died was 827.7 ± 385.1 g (P=0.002). There was no statistically significant difference between the RA and RS groups for GA (P=0.93),BW(P=0.4),general complications (P=0.96),anastomosis and stoma complications (P=0.48),and deaths (P=0.42). Conclusions:RA,rather than stoma,is an acceptable option in the surgical management of preterm neonates with IIP or NEC.
