PERITONEAL DRAINAGE AS DEFINITIVE TREATMENT FOR INTESTINAL PERFORATION IN INFANTS WITH EXTREMELY LOW-BIRTH-WEIGHT (LESS-THAN-750G)

Background: Advances in neonatal intensive care have improved the surv ival of the extremely premature infant. However, survival at less than 25 weeks' gestational age remains tenuous, with intestinal perforatio n presenting a significant mortality. Methods: During an 18-month peri od from 1995 to 1996, nine patients weighing less than 750 g (range, 4 85 to 740 g; mean, 615 g) presented with intestinal perforation. All p atients were treated with peritoneal drainage. Drains were removed aft er clinical improvement and the cessation of peritoneal drainage. Resu lts: Seven patients survived the initial drainage procedure (78%). At a mean follow-up of 12 months, the six long-term survivors are all tol erating full enteral feeds, and none developed intestinal strictures o r intraabdominal abscess. No patient required subsequent celiotomy. Pe ritoneal drainage has previously been considered in some centers as te mporary therapy in extremely ill neonates deemed unlikely to survive o peration. The authors have adopted drainage as the sole treatment in s elected patients. Conclusion: Peritoneal drainage alone may be conside red definitive therapy for intestinal perforation in the majority of m icro premature infants. Copyright (C) 1998 by W.B. Saunders Company.