Ms. Lessin et al., PERITONEAL DRAINAGE AS DEFINITIVE TREATMENT FOR INTESTINAL PERFORATION IN INFANTS WITH EXTREMELY LOW-BIRTH-WEIGHT (LESS-THAN-750G), Journal of pediatric surgery, 33(2), 1998, pp. 370-372
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.