Does the initial surgery for necrotizing enterocolitis matter? Comparative outcomes for laparotomy vs. peritoneal drain as initial surgery for necrotizing enterocolitis in infants <1000â¯g birth weight.
J Pediatr Surg
; 54(4): 712-717, 2019 Apr.
Article
en En
| MEDLINE
| ID: mdl-30765157
ABSTRACT
PURPOSE:
Quantify short-term outcomes associated with initial surgery [laparotomy (LAP) vs. peritoneal drain (PD)] for necrotizing enterocolitis (NEC) in extremely-low-birth-weight (ELBW) infants.METHODS:
Using the Children's Hospitals Neonatal Database, we identified ELBW infants <32â¯weeks' gestation with surgical NEC (sNEC). Unadjusted and multivariable regression analyses were used to estimate the associations between LAP (or PD) and death/short bowel syndrome (SBS) and length of stay (LOS).RESULTS:
LAP was the more common initial procedure for sNEC (nâ¯=â¯359/528, 68%). Infants receiving LAP were older and heavier. Initial procedure was unrelated to death/SBS in both bivariate (LAP 43% vs PD 46%, pâ¯=â¯0.573) and multivariable analyses (ORâ¯=â¯0.89, 95% CIâ¯=â¯0.57, 1.38, pâ¯=â¯0.6). LAP was inversely related to mortality (29% vs. 41%, pâ¯<â¯0.007) in bivariate analysis, but not significant in multivariable analysis accounting for markers of preoperative illness severity. However, the association between LAP and SBS (14% vs. 5%, pâ¯=â¯0.012) remained significant in multivariable analyses (adjusted ORâ¯=â¯2.25, pâ¯=â¯0.039). LOS among survivors was unrelated to the first surgical procedure in multivariable analysis.CONCLUSION:
ELBW infants who undergo LAP as the initial operative procedure for sNEC may be at higher risk for SBS without a clear in-hospital survival advantage or shorter hospitalization. LEVEL OF EVIDENCE Level II.Palabras clave
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Peritoneo
/
Drenaje
/
Enterocolitis Necrotizante
/
Laparotomía
Tipo de estudio:
Etiology_studies
/
Observational_studies
/
Risk_factors_studies
Límite:
Female
/
Humans
/
Infant
/
Newborn
Idioma:
En
Revista:
J Pediatr Surg
Año:
2019
Tipo del documento:
Article