Article ; Online: Does the initial surgery for necrotizing enterocolitis matter? Comparative outcomes for laparotomy vs. peritoneal drain as initial surgery for necrotizing enterocolitis in infants <1000 g birth weight.
2019 Volume 54, Issue 4, Page(s) 712–717
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 ... ...
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 <32 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 (n = 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%, p = 0.573) and multivariable analyses (OR = 0.89, 95% CI = 0.57, 1.38, p = 0.6). LAP was inversely related to mortality (29% vs. 41%, p < 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%, p = 0.012) remained significant in multivariable analyses (adjusted OR = 2.25, p = 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. |
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MeSH term(s) | Birth Weight ; Databases, Factual ; Drainage/adverse effects ; Drainage/methods ; Enterocolitis, Necrotizing/mortality ; Enterocolitis, Necrotizing/surgery ; Female ; Hospitals, Pediatric ; Humans ; Infant ; Infant, Extremely Low Birth Weight ; Infant, Newborn ; Laparotomy/adverse effects ; Laparotomy/methods ; Length of Stay/statistics & numerical data ; Peritoneum/surgery ; Retrospective Studies ; Short Bowel Syndrome/epidemiology ; Short Bowel Syndrome/etiology ; Survival Rate ; Treatment Outcome |
Language | English |
Publishing date | 2019-01-19 |
Publishing country | United States |
Document type | Comparative Study ; Journal Article |
ZDB-ID | 80165-3 |
ISSN | 1531-5037 ; 0022-3468 |
ISSN (online) | 1531-5037 |
ISSN | 0022-3468 |
DOI | 10.1016/j.jpedsurg.2018.12.010 |
Database | MEDical Literature Analysis and Retrieval System OnLINE |
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