Juan E Sola1, Joseph J Tepas, Leonidas G Koniaris. 1. DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida 33136, USA. jsola@med.miami.edu
Abstract
BACKGROUND: To determine whether peritoneal drain (PD) or laparotomy (LAP) is the most effective intervention in premature neonates with necrotizing enterocolitis (NEC) or intestinal perforation (IP). METHODS: A systematic review of the published literature between January 2000 and December 2008 was undertaken. Prospective studies with at least 25 patients in each of the PD and LAP arms were selected. Gestational age, birth weight, operation, and mortality data were extracted. RESULTS: Five prospective studies (two level I, three level II) with 523 (273 PD, 250 LAP) participants followed for mortality met selection criteria. Using a fixed effect model, the combined estimate indicates an increased mortality of 55% with PD (OR 1.55, 95% CI: 1.08-2.22, P=0.02) without statistical heterogeneity (chi(2)=5.88, P=0.21). PD patients were 0.78 wk younger (P =0.0002) and 67 g smaller (P =0.0006). Analysis of the three level II trials yielded a combined estimate indicating an excess mortality of 89% with PD patients (95% CI: 1.20-2.98, P =0.006) without statistical heterogeneity (chi(2)=3.74, P=0.15). CONCLUSIONS: PD is associated with 55% excess mortality compared with LAP. Pediatric surgeons must individually assess and select patients with NEC and IP for optimal surgical therapy. Copyright (c) 2010 Elsevier Inc. All rights reserved.
BACKGROUND: To determine whether peritoneal drain (PD) or laparotomy (LAP) is the most effective intervention in premature neonates with necrotizing enterocolitis (NEC) or intestinal perforation (IP). METHODS: A systematic review of the published literature between January 2000 and December 2008 was undertaken. Prospective studies with at least 25 patients in each of the PD and LAP arms were selected. Gestational age, birth weight, operation, and mortality data were extracted. RESULTS: Five prospective studies (two level I, three level II) with 523 (273 PD, 250 LAP) participants followed for mortality met selection criteria. Using a fixed effect model, the combined estimate indicates an increased mortality of 55% with PD (OR 1.55, 95% CI: 1.08-2.22, P=0.02) without statistical heterogeneity (chi(2)=5.88, P=0.21). PDpatients were 0.78 wk younger (P =0.0002) and 67 g smaller (P =0.0006). Analysis of the three level II trials yielded a combined estimate indicating an excess mortality of 89% with PDpatients (95% CI: 1.20-2.98, P =0.006) without statistical heterogeneity (chi(2)=3.74, P=0.15). CONCLUSIONS:PD is associated with 55% excess mortality compared with LAP. Pediatric surgeons must individually assess and select patients with NEC and IP for optimal surgical therapy. Copyright (c) 2010 Elsevier Inc. All rights reserved.
Authors: Anne Stey; Elizabeth S Barnert; Chi-Hong Tseng; Emmett Keeler; Jack Needleman; Mei Leng; Lorraine I Kelley-Quon; Stephen B Shew Journal: Pediatrics Date: 2015-04-13 Impact factor: 7.124
Authors: Shelly Choo; Dominic Papandria; Yiyi Zhang; Melissa Camp; Jose H Salazar; Stefan Scholz; Daniel Rhee; David Chang; Fizan Abdullah Journal: Pediatr Surg Int Date: 2011-03-13 Impact factor: 1.827