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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
- Source :
- Journal of Pediatric Surgery. 54:712-717
- Publication Year :
- 2019
- Publisher :
- Elsevier BV, 2019.
-
Abstract
- 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.Using the Children's Hospitals Neonatal Database, we identified ELBW infants32 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).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.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 II.
- Subjects :
- Short Bowel Syndrome
medicine.medical_specialty
Databases, Factual
Birth weight
medicine.medical_treatment
Enterocolitis, Necrotizing
Laparotomy
medicine
Birth Weight
Humans
Survival advantage
Retrospective Studies
business.industry
digestive, oral, and skin physiology
Infant, Newborn
Infant
General Medicine
Length of Stay
Hospitals, Pediatric
Short bowel syndrome
medicine.disease
Surgery
Survival Rate
Treatment Outcome
Infant, Extremely Low Birth Weight
Pediatrics, Perinatology and Child Health
Necrotizing enterocolitis
Drainage
Female
Level ii
Peritoneum
business
human activities
Peritoneal drain
Subjects
Details
- ISSN :
- 00223468
- Volume :
- 54
- Database :
- OpenAIRE
- Journal :
- Journal of Pediatric Surgery
- Accession number :
- edsair.doi.dedup.....931823358acdf1120c1cb3915477c6ec