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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

Authors :
J Sharma
Isabella Zaniletti
Karna Murthy
Beverly S. Brozanski
Kristina M. Reber
Toby D Yanowitz
Anthony J. Piazza
Rajan Wadhawan
Kevin M Sullivan
Sujir Pritha Nayak
Robert DiGeronimo
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&#39;s Hospitals Neonatal Database, we identified ELBW infants32 weeks&#39; 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.

Details

ISSN :
00223468
Volume :
54
Database :
OpenAIRE
Journal :
Journal of Pediatric Surgery
Accession number :
edsair.doi.dedup.....931823358acdf1120c1cb3915477c6ec