Peritoneal drainage as definitive management of intestinal perforation in extremely low-birth-weight infants.

BACKGROUND/PURPOSE: The optimal management of extremely low-birth-weight (ELBW) infants with intestinal perforation remains unclear. The authors evaluated ELBW neonates with intestinal perforation in whom peritoneal drainage (PD) was intended as definitive therapy.

METHODS

The records of 29 consecutive ELBW infants with intestinal perforation were reviewed. All underwent PD. Survival, the need for other abdominal procedures, the transition to enteral feeding, and the incidence of cholestasis and infectious complications were noted. Variables associated with nonsurvival were assessed.

RESULTS

Overall survival rate was 66%. In 24% of cases, a second abdominal procedure was required. Full feedings were achieved at a mean of 69 days. Extraabdominal infectious complications occurred in 63% of survivors, and direct bilirubin was greater than 2.0 mg/dL in 57% at 2 months. Thrombocytopenia and vasopressor requirements at the time of perforation were associated with nonsurvival.

CONCLUSIONS

In this consecutive series of ELBW infants in whom PD was intended as definitive treatment for intestinal perforation survival was comparable with that found in series in which immediate laparotomy and resection were used. Few secondary abdominal procedures were required. The interval between PD and full enteral nutrition, however, was long, and the incidence of nonabdominal infectious complications and cholestasis was substantial.