Rehane Kibria, Saifud Din Awan.
Necrotizing Enterocolitis in premature babies; Laparotomy versus Peritioneal drainage.
Professional Med J Jan ;15(3):350-3.

Premature infants with necrotizing enterocolitis (NEC) or intestinal perforation (IP) are treated either surgically with laprotomy or peritoneal drain placement. Objective: (1) To develop a hypothesis about the relative effect of these 2 therapies on risk adjusted outcomes through 18 months in premature infants. (2) To obtain data that would be useful in designing and conducting a successful trial of this hypothesis. Design: A prospective, observational study. Setting: In pediatric surgical departments of Military Hospital Rawalpindi & Combined Military Hospital Rawalpindi. Period: From Nov 2005 to April 2007. Materials & Methods: To assist in risk adjustment, the attending pediatric surgeon recorded the preoperative diagnosis and intraoperative diagnosis and identified infants who were considered to be too ill for laprotomy. Results: Severe NEC or IP in 156 of 2987 premature infants; 80 were treated with initial drainage and 76 were treated with initial laprotomy. By 16 months, 76 (50%) had died; outcome remained worse in subgroup with NEC. Laprotomy was not performed in 76% (28 of 36) of drain treated survivors. Conclusions: Drainage was commonly used , and outcome was poor. Our findings, particularly the risk adjusted odds ratio favoring laparotomy, indicate the need for a large, multicenter clinical trial to assess the effect of initial surgery therapy on out come at >16 months.

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