Document Detail


Peritoneal drainage does not stabilize extremely low birth weight infants with perforated bowel: data from the NET Trial.
MedLine Citation:
PMID:  20152345     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: Proponents of peritoneal drainage (PD) hypothesize that it allows stabilization before laparotomy. We examined this hypothesis by comparing clinical status before and after either PD or primary laparotomy (LAP). METHODS: In an ethically approved, international, prospective randomized controlled trial (2002-2006), extremely low birth weight (<1000 g) infants with pneumoperitoneum received primary PD (n = 35) or LAP (n = 34). Physiologic data were collected prospectively and organ failure scores calculated and compared between preprocedure and day 1 after procedure. Data, expressed as mean +/- SD or median (range), were analyzed using appropriate statistical tests. RESULTS: There was no postprocedure improvement in either PD or LAP group comparing heart rate (PD, P = 1.0; LAP, P = .6), blood pressure (PD, P = .6; LAP, P = .8), inotrope requirement (PD, P = .2; LAP, P = .3), or Arterial partial pressure of oxygen/fraction of inspired oxygen ratio (PD, P = .1; LAP, P = .5). Infants managed with PD had a worsening cardiovascular status (P = .05). There were no differences in total organ failure score in either group (PD, P = .5; LAP, P = 1). Only 4 infants survived with PD alone with no difference between preprocedure and postprocedure organ failure score (P = .4). CONCLUSIONS: Peritoneal drainage does not immediately improve clinical status in extremely low birth weight infants with bowel perforation. The use of PD as a stabilizing or temporizing measure is not supported by these results.
Authors:
Clare M Rees; Simon Eaton; A Kate Khoo; Edward M Kiely; ; Agostino Pierro
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of pediatric surgery     Volume:  45     ISSN:  1531-5037     ISO Abbreviation:  J. Pediatr. Surg.     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-02-15     Completed Date:  2010-04-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0052631     Medline TA:  J Pediatr Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  324-8; discussion 328-9     Citation Subset:  IM    
Copyright Information:
Copyright 2010 Elsevier Inc. All rights reserved.
Affiliation:
Department of Pediatric Surgery, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, London WC1N 1EH, United Kingdom.
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MeSH Terms
Descriptor/Qualifier:
Drainage / methods*
Enterocolitis, Necrotizing / surgery*
Humans
Infant, Extremely Low Birth Weight / physiology
Infant, Newborn
Infant, Premature
Intestinal Perforation / surgery*
Laparotomy / methods*
Multiple Organ Failure / diagnosis,  epidemiology
Peritoneum / surgery
Pneumoperitoneum / surgery
Postoperative Care
Postoperative Complications / diagnosis,  epidemiology
Preoperative Care
Risk Factors
Severity of Illness Index
Survival Analysis
Treatment Outcome
Investigator
Investigator/Affiliation:
A Nika / ; P Gamba / ; M Zamparelli / ; G Jawaheer / ; S Clarke / ; M Miserez / ; M Davenport / ; P Bagolan / ; F Morini / ; V P Carnielli / ; A Calisti / ; C A Yeung / ; P K H Tam / ; S Marven / ; P Morreau / ; J Hamill / ; C Gitzelmann / ; R Surana / ; M H?llwarth / ; F Beyerlein /

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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