Laparotomy versus peritoneal drainage for necrotizing enterocolitis and perforation

R. Lawrence Moss, Reed A. Dimmitt, Douglas C. Barnhart, Karl G. Sylvester, Rebeccah L. Brown, David M. Powell, Saleem Islam, Jacob C. Langer, Thomas T. Sato, Mary L. Brandt, Hanmin Lee, Martin L. Blakely, Eric L. Lazar, Ronald B. Hirschl, Brian D. Kenney, David Hackam, Daniel Zelterman, Bonnie L. Silverman

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Perforated necrotizing enterocolitis is a major cause of morbidity and mortality in premature infants, and the optimal treatment is uncertain. We designed this multicenter randomized trial to compare outcomes of primary peritoneal drainage with laparotomy and bowel resection in preterm infants with perforated necrotizing enterocolitis. METHODS: We randomly assigned 117 preterm infants (delivered before 34 weeks of gestation) with birth weights less than 1500 g and perforated necrotizing enterocolitis at 15 pediatric centers to undergo primary peritoneal drainage or laparotomy with bowel resection. Postoperative care was standardized. The primary outcome was survival at 90 days postoperatively. Secondary outcomes included dependence on parenteral nutrition 90 days postoperatively and length of hospital stay. RESULTS: At 90 days postoperatively, 19 of 55 infants assigned to primary peritoneal drainage had died (34.5 percent), as compared with 22 of 62 infants assigned to laparotomy (35.5 percent, P = 0.92). The percentages of infants who depended on total parenteral nutrition were 17 of 36 (47.2 percent) in the peritoneal-drainage group and 16 of 40 (40.0 percent) in the laparotomy group (P = 0.53). The mean (±SD) length of hospitalization for the 76 infants who were alive 90 days after operation was similar in the primary peritoneal-drainage and laparotomy groups (126±58 days and 116±56 days, respectively; P = 0.43). Subgroup analyses stratified according to the presence or absence of radiographic evidence of extensive necrotizing enterocolitis (pneumatosis intestinalis), gestational age of less than 25 weeks, and serum pH less than 7.30 at presentation showed no significant advantage of either treatment in any group. CONCLUSIONS: The type of operation performed for perforated necrotizing enterocolitis does not influence survival or other clinically important early outcomes in preterm infants.

Original languageEnglish (US)
Pages (from-to)2225-2234
Number of pages10
JournalNew England Journal of Medicine
Volume354
Issue number21
DOIs
StatePublished - May 25 2006
Externally publishedYes

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Necrotizing Enterocolitis
Laparotomy
Drainage
Premature Infants
Length of Stay
Total Parenteral Nutrition
Postoperative Care
Parenteral Nutrition
Birth Weight
Gestational Age
Multicenter Studies
Hospitalization
Pediatrics
Morbidity
Pregnancy
Mortality
Therapeutics
Serum

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Moss, R. L., Dimmitt, R. A., Barnhart, D. C., Sylvester, K. G., Brown, R. L., Powell, D. M., ... Silverman, B. L. (2006). Laparotomy versus peritoneal drainage for necrotizing enterocolitis and perforation. New England Journal of Medicine, 354(21), 2225-2234. https://doi.org/10.1056/NEJMoa054605

Laparotomy versus peritoneal drainage for necrotizing enterocolitis and perforation. / Moss, R. Lawrence; Dimmitt, Reed A.; Barnhart, Douglas C.; Sylvester, Karl G.; Brown, Rebeccah L.; Powell, David M.; Islam, Saleem; Langer, Jacob C.; Sato, Thomas T.; Brandt, Mary L.; Lee, Hanmin; Blakely, Martin L.; Lazar, Eric L.; Hirschl, Ronald B.; Kenney, Brian D.; Hackam, David; Zelterman, Daniel; Silverman, Bonnie L.

In: New England Journal of Medicine, Vol. 354, No. 21, 25.05.2006, p. 2225-2234.

Research output: Contribution to journalArticle

Moss, RL, Dimmitt, RA, Barnhart, DC, Sylvester, KG, Brown, RL, Powell, DM, Islam, S, Langer, JC, Sato, TT, Brandt, ML, Lee, H, Blakely, ML, Lazar, EL, Hirschl, RB, Kenney, BD, Hackam, D, Zelterman, D & Silverman, BL 2006, 'Laparotomy versus peritoneal drainage for necrotizing enterocolitis and perforation', New England Journal of Medicine, vol. 354, no. 21, pp. 2225-2234. https://doi.org/10.1056/NEJMoa054605
Moss RL, Dimmitt RA, Barnhart DC, Sylvester KG, Brown RL, Powell DM et al. Laparotomy versus peritoneal drainage for necrotizing enterocolitis and perforation. New England Journal of Medicine. 2006 May 25;354(21):2225-2234. https://doi.org/10.1056/NEJMoa054605
Moss, R. Lawrence ; Dimmitt, Reed A. ; Barnhart, Douglas C. ; Sylvester, Karl G. ; Brown, Rebeccah L. ; Powell, David M. ; Islam, Saleem ; Langer, Jacob C. ; Sato, Thomas T. ; Brandt, Mary L. ; Lee, Hanmin ; Blakely, Martin L. ; Lazar, Eric L. ; Hirschl, Ronald B. ; Kenney, Brian D. ; Hackam, David ; Zelterman, Daniel ; Silverman, Bonnie L. / Laparotomy versus peritoneal drainage for necrotizing enterocolitis and perforation. In: New England Journal of Medicine. 2006 ; Vol. 354, No. 21. pp. 2225-2234.
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T1 - Laparotomy versus peritoneal drainage for necrotizing enterocolitis and perforation

AU - Moss, R. Lawrence

AU - Dimmitt, Reed A.

AU - Barnhart, Douglas C.

AU - Sylvester, Karl G.

AU - Brown, Rebeccah L.

AU - Powell, David M.

AU - Islam, Saleem

AU - Langer, Jacob C.

AU - Sato, Thomas T.

AU - Brandt, Mary L.

AU - Lee, Hanmin

AU - Blakely, Martin L.

AU - Lazar, Eric L.

AU - Hirschl, Ronald B.

AU - Kenney, Brian D.

AU - Hackam, David

AU - Zelterman, Daniel

AU - Silverman, Bonnie L.

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Y1 - 2006/5/25

N2 - BACKGROUND: Perforated necrotizing enterocolitis is a major cause of morbidity and mortality in premature infants, and the optimal treatment is uncertain. We designed this multicenter randomized trial to compare outcomes of primary peritoneal drainage with laparotomy and bowel resection in preterm infants with perforated necrotizing enterocolitis. METHODS: We randomly assigned 117 preterm infants (delivered before 34 weeks of gestation) with birth weights less than 1500 g and perforated necrotizing enterocolitis at 15 pediatric centers to undergo primary peritoneal drainage or laparotomy with bowel resection. Postoperative care was standardized. The primary outcome was survival at 90 days postoperatively. Secondary outcomes included dependence on parenteral nutrition 90 days postoperatively and length of hospital stay. RESULTS: At 90 days postoperatively, 19 of 55 infants assigned to primary peritoneal drainage had died (34.5 percent), as compared with 22 of 62 infants assigned to laparotomy (35.5 percent, P = 0.92). The percentages of infants who depended on total parenteral nutrition were 17 of 36 (47.2 percent) in the peritoneal-drainage group and 16 of 40 (40.0 percent) in the laparotomy group (P = 0.53). The mean (±SD) length of hospitalization for the 76 infants who were alive 90 days after operation was similar in the primary peritoneal-drainage and laparotomy groups (126±58 days and 116±56 days, respectively; P = 0.43). Subgroup analyses stratified according to the presence or absence of radiographic evidence of extensive necrotizing enterocolitis (pneumatosis intestinalis), gestational age of less than 25 weeks, and serum pH less than 7.30 at presentation showed no significant advantage of either treatment in any group. CONCLUSIONS: The type of operation performed for perforated necrotizing enterocolitis does not influence survival or other clinically important early outcomes in preterm infants.

AB - BACKGROUND: Perforated necrotizing enterocolitis is a major cause of morbidity and mortality in premature infants, and the optimal treatment is uncertain. We designed this multicenter randomized trial to compare outcomes of primary peritoneal drainage with laparotomy and bowel resection in preterm infants with perforated necrotizing enterocolitis. METHODS: We randomly assigned 117 preterm infants (delivered before 34 weeks of gestation) with birth weights less than 1500 g and perforated necrotizing enterocolitis at 15 pediatric centers to undergo primary peritoneal drainage or laparotomy with bowel resection. Postoperative care was standardized. The primary outcome was survival at 90 days postoperatively. Secondary outcomes included dependence on parenteral nutrition 90 days postoperatively and length of hospital stay. RESULTS: At 90 days postoperatively, 19 of 55 infants assigned to primary peritoneal drainage had died (34.5 percent), as compared with 22 of 62 infants assigned to laparotomy (35.5 percent, P = 0.92). The percentages of infants who depended on total parenteral nutrition were 17 of 36 (47.2 percent) in the peritoneal-drainage group and 16 of 40 (40.0 percent) in the laparotomy group (P = 0.53). The mean (±SD) length of hospitalization for the 76 infants who were alive 90 days after operation was similar in the primary peritoneal-drainage and laparotomy groups (126±58 days and 116±56 days, respectively; P = 0.43). Subgroup analyses stratified according to the presence or absence of radiographic evidence of extensive necrotizing enterocolitis (pneumatosis intestinalis), gestational age of less than 25 weeks, and serum pH less than 7.30 at presentation showed no significant advantage of either treatment in any group. CONCLUSIONS: The type of operation performed for perforated necrotizing enterocolitis does not influence survival or other clinically important early outcomes in preterm infants.

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