Initial surgery for spontaneous intestinal perforation in extremely low birth weight infants is not associated with mortality or in-hospital morbidities.

Amy B Hair Kevin M Sullivan Irfan Ahmad Isabella Zaniletti Shannon N Acker Muralidhar H Premkumar Kristina Reber Katie A Huff Sujir Pritha Nayak Robert DiGeronimo Jae Kim Jessica Roberts Troy A Markel Beverly Brozanski Jotishna Sharma Anthony J Piazza Toby D Yanowitz

J Perinatol

University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.

Published: December 2024

The study aimed to evaluate short-term outcomes such as mortality and length of stay for extremely low birth weight infants with spontaneous intestinal perforation, comparing three surgical approaches: peritoneal drain (PD), laparotomy after PD (PD-LAP), and straight laparotomy (LAP).
Out of 729 identified infants, those treated with PD had lower gestational ages and higher infection rates, with PD associated with higher mortality rates compared to PD-LAP and LAP in initial analysis, but this link was not confirmed in more complex statistical models.
Ultimately, the findings suggest that the type of initial surgical approach does not significantly affect mortality or length of stay for these infants, indicating that other factors such

Objective: Determine short-term outcomes following peritoneal drain (PD), laparotomy (LAP) after PD (PD-LAP), and LAP in extremely low birth weight (ELBW) infants with spontaneous intestinal perforation (SIP).

Study Design: ELBW infants with SIP were identified using the Children's Hospitals Neonatal Database. Mortality and length of stay (LOS) were compared among groups.

Results: Of 729 SIP infants from 6/2010-12/2016, 383(53%) received PD, 61(8%) PD-LAP, and 285(39%) LAP. PD infants had lower GA at birth, at SIP diagnosis and upon admission than PD-LAP or LAP; and higher sepsis rates than LAP. Bivariate analysis and Kaplan-Meier survival estimates suggested PD had increased mortality vs. PD-LAP and LAP (27%, 11.5%, and 15.8% respectively, p < 0.001). However, surgical approach was not significantly associated with mortality in multivariable analysis accounting for GA and illness severity. LOS did not differ by surgical approach.

Conclusions: In ELBW infants with SIP, mortality, and LOS are independent of the initial surgical approach.

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http://dx.doi.org/10.1038/s41372-024-02037-8	DOI Listing

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