Laparotomy versus Peritoneal Drainage as Primary Treatment for Surgical Necrotizing Enterocolitis or Spontaneous Intestinal Perforation in Preterm Neonates: A Systematic Review and Meta-Analysis.

Autor:	Solis-Garcia G; Division of Neonatology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada.; Department of Pediatrics, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada.; Department of Pediatrics, University of Toronto, Toronto, ON M5S 1A1, Canada., Pierro A; Department of Pediatrics, University of Toronto, Toronto, ON M5S 1A1, Canada.; Department of Surgery, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada., Jasani B; Division of Neonatology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada.; Department of Pediatrics, University of Toronto, Toronto, ON M5S 1A1, Canada.
Jazyk:	angličtina
Zdroj:	Children (Basel, Switzerland) [Children (Basel)] 2023 Jul 06; Vol. 10 (7). Date of Electronic Publication: 2023 Jul 06.
DOI:	10.3390/children10071170
Abstrakt:	Aim: to systematically review and meta-analyze the impact on morbidity and mortality of peritoneal drainage (PD) compared to laparotomy (LAP) in preterm neonates with surgical NEC (sNEC) or spontaneous intestinal perforation (SIP). Methods: Medical databases were searched until June 2022 for studies comparing PD and LAP as primary surgical treatment of preterm neonates with sNEC or SIP. The primary outcome was survival during hospitalization; predefined secondary outcomes included need for parenteral nutrition at 90 days, time to reach full enteral feeds, need for subsequent laparotomy, duration of hospitalization and complications. Results: Three RCTs (N = 493) and 49 observational studies (N = 19,447) were included. No differences were found in the primary outcome for RCTs, but pooled observational data showed that, compared to LAP, infants with sNEC/SIP who underwent PD had lower survival [48 studies; N = 19,416; RR 0.85; 95% CI 0.79-0.90; GRADE: low]. Observational studies also showed that the subgroup of infants with sNEC had increased survival in the LAP group (30 studies; N = 9370; RR = 0.82; 95% CI 0.72-0.91; GRADE: low). Conclusions: Compared to LAP, PD as primary surgical treatment for sNEC or SIP has similar survival rates when analyzing data from RCTs. PD was associated with lower survival rates in observational studies.
Databáze:	MEDLINE
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