Protocol-Driven Surgical Care of Necrotizing Enterocolitis and Spontaneous Intestinal Perforation
| Autor: | Anthony R. Hogan, Krishnamurti A. Rao, Holly L. Neville, Juan E. Sola, Hallie J. Quiroz, Eduardo A. Perez, Ann Christina Brady, Chad M. Thorson |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Birth weight Improved survival 03 medical and health sciences 0302 clinical medicine Postoperative Complications Clinical Protocols Peritoneal drainage Enterocolitis Necrotizing Laparotomy medicine Spontaneous Intestinal Perforation Definitive surgery Humans business.industry Surgical care Infant Newborn medicine.disease Surgery Treatment Outcome Intestinal Perforation 030220 oncology & carcinogenesis Necrotizing enterocolitis Florida Drainage 030211 gastroenterology & hepatology Female business Infant Premature |
| Zdroj: | The Journal of surgical research. 255 |
| ISSN: | 1095-8673 |
| Popis: | There is no clear consensus on the optimal operative management of premature infants with surgical necrotizing enterocolitis (sNEC) or spontaneous intestinal perforation (SIP); thus, a protocol was developed to guide surgical decision making regarding initial peritoneal drainage (PD) versus initial laparotomy (LAP). We sought to evaluate outcomes after implementation of the protocol.Pre-post study including multiple urban hospitals. Premature infants with sNEC/SIP were accrued after implementation of surgical protocol-directed care (June 2014-June 2019). Patients with a birth weight of750 g and less than 2 wk of age without pneumatosis or portal venous gas were treated with PD on perforation. PD patients received subsequent LAP for clinical deterioration or continued meconium/bilious drainage. Postprotocol characteristics and outcomes were compared with institutional historical controls. Significance set at P 0.05.Preprotocol and postprotocol cohorts comprise 35 and 73 patients, respectively. There was a statistically significant difference in age at intervention between historical control PD (14 ± 13 d) and postprotocol PD (9 ± 4 d) groups (P = 0.01), PD patient's birth weight (716 ± 212 g versus 610 ± 141 g, P = 0.02) and estimated gestational age of LAP patients (27 ± 1.7 wk versus 31 ± 4 wk, P = 0.002). PD was definitive surgery in 27% (12 of 44) of postprotocol patients compared with 13% (3 of 23) historical controls. A trend in improved survival postprotocol occurred in all PD infants (73% versus 65%), all LAP (75% versus 70%), and for initial PD and subsequent LAP (82% versus 67%).Utilization of a surgical protocol in sNEC/SIP is associated with improved success of PD as definitive surgery and improved survival. |
| Databáze: | OpenAIRE |
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