Does the initial surgery for necrotizing enterocolitis matter? Comparative outcomes for laparotomy vs. peritoneal drain as initial surgery for necrotizing enterocolitis in infants < 1000 g birth weight
| Autor: | J Sharma, Isabella Zaniletti, Karna Murthy, Beverly S. Brozanski, Kristina M. Reber, Toby D Yanowitz, Anthony J. Piazza, Rajan Wadhawan, Kevin M Sullivan, Sujir Pritha Nayak, Robert DiGeronimo |
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| Rok vydání: | 2019 |
| Předmět: |
Short Bowel Syndrome
medicine.medical_specialty Databases Factual Birth weight medicine.medical_treatment Enterocolitis Necrotizing Laparotomy medicine Birth Weight Humans Survival advantage Retrospective Studies business.industry digestive oral and skin physiology Infant Newborn Infant General Medicine Length of Stay Hospitals Pediatric Short bowel syndrome medicine.disease Surgery Survival Rate Treatment Outcome Infant Extremely Low Birth Weight Pediatrics Perinatology and Child Health Necrotizing enterocolitis Drainage Female Level ii Peritoneum business human activities Peritoneal drain |
| Zdroj: | Journal of Pediatric Surgery. 54:712-717 |
| ISSN: | 0022-3468 |
| DOI: | 10.1016/j.jpedsurg.2018.12.010 |
| Popis: | Quantify short-term outcomes associated with initial surgery [laparotomy (LAP) vs. peritoneal drain (PD)] for necrotizing enterocolitis (NEC) in extremely-low-birth-weight (ELBW) infants.Using the Children's Hospitals Neonatal Database, we identified ELBW infants32 weeks' gestation with surgical NEC (sNEC). Unadjusted and multivariable regression analyses were used to estimate the associations between LAP (or PD) and death/short bowel syndrome (SBS) and length of stay (LOS).LAP was the more common initial procedure for sNEC (n = 359/528, 68%). Infants receiving LAP were older and heavier. Initial procedure was unrelated to death/SBS in both bivariate (LAP: 43% vs PD: 46%, p = 0.573) and multivariable analyses (OR = 0.89, 95% CI = 0.57, 1.38, p = 0.6). LAP was inversely related to mortality (29% vs. 41%, p 0.007) in bivariate analysis, but not significant in multivariable analysis accounting for markers of preoperative illness severity. However, the association between LAP and SBS (14% vs. 5%, p = 0.012) remained significant in multivariable analyses (adjusted OR = 2.25, p = 0.039). LOS among survivors was unrelated to the first surgical procedure in multivariable analysis.ELBW infants who undergo LAP as the initial operative procedure for sNEC may be at higher risk for SBS without a clear in-hospital survival advantage or shorter hospitalization.Level II. |
| Databáze: | OpenAIRE |
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