Peritoneal drainage for newborn intestinal perforation: primary treatment or unnecessary delay?

Abstract

Background Peritoneal drainage (PD) was introduced 30 years ago as a temporizing treatment for extremely ill newborns with intestinal perforation (IP). Subsequent reports have shown it to be helpful as a definitive treatment, whereas others have labeled it as an unnecessary delay before laparotomy.
Methods This is a retrospective analysis of all newborns (2004–2009) with presumed IP treated with PD irrespective of gestational age or weight. Drainage was achieved with a single Penrose drain placed between incisions in each lower quadrant. This was followed by extensive irrigation. Laparotomy was performed if needed for progressive sepsis, intestinal stricture, or persistent leak. Parameters analyzed included gestational age and weight, time before IP, findings at drain placement, and need for subsequent operations.
Results Drains were placed in 24 consecutive newborns with IP. The median gestational age was 29 weeks and weight was 755 g. IP was confirmed in nine (38%) by free air on radiograph. In 15 newborns, PD was performed for progressive sepsis and succus was identified in 11 (73%). The overall mortality rate was 33% (25% in newborns <1500 g, 75% in those >1500 g). No parameters were statistically significant in predicting mortality. PD served as a definitive treatment without the need for further laparotomy in 50% of survivors.
Conclusion PD with extensive irrigation for newborns with IP has an acceptable mortality rate. It is not a delay tactic but serves as a definitive treatment for 50% of survivors. Children weighing more than 1500 g and those without succus at the time of drain placement should, however, receive laparotomy as the primary treatment.

Keywords: intestinal perforation in newborn, necrotizing enterocolitis, primary peritoneal drainage