J Korean Assoc Pediatr Surg.  2008 Jun;14(1):37-47.

Experience with Peritoneal Drainage in Extremely Low-birth-weight Infants

• Nam SH
• Kim DY
• Kim SC
• Kim AR
• Kim KS
• Pi SY
• Kim IK

Abstract

Recently, the survival rates of extremely low-birth-weight (ELBW) infants have improved with the development of neonatal intensive care. However, these infants were susceptible to intestinal perforation due to prematurity, fluid restriction, and injection of indomethacin, etc. Because of the risks of transportation, anesthesia and surgery itself, peritoneal drainage has been compared with laparotomy. Through our experience, we investigate the usefulness of peritoneal drainage retrospectively. From 1997 to 2007, six ELBW (M:F=5:1) underwent primary peritoneal drainage for intestinal perforation. Their median birth weight was 685 g (405~870) and gestational age was 25(+1) weeks (24(+3)~27(+0)). We noticed the intestinal perforation at median 10.5 days (8~18) after birth, and placed Penrose drain or Jackson-Pratt drain through right lower quadrant incision under local anesthesia. The cause of intestinal perforation was necrotizing enterocolitis in one patient, but that of the others was not clear. Three patients who showed normal platelet count and stable vital signs recovered uneventfully. Two patients (birth weight less than 500 g) who showed unstable vital signs and low platelet count (12,000 / mm3 to 30,000 / mm3) expired despite aggressive resuscitation. One patient required laparotomy due to persistent intestinal obstruction after drain removal and survived. Our experience shows that peritoneal drainage was an acceptable treatment for ELBW infants and the prognosis was related to vital sign and platelet count at the time of intestinal perforation, and birth weight.

Keyword

Peritoneal drainage; Intestinal perforation; Extremely low-birth-weight infant

MeSH Terms

Anesthesia
Anesthesia, Local
Birth Weight
Drainage
Enterocolitis, Necrotizing
Gestational Age
Humans
Indomethacin
Infant
Infant, Low Birth Weight
Infant, Newborn
Intensive Care, Neonatal
Intestinal Obstruction
Intestinal Perforation
Laparotomy
Parturition
Platelet Count
Prognosis
Resuscitation
Retrospective Studies
Survival Rate
Transportation
Vital Signs
Indomethacin