Laparotomy versus peritoneal drainage for necrotizing enterocolitis or isolated intestinal perforation in extremely low birth weight infants: outcomes through 18 months adjusted age.
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| Title: | Laparotomy versus peritoneal drainage for necrotizing enterocolitis or isolated intestinal perforation in extremely low birth weight infants: outcomes through 18 months adjusted age. |
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| Authors: | Blakely ML (AUTHOR), Tyson JE (AUTHOR), Lally KP (AUTHOR), McDonald S (AUTHOR), Stoll BJ (AUTHOR), Stevenson DK (AUTHOR), Poole WK (AUTHOR), Jobe AH (AUTHOR), Wright LL (AUTHOR), Higgins RD (AUTHOR), NICHD Neonatal Research Network (CORPORATE AUTHOR) |
| Source: | Pediatrics. Apr2006 Supplement, Vol. 117, pe680-7. 1p. |
| Abstract: | OBJECTIVE: Extremely low birth weight (ELBW; < or =1000 g) infants with necrotizing enterocolitis (NEC) or isolated intestinal perforation (IP) are treated surgically with either initial laparotomy or peritoneal drain placement. The only published data comparing these therapies are from small, retrospective, single-center studies that do not address outcomes beyond nursery discharge. The objective of this study was to conduct a prospective, multicenter, observational study to (1) develop a hypothesis about the relative effect of these 2 therapies on risk-adjusted outcomes through 18 to 22 months in ELBW infants and (2) to obtain data that would be useful in designing and conducting a successful trial of this hypothesis. METHODS: A prospective, cohort study was conducted at 16 clinical centers within the National Institute of Child Health and Human Development Neonatal Research Network. To assist in risk adjustment, the attending pediatric surgeon recorded the preoperative diagnosis and intraoperative diagnosis and identified infants who were considered to be too ill for laparotomy. Predefined measures of short- and longer-term outcome included (1) either predischarge death or prolonged parenteral nutrition (>85 days) after enrollment and (2) either death or neurodevelopmental impairment on a standardized examination at 18 to 22 months' adjusted age. RESULTS: Severe NEC or IP occurred in 156 (5.2%) of 2987 ELBW infants; 80 were treated with initial drainage, and 76 were treated with initial laparotomy. By 18 to 22 months, 78 (50%) had died; 112 (72%) had died or were shown to be impaired. Outcome was worse in the subgroup with NEC. Laparotomy was never performed in 76% (28 of 36) of drain-treated survivors. CONCLUSIONS: Drainage was commonly used, and outcome was poor. Our findings, particularly the risk-adjusted odds ratio favoring laparotomy for death or impairment, indicate the need for a large, multicenter clinical trial to assess the effect of the initial surgical therapy on outcome at > or =18 months. [ABSTRACT FROM AUTHOR] |
| Copyright of Pediatrics is the property of American Academy of Pediatrics and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) | |
| Database: | Psychology and Behavioral Sciences Collection |
| FullText | Text: Availability: 0 |
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| Header | DbId: pbh DbLabel: Psychology and Behavioral Sciences Collection An: 106303632 AccessLevel: 6 PubType: Academic Journal PubTypeId: academicJournal PreciseRelevancyScore: 0 |
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| Items | – Name: Title Label: Title Group: Ti Data: Laparotomy versus peritoneal drainage for necrotizing enterocolitis or isolated intestinal perforation in extremely low birth weight infants: outcomes through 18 months adjusted age. – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Blakely+ML%22">Blakely ML</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Tyson+JE%22">Tyson JE</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Lally+KP%22">Lally KP</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22McDonald+S%22">McDonald S</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Stoll+BJ%22">Stoll BJ</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Stevenson+DK%22">Stevenson DK</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Poole+WK%22">Poole WK</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Jobe+AH%22">Jobe AH</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Wright+LL%22">Wright LL</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Higgins+RD%22">Higgins RD</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22NICHD+Neonatal+Research+Network%22">NICHD Neonatal Research Network</searchLink> (CORPORATE AUTHOR) – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="JN" term="%22Pediatrics%22">Pediatrics</searchLink>. Apr2006 Supplement, Vol. 117, pe680-7. 1p. – Name: Abstract Label: Abstract Group: Ab Data: OBJECTIVE: Extremely low birth weight (ELBW; < or =1000 g) infants with necrotizing enterocolitis (NEC) or isolated intestinal perforation (IP) are treated surgically with either initial laparotomy or peritoneal drain placement. The only published data comparing these therapies are from small, retrospective, single-center studies that do not address outcomes beyond nursery discharge. The objective of this study was to conduct a prospective, multicenter, observational study to (1) develop a hypothesis about the relative effect of these 2 therapies on risk-adjusted outcomes through 18 to 22 months in ELBW infants and (2) to obtain data that would be useful in designing and conducting a successful trial of this hypothesis. METHODS: A prospective, cohort study was conducted at 16 clinical centers within the National Institute of Child Health and Human Development Neonatal Research Network. To assist in risk adjustment, the attending pediatric surgeon recorded the preoperative diagnosis and intraoperative diagnosis and identified infants who were considered to be too ill for laparotomy. Predefined measures of short- and longer-term outcome included (1) either predischarge death or prolonged parenteral nutrition (>85 days) after enrollment and (2) either death or neurodevelopmental impairment on a standardized examination at 18 to 22 months' adjusted age. RESULTS: Severe NEC or IP occurred in 156 (5.2%) of 2987 ELBW infants; 80 were treated with initial drainage, and 76 were treated with initial laparotomy. By 18 to 22 months, 78 (50%) had died; 112 (72%) had died or were shown to be impaired. Outcome was worse in the subgroup with NEC. Laparotomy was never performed in 76% (28 of 36) of drain-treated survivors. CONCLUSIONS: Drainage was commonly used, and outcome was poor. Our findings, particularly the risk-adjusted odds ratio favoring laparotomy for death or impairment, indicate the need for a large, multicenter clinical trial to assess the effect of the initial surgical therapy on outcome at > or =18 months. [ABSTRACT FROM AUTHOR] – Name: AbstractSuppliedCopyright Label: Group: Ab Data: <i>Copyright of Pediatrics is the property of American Academy of Pediatrics and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.) |
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| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1542/peds.2005-1273 Languages: – Code: eng Text: English PhysicalDescription: Pagination: PageCount: 1 StartPage: e680 Titles: – TitleFull: Laparotomy versus peritoneal drainage for necrotizing enterocolitis or isolated intestinal perforation in extremely low birth weight infants: outcomes through 18 months adjusted age. Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Blakely ML – PersonEntity: Name: NameFull: Tyson JE – PersonEntity: Name: NameFull: Lally KP – PersonEntity: Name: NameFull: McDonald S – PersonEntity: Name: NameFull: Stoll BJ – PersonEntity: Name: NameFull: Stevenson DK – PersonEntity: Name: NameFull: Poole WK – PersonEntity: Name: NameFull: Jobe AH – PersonEntity: Name: NameFull: Wright LL – PersonEntity: Name: NameFull: Higgins RD – PersonEntity: Name: NameFull: NICHD Neonatal Research Network IsPartOfRelationships: – BibEntity: Dates: – D: 02 M: 04 Text: Apr2006 Supplement Type: published Y: 2006 Identifiers: – Type: issn-print Value: 00314005 Numbering: – Type: volume Value: 117 Titles: – TitleFull: Pediatrics Type: main |
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