What is the role of peritoneal drainage in the treatment of necrotizing enterocolitis (NEC)?

Updated: Dec 27, 2017
  • Author: Shelley C Springer, JD, MD, MSc, MBA, FAAP; Chief Editor: Muhammad Aslam, MD  more...
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Answer

Neonates who are extremely ill and unable to tolerate surgery may be treated by means of peritoneal drainage in a technique described by Ein et al. [50] A right lower quadrant incision is made at the bedside under local anesthesia, and a Penrose drain is inserted. The procedure was initially intended as a means of temporizing with regard to surgical treatment, and indeed, some infants survived with this procedure alone and did not require subsequent laparotomy.

A multicenter, randomized clinical trial failed to show a significant difference in survival at 90 days between primary peritoneal drainage and laparotomy with resection for premature infants with very low birth weight (51</ref>

Critically ill newborns with a relative contraindication to formal operative exploration may be treated with the placement of a peritoneal drain. Although this is typically a temporizing measure, these extremely ill infants may recover with drain placement alone and do not require exploratory laparotomy.

Peritoneal drain placement may be the treatment of choice for extremely small (<600 g) premature newborns. Such premature, critically ill infants cannot tolerate formal exploration, and drain placement may be preferred and definitive. Nevertheless, many infants whose condition is too unstable for formal exploration do not survive, regardless of intervention.


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