Surgical Treatment of Perforated Necrotizing Enterocolitis and Spontaneous Intestinal Perforation in Extremely Low Birth Weight Premature Infants- Is Resection and Primary Anastomosis a Safe Option?

IF 2.4 2区医学 Q1 PEDIATRICS

Journal of pediatric surgery Pub Date : 2025-01-30 DOI:10.1016/j.jpedsurg.2025.162219

Ayah Alzamrooni , Lisandro Luques , Pattamon Sutthatarn , Eveline Lapidus-Krol , Priscilla P.L. Chiu

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引用次数: 0

Abstract

Introduction

Necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) lead to significant morbidity and mortality in extreme-low birth weight (ELBW) infants. This study examined surgical management and outcomes for these conditions.

Methods

A retrospective chart review of ELBW infants (birthweight <1000 g) who had laparotomy for NEC or SIP managed with primary anastomosis (PA) and stoma formation (SF) at a single high-volume center from 2000 to 2022 was performed. Patient data included demographics, pre-operative status, operative findings, post-operative complications, and outcomes at discharge and at 12 months. Statistical analyses were performed using Fisher's exact test and the Mann–Whitney test.

Results

Of 132 patients included, 40 underwent PA and 92 underwent SF. SF patients had lower birth weights and older post-gestational age at surgery. SF patients exhibited higher pre-operative CRP and lower platelet counts. No significant differences were found in intra-operative findings. Post-operatively, SF patients had higher conjugated bilirubin levels, longer hospital stays, and longer times to full enteral feeds. Mortality rates were similar between groups. Nutritional outcomes at 12 months did not significantly differ. Micropreemies (weight <750 g at surgery) had higher mortality and more comorbidities, but no significant differences were observed between PA and SF management cohorts.

Conclusion

PA is a safe alternative to SF for managing NEC and SIP in ELBW infants with shorter hospital stays and faster progression to full feeds but the severity of pre-operative illness may influence surgical decision. Further studies are needed to refine patient selection criteria and optimize surgical outcomes.

Type of Study

Clinical Research.

Level of evidence

Level III Retrospective Comparative Cohort Study.

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来源期刊

Journal of pediatric surgery 医学-外科

CiteScore

1.10

自引率

12.50%

发文量

569

审稿时长

38 days

期刊介绍： The journal presents original contributions as well as a complete international abstracts section and other special departments to provide the most current source of information and references in pediatric surgery. The journal is based on the need to improve the surgical care of infants and children, not only through advances in physiology, pathology and surgical techniques, but also by attention to the unique emotional and physical needs of the young patient.