Primary peritoneal drainage for increasing ventilatory requirements in critically ill neonates with necrotizing enterocolitis

Background/Purpose: Primary peritoneal drainage (PPD) is an established therapy for premature neonates with necrotizing enterocolitis (NEC) and free intraperitoneal air. This study seeks to evaluate the efficacy of PPD in ill premature neonates with severe abdominal distension and increasing ventilatory requirements without free intraperitoneal air. Methods: Eleven neonates (gestational age, 27 +/- 0.59 weeks; age, 25 +/- 4.3 days; birth weight, 862 +/- 67 g) with NEC underwent bedside PPD under local anesthesia for rapid clinical deterioration characterized by severe abdominal distension and increasing ventilatory requirements. None showed radiographic evidence of free intraperitoneal air. Mean airway pressure (MAP) and oxygenation-index (OI) were analyzed 24 hours before, immediately before and 24 hours after surgery. The patients were followed up to discharge from hospital. Statistical analyses were performed using analysis of variance (ANOVA) for repeated measures. Results: Mean airway pressure (MAP) showed a significant difference (P <.05) increasing from 7.1 +/- 0.75 cm H2O 24 hours before surgery to 11 +/- 1.3 cm H2O immediately before surgery and decreasing to 9.9 +/- 1.1 cm H2O 24 hours after drainage. Likewise, OI measured at the same time intervals showed significant differences (P <.05) deteriorating from 5 +/- 1.2 to 26 +/- 6.9 then improving to 13 +/- 3.5. A significant quadratic effect (P <.03) was evident for MAP and OI (ie, values significantly rose then fell). There were six 30-day survivors (55%), and 3 survived to discharge (27%). Of the long-term survivors, 2 required operative fistula closure, and 1 needed no further surgery. Conclusion: Bedside PPD for increasing ventilatory requirements and abdominal distension in critically ill neonates with nonperforated NEC is a simple technique that offers rapid stabilization, although ultimate mortality rate remains high. J Pediatr Surg 36:730-732. Copyright (C) 2001 by W.B. Saunders Company.