Chiu Bill, Pillai Srikumar B, Almond P Stephen, Beth Madonna Mary, Reynolds Marleta, Luck Susan R, Arensman Robert M
Children's Memorial Hospital, 2300 Children's Plaza, Box 63, Chicago, IL 60614, USA.
J Perinat Med. 2006;34(4):338-41. doi: 10.1515/JPM.2006.065.
The optimal surgical treatment for extremely-low-birth-weight (ELBW) neonates with pneumoperitoneum is controversial. This study aimed to identify clinical factors associated with two known causes of pneumoperitoneum-necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP), and assesses the treatment outcome with primary peritoneal drainage (PPD) vs. laparotomy.
We reviewed and analyzed clinical characteristics and outcome from records of neonates with pneumoperitoneum treated at our institution from January 1999 to January 2003.
Forty-six neonates (31 NEC, 15 SIP) were treated with either PPD (20 with NEC, 13 with SIP) or laparotomy (11 with NEC, 2 with SIP). In neonates who underwent PPD, those with NEC (vs. SIP) were less likely to have a patent ductus arteriosus, but were more likely to have been fed, have drains placed later in life, have a subsequent laparotomy, a longer total parental nutrition course, a higher 30-day mortality, and to take more days to begin enteral feeds.
The etiology of pneumoperitoneum (NEC vs. SIP) in ELBW neonates can usually be determined preoperatively. Neonates with SIP should have a drain placed while those with NEC should undergo laparotomy.
极低出生体重（ELBW）合并气腹的新生儿的最佳手术治疗方法存在争议。本研究旨在确定与气腹的两种已知病因——坏死性小肠结肠炎（NEC）和自发性肠穿孔（SIP）相关的临床因素，并评估原发性腹膜引流（PPD）与剖腹手术的治疗效果。
我们回顾并分析了1999年1月至2003年1月在我院接受治疗的气腹新生儿的临床特征和治疗结果。
46例新生儿（31例NEC，15例SIP）接受了PPD（20例NEC，13例SIP）或剖腹手术（11例NEC，2例SIP）治疗。在接受PPD的新生儿中，患有NEC（与SIP相比）的新生儿动脉导管未闭的可能性较小，但更有可能接受过喂养、在出生后更晚放置引流管、随后接受剖腹手术、全肠外营养疗程更长、30天死亡率更高，并且开始肠内喂养的时间更长。
ELBW新生儿气腹的病因（NEC与SIP）通常可以在术前确定。患有SIP的新生儿应放置引流管，而患有NEC的新生儿应接受剖腹手术。
