Solis-Garcia Gonzalo, Pierro Agostino, Jasani Bonny
Division of Neonatology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
Department of Pediatrics, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada.
Children (Basel). 2023 Jul 6;10(7):1170. doi: 10.3390/children10071170.
to systematically review and meta-analyze the impact on morbidity and mortality of peritoneal drainage (PD) compared to laparotomy (LAP) in preterm neonates with surgical NEC (sNEC) or spontaneous intestinal perforation (SIP).
Medical databases were searched until June 2022 for studies comparing PD and LAP as primary surgical treatment of preterm neonates with sNEC or SIP. The primary outcome was survival during hospitalization; predefined secondary outcomes included need for parenteral nutrition at 90 days, time to reach full enteral feeds, need for subsequent laparotomy, duration of hospitalization and complications.
Three RCTs (N = 493) and 49 observational studies (N = 19,447) were included. No differences were found in the primary outcome for RCTs, but pooled observational data showed that, compared to LAP, infants with sNEC/SIP who underwent PD had lower survival [48 studies; N = 19,416; RR 0.85; 95% CI 0.79-0.90; GRADE: low]. Observational studies also showed that the subgroup of infants with sNEC had increased survival in the LAP group (30 studies; N = 9370; RR = 0.82; 95% CI 0.72-0.91; GRADE: low).
Compared to LAP, PD as primary surgical treatment for sNEC or SIP has similar survival rates when analyzing data from RCTs. PD was associated with lower survival rates in observational studies.
系统评价和荟萃分析在患有外科坏死性小肠结肠炎（sNEC）或自发性肠穿孔（SIP）的早产儿中，与剖腹手术（LAP）相比，腹膜引流（PD）对发病率和死亡率的影响。
检索医学数据库至2022年6月，以查找比较PD和LAP作为患有sNEC或SIP的早产儿主要手术治疗方法的研究。主要结局是住院期间的生存率；预先定义的次要结局包括90天时肠外营养的需求、达到完全肠内喂养的时间、后续剖腹手术的需求、住院时间和并发症。
纳入了3项随机对照试验（N = 493）和49项观察性研究（N = 19,447）。随机对照试验的主要结局未发现差异，但汇总的观察性数据显示，与LAP相比，接受PD治疗的sNEC/SIP婴儿生存率较低[48项研究；N = 19,416；风险比（RR）0.85；95%置信区间（CI）0.79 - 0.90；证据质量等级：低]。观察性研究还显示，sNEC婴儿亚组中，LAP组的生存率有所提高（30项研究；N = 9370；RR = 0.82；95% CI 0.72 - 0.91；证据质量等级：低）。
在分析随机对照试验数据时，与LAP相比，PD作为sNEC或SIP的主要手术治疗方法具有相似的生存率。在观察性研究中，PD与较低的生存率相关。
