Department of Surgery, Section of Pediatric Surgery, University of Michigan, Michigan Medicine, C.S. Mott Children's Hospital, Ann Arbor, Michigan.
Department of Surgery, Section of Pediatric Surgery, University of Michigan, Michigan Medicine, C.S. Mott Children's Hospital, Ann Arbor, Michigan.
J Surg Res. 2024 Oct;302:509-516. doi: 10.1016/j.jss.2024.07.093. Epub 2024 Aug 22.
Although pneumoperitoneum from necrotizing enterocolitis or spontaneous intestinal perforation is a surgical emergency, risk stratification to determine which neonates benefit from initial peritoneal drainage (PD) is lacking.
Using a single-center retrospective review of very low birth weight neonates under 1500 g who underwent PD for pneumoperitoneum (January 2015 to December 2023) from necrotizing enterocolitis or spontaneous intestinal perforation, two cohorts were created: drain "responders" (patients managed definitively with PD; includes placement of a second drain) and "nonresponders" (patients who underwent subsequent laparotomy or died after PD). Antenatal/postnatal characteristics, periprocedural clinical data, and hospital outcomes were compared between responders and nonresponders using Student's t-test, chi-squared test, or Kruskal-Wallis test as appropriate, with P < 0.05 considered significant.
Fifty-six neonates were included: 31 (55%) drain responders and 25 (45%) nonresponders. Birth weight, gestational age, sex, ethnicity, use of postnatal steroids, and enteral feeds were similar between the cohorts. Nonresponders had higher base deficits (-3.4 versus -5.0, P = 0.032) and FiO (0.25 versus 0.52, P = 0.001) after drain placement. Drain responders had significantly shorter lengths of stay (89 versus 148 days, P = 0.014) and lower mortality (6.4% versus 56%, P < 0.001). A subgroup analysis of the nonresponders showed no differences in birth weight, vasopressor requirement, FiO, or postdrain base deficit between nonresponders who had a drain alone versus laparotomy following drain placement.
PD remains a viable initial therapy for pneumoperitoneum in premature very low birth weight neonates (< 1500 g), demonstrating clinical response in more than half. Ongoing clinical assessment and judgment is imperative after drain placement to ensure continued clinical improvement.
尽管由坏死性小肠结肠炎或自发性肠穿孔引起的气腹是一种外科急症，但缺乏风险分层来确定哪些新生儿受益于初始腹腔引流（PD）。
使用单中心回顾性研究，纳入了体重低于 1500 克的极低出生体重儿，这些患儿在 2015 年 1 月至 2023 年 12 月期间因气腹而行 PD 治疗，病因包括坏死性小肠结肠炎或自发性肠穿孔。研究创建了两个队列：引流“反应者”（经 PD 治疗明确治疗的患者，包括放置第二个引流管）和“非反应者”（接受后续剖腹手术或 PD 后死亡的患者）。使用学生 t 检验、卡方检验或 Kruskal-Wallis 检验比较反应者和非反应者之间的围手术期临床数据和住院结局，P 值小于 0.05 认为有统计学意义。
共纳入 56 名新生儿：31 名（55%）为引流反应者，25 名（45%）为非反应者。两组患儿的出生体重、胎龄、性别、种族、是否使用产后类固醇和肠内喂养均相似。非反应者在放置引流管后基础缺陷（-3.4 与-5.0，P=0.032）和 FiO（0.25 与 0.52，P=0.001）更高。引流反应者的住院时间明显更短（89 天与 148 天，P=0.014），死亡率更低（6.4%与 56%，P<0.001）。非反应者的亚组分析显示，在单独放置引流管与放置引流管后行剖腹手术的非反应者之间，出生体重、血管加压素需求、FiO 和引流后基础缺陷无差异。
PD 仍然是治疗早产儿气腹（体重低于 1500 克）的可行初始治疗方法，在超过一半的患者中显示出临床反应。放置引流管后，需要持续进行临床评估和判断，以确保持续的临床改善。
