A meta-analysis of peritoneal drainage versus laparotomy for perforated necrotizing enterocolitis*
Section snippets
Materials and methods
We identified all published studies in the English-language literature reporting surgical treatment of NEC from 1978 through 1999. We identified 10 studies reporting use of PPD and LAP in 475 patients.2, 3, 4, 5, 6, 7, 8, 9, 10, 11 We analyzed the birth weight, gestational age, type of operation, and survival rate of patients from each study. Data on comorbid conditions associated with prematurity were not uniformly available.
We next contacted the authors of these studies and obtained raw data
Published data analysis
Table 1 lists studies by author, birth weight, gestational age, type of operation, and survival rate.Empty Cell PPD LAP Study No. GA (wk)* BW (g)* Survival Rate (%) No. GA (wk)* BW (g)* Survival Rate (%) Cheu et al2 51 29 1,158 18 (35) 41 32 1,875 31 (76) Takamatsu et al3 4 27 808 4 (100) 3 3 3 3 Morgan et al4 29 27 994 23 (79) 20 32 1,854 18 (90) Azarow et al5 44 28 1,100 27 (61) 42 31 1,700 24 (57) Snyder et al6 12 29 1,134 3 (25) 91 31 1,628 52
Discussion
Despite extensive analysis of published studies and individual patient data, we were not able to determine the relative merits of PPD and LAP for perforated NEC. This was primarily because of the marked bias in treatment assignment. This bias was significant in published data and even more pronounced in unpublished raw data from 3 large centers.
There is agreement that the highest quality data are generated from a randomized controlled clinical trial.12 However, these type of data often are not
Acknowledgements
The authors thank the following individuals for providing us with patient data used in this report: Charles Snyder, MD, Children's Mercy Hospital, Kansas City, MO; Adine Moore, MD, Hospital for Sick Children, Toronto, ON; Thomas Curran, MD, Emmanuel Hospital, Portland, OR; and Eugene McGahren, MD, University of Virginia, Charlottesville, VA.
References (14)
- et al.
Peritoneal drainage under local anesthesia for perforations from necrotizing enterocolitis
J Pediatr Surg
(1977) - et al.
Peritoneal drainage for necrotizing enterocolitis
J Pediatr Surg
(1988) - et al.
Treatment for necrotizing enterocolitis perforation in the extremely premature infant (weighing < 1,000 g)
J Pediatr Surg
(1992) - et al.
Survival after necrotizing enterocolitis in infants weighing less than 1,000g: 25 years' experience at a single institution
J Pediatr Surg
(1997) - et al.
Peritoneal drainage as definitive treatment for intestinal perforation in infants with extremely low birth weight (less than 750 grams)
J Pediatr Surg
(1998) - et al.
The role of peritoneal drains in treatment of perforated necrotizing enterocolitis: Recommendations from recent experience
J Pediatr Surg
(1998) - et al.
The role of peritoneal drainage for intestinal perforation in infants with and without necrotizing enterocolitis
J Pediatr Surg
(1999)
Cited by (98)
Necrotizing Enterocolitis and Short Bowel Syndrome
2023, Avery's Diseases of the NewbornDoes Surgical Management Alter Outcome in Necrotizing Enterocolitis?
2019, Clinics in PerinatologyNew insights into necrotizing enterocolitis: From laboratory observation to personalized prevention and treatment
2019, Journal of Pediatric SurgeryNecrotizing Enterocolitis and Short Bowel Syndrome
2018, Avery's Diseases of the Newborn: Tenth EditionMorbidity and mortality among “big” babies who develop necrotizing enterocolitis: A prospective multicenter cohort analysis
2018, Journal of Pediatric SurgeryCitation Excerpt :Previous studies have shown a much higher rate of PPD ranging from 17% to 49% in surgically treated VLBW infants [23–25]. Moss et al. reported in a meta-analysis that higher birth weight infants were more likely to have laparotomy than PPD, which would explain the low rate of PPD in our cohort [26]. A more recent systematic review showed similar results regarding gestational age and birth weight [27], albeit a smaller difference than Moss [26]; in addition, there was a much higher rate of mortality in the PPD group.
- *
Address reprint requests to R. Lawrence Moss, MD, Division of Pediatric Surgery, Packard Children's Hospital, 725 Welch Rd, Palo Alto, CA 94304.