Is there a benefit of peritoneal drainage for necrotizing enterocolitis in newborn infants?

摘要

Primary peritoneal drainage in infants with perforated necrotizing enterocolitis (NEC) has been used for many years [1-3]. Pediatric surgeons have viewed peritoneal drainage as a definitive treatment in some patients [3] but also as a temporizing measure, facilitating stabilization of very sick infants for a subsequent laparotomy before or after transfer to a pediatric surgical center [1,2].Two multicenter randomized controlled trials comparing survival after primary peritoneal drainage or primary laparotomy have recently been published [4,5] Neither trial reached the recruitment target nor showed a significant benefit from drain or laparotomy. A meta-analysis of these 2 trials indicates no clear benefit from either treatment [4]. A third randomized controlled trial has been initiated in the United States (ClinicalTrials.gov Identifier: NCT01029353) with the primary outcome of death or neurodevelopmental impairment at 18 to 22 months of corrected age. Unless this current trial shows a dramatically different result from the others, it would seem unlikely that peritoneal drainage has a role in the future as a definitive treatment in NEC.