Enterocolitis necrotizante y perforaciones intestinales en prematuros de muy bajo peso. ¿Cuál es la mejor opción quirúrgica? / Necrotizing entercolitis and intestinal perforation in very low weight premature infants: which is the best surgical option?

La enterocolitis necrotizante (ECN) y la perforación intestinal aislada(PIA) son frecuentes en recién nacidos de muy bajo peso (RNMBP) y requieren cirugía el 20-40%. Hemos revisado retrospectivamente los RNMBP intervenidos por ECN y PIA entre el 2000 y el 2010, dividiendo la muestra en 3 grupos: 1) laparotomía inicial; 2) drenaje peritoneal temporal y laparotomía diferida; 3) drenaje peritoneal. De los 487 RNMBP ingresados en nuestro Hospital, 80 casos fueron ECN o PIA y de estos, el 31% (n= 25)fueron intervenidos quirúrgicamente. La edad gestacional media fue de 26 +3 semanas, 14 niñas y 11 niños, peso medio de 801,4 g (rango: 460 a 1.490g). Tuvieron neumoperitoneo el 48% (n= 12). Realizamos laparotomía inicial en 12 casos, drenaje más laparotomía en 10 y drenaje en 3 pacientes. El promedio de horas entre el drenaje y la laparotomía fue de 69,6. El 68%eran ECN y el 32% PIA. La laparotomía inicial aportó mayor supervivencia(P= 0,001) y la mortalidad general fue del 32% (8 éxitus). El procedimiento quirúrgico óptimo debe basarse en las condiciones clínicas del paciente .Consideramos que la laparotomía inicial debería ser el tratamiento para los pacientes con perforación intestinal por ECN y PIA (AU)

Necrotizing enterocolitis (NEC) and isolated intestinal perforation(IP) are common diseases in very low birth weight infants (VLBW) and require surgery in 20-40% of cases. We have performed a retrospective ereview of VLBW infants with NEC or IP who underwent a surgical procedure between 2000 and 2010, either initial laparotomy (group 1),peritoneal drain placement and subsequent laparotomy (group 2) orperitoneal drainage (group 3). Of 487 VLBW infants admitted to our hospital in the last ten years, 80 patients had NEC or IP, out of these,31% (n= 25) were treated surgically. The study population consisted of 14 girls and 11 boys with a mean gestational age of 26+3 weeks and mean birth weight of 801.4 g (range460 to 1,490 g). Pneumoperitoneum was seen in 48% of cases (n= 12).Twelve patients underwent initial laparotomy, 10 patients were treated with peritoneal drainage and subsequent laparotomy and in 3 patient a peritoneal drainage was placed .Mean time between drainage and laparotomy was 69.6 hours Sixty eight percent of patients had NEC and thirty-two percent were IP. Survivalrate was higher in the group who underwent initial laparotomy(p= 0.001) with an overall mortality of 32% (8 deaths). Optimal surgical procedure must be decided upon clinical condition of individual patients.We consider that initial laparotomy should be the treatment option inVLBW infants with intestinal perforation due to NEC or IP (AU)

[Necrotizing entercolitis and intestinal perforation in very low weight premature infants: which is the best surgical option?]. / Enterocolitis necrotizante y perforaciones intestinales en prematuros de muy bajo peso. Cuá1 es la mejor opción quirúrgica?

Necrotizing enterocolitis (NEC) and isolated intestinal perforation (IP) are common diseases in very low birth weight infants (VLBW) and require surgery in 20-40% of cases. We have performed a retrospective review of VLBW infants with NEC or IP who underwent a surgical procedure between 2000 and 2010, either initial laparotomy (group 1), peritoneal drain placement and subsequent laparotomy (group 2) or peritoneal drainage (group 3). Of 487 VLBW infants admitted to our hospital in the last ten years, 80 patients had NEC or IP, out of these, 31% (n=25) were treated surgically. The study population consisted of 14 girls and 11 boys with a mean gestational age of 26+3 weeks and mean birth weight of 801.4 g (range 460 to 1490 g). Pneumoperitoneum was seen in 48% of cases (n=12). Twelve patients underwent initial laparotomy, 10 patients were treated with peritoneal drainage and subsequent laparotomy and in 3 patients a peritoneal drainage was placed. Mean time between drainage and laparotomy was 69.6 hours. Sixty-eight percent of patients had NEC and thirty-two percent were IP. Survival rate was higher in the group who underwent initial laparotomy (p = 0.001) with an overall mortality of 32% (8 deaths). Optimal surgical procedure must be decided upon clinical condition of individual patients. We consider that initial laparotomy should be the treatment option in VLBW infants with intestinal perforation due to NEC or IP.