Abstract
Background: To determine whether peritoneal drain (PD) or laparotomy (LAP) is the most effective intervention in premature neonates with necrotizing enterocolitis (NEC) or intestinal perforation (IP). Methods: A systematic review of the published literature between January 2000 and December 2008 was undertaken. Prospective studies with at least 25 patients in each of the PD and LAP arms were selected. Gestational age, birth weight, operation, and mortality data were extracted. Results: Five prospective studies (two level I, three level II) with 523 (273 PD, 250 LAP) participants followed for mortality met selection criteria. Using a fixed effect model, the combined estimate indicates an increased mortality of 55% with PD (OR 1.55, 95% CI: 1.08-2.22, P = 0.02) without statistical heterogeneity (χ2 = 5.88, P = 0.21). PD patients were 0.78 wk younger (P = 0.0002) and 67g smaller (P = 0.0006). Analysis of the three level II trials yielded a combined estimate indicating an excess mortality of 89% with PD patients (95% CI: 1.20-2.98, P = 0.006) without statistical heterogeneity (χ2 = 3.74, P = 0.15). Conclusions: PD is associated with 55% excess mortality compared with LAP. Pediatric surgeons must individually assess and select patients with NEC and IP for optimal surgical therapy.
| Original language | English |
|---|---|
| Pages (from-to) | 95-100 |
| Number of pages | 6 |
| Journal | Journal of Surgical Research |
| Volume | 161 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jun 1 2010 |
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Keywords
- intestinal perforation
- laparotomy
- meta-analysis
- necrotizing enterocolitis
- neonatal surgery
- peritoneal drainage
ASJC Scopus subject areas
- Surgery
Cite this
Peritoneal Drainage versus Laparotomy for Necrotizing Enterocolitis and Intestinal Perforation : A Meta-Analysis. / Sola, Juan E; Tepas, Joseph J.; Koniaris, Leonidas G.
In: Journal of Surgical Research, Vol. 161, No. 1, 01.06.2010, p. 95-100.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Peritoneal Drainage versus Laparotomy for Necrotizing Enterocolitis and Intestinal Perforation
T2 - A Meta-Analysis
AU - Sola, Juan E
AU - Tepas, Joseph J.
AU - Koniaris, Leonidas G.
PY - 2010/6/1
Y1 - 2010/6/1
N2 - Background: To determine whether peritoneal drain (PD) or laparotomy (LAP) is the most effective intervention in premature neonates with necrotizing enterocolitis (NEC) or intestinal perforation (IP). Methods: A systematic review of the published literature between January 2000 and December 2008 was undertaken. Prospective studies with at least 25 patients in each of the PD and LAP arms were selected. Gestational age, birth weight, operation, and mortality data were extracted. Results: Five prospective studies (two level I, three level II) with 523 (273 PD, 250 LAP) participants followed for mortality met selection criteria. Using a fixed effect model, the combined estimate indicates an increased mortality of 55% with PD (OR 1.55, 95% CI: 1.08-2.22, P = 0.02) without statistical heterogeneity (χ2 = 5.88, P = 0.21). PD patients were 0.78 wk younger (P = 0.0002) and 67g smaller (P = 0.0006). Analysis of the three level II trials yielded a combined estimate indicating an excess mortality of 89% with PD patients (95% CI: 1.20-2.98, P = 0.006) without statistical heterogeneity (χ2 = 3.74, P = 0.15). Conclusions: PD is associated with 55% excess mortality compared with LAP. Pediatric surgeons must individually assess and select patients with NEC and IP for optimal surgical therapy.
AB - Background: To determine whether peritoneal drain (PD) or laparotomy (LAP) is the most effective intervention in premature neonates with necrotizing enterocolitis (NEC) or intestinal perforation (IP). Methods: A systematic review of the published literature between January 2000 and December 2008 was undertaken. Prospective studies with at least 25 patients in each of the PD and LAP arms were selected. Gestational age, birth weight, operation, and mortality data were extracted. Results: Five prospective studies (two level I, three level II) with 523 (273 PD, 250 LAP) participants followed for mortality met selection criteria. Using a fixed effect model, the combined estimate indicates an increased mortality of 55% with PD (OR 1.55, 95% CI: 1.08-2.22, P = 0.02) without statistical heterogeneity (χ2 = 5.88, P = 0.21). PD patients were 0.78 wk younger (P = 0.0002) and 67g smaller (P = 0.0006). Analysis of the three level II trials yielded a combined estimate indicating an excess mortality of 89% with PD patients (95% CI: 1.20-2.98, P = 0.006) without statistical heterogeneity (χ2 = 3.74, P = 0.15). Conclusions: PD is associated with 55% excess mortality compared with LAP. Pediatric surgeons must individually assess and select patients with NEC and IP for optimal surgical therapy.
KW - intestinal perforation
KW - laparotomy
KW - meta-analysis
KW - necrotizing enterocolitis
KW - neonatal surgery
KW - peritoneal drainage
UR - http://www.scopus.com/inward/record.url?scp=77951623422&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=77951623422&partnerID=8YFLogxK
U2 - 10.1016/j.jss.2009.05.007
DO - 10.1016/j.jss.2009.05.007
M3 - Article
C2 - 19691973
AN - SCOPUS:77951623422
VL - 161
SP - 95
EP - 100
JO - Journal of Surgical Research
JF - Journal of Surgical Research
SN - 0022-4804
IS - 1
ER -