Bedside peritoneal drainage in very low birth weight infants

Background: Bedside peritoneal drainage is emerging as a useful therapy for premature infants with intestinal perforation in the newborn period. Some authors recommend that bedside drainage be primary therapy for very low birth weight neonates. Surprisingly, some series report up to 70% of neonates so treated never require further or definitive surgery. Methods: This is a retrospective chart review of all premature newborns with a diagnosis of either necrotizing enterocolitis or bowel perforation between November 1996 and May 2000. Results: Sixty-seven patients were identified, of whom 27 were treated medically only and not considered here. Thirty-two neonates were treated with laparotomy primarily, with 26 survivors. Eight neonates were treated first with bedside peritoneal drainage. Of these, 4 survived, 6 required secondary surgery for obstruction or infection, and 2 died before any further intervention. Conclusions: Bedside peritoneal drainage is a useful adjunct in the approach to treating the very sick, very low birth weight neonate with evidence of intestinal perforation. Our experience does not support drainage as definitive therapy.