Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jul 27, 2023; 15(7): 1416-1422
Published online Jul 27, 2023. doi: 10.4240/wjgs.v15.i7.1416
Efficacy of peritoneal drainage in very-low-birth-weight neonates with Bell’s stage II necrotizing enterocolitis: A single-center retrospective study
Yong Shen, Yu Lin, Yi-Fan Fang, Dian-Ming Wu, Yuan-Bin He
Yong Shen, Yu Lin, Yi-Fan Fang, Dian-Ming Wu, Yuan-Bin He, Department of Pediatric Surgery, Fujian Children’s Hospital (Fujian Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350000, Fujian Province, China
Author contributions: Shen Y and Lin Y contributed equally to this work and are co-first authors; Shen Y and Lin Y designed the research study; Shen Y, Lin Y, Fang YF and Wu DM contributed reagents and analytic tools; Shen Y, Lin Y and He YB analyzed the data; Shen Y and Lin Y wrote the manuscript; and all authors have read and approved the final manuscript.
Institutional review board statement: The study was conducted according to the guidelines of the Declaration of Helsinki and was approved by the Medical Ethics Committee of Fujian Children’s Hospital (registration number: 2022ETKLR08021).
Informed consent statement: This is a retrospective study, and since the analysis used anonymous clinical data approved by the Ethics Committee of Fujian Children’s Hospital, the need for informed consent from subjects or guardians was waived.
Conflict-of-interest statement: The authors declare no competing interests.
Data sharing statement: The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yuan-Bin He, MM, Doctor, Department of Pediatric Surgery, Fujian Children’s Hospital (Fujian Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, No. 966 Hengyu Road, Jinan District, Fuzhou 350000, Fujian Province, China. heyb1989@fjmu.edu.cn
Received: March 22, 2023
Peer-review started: March 22, 2023
First decision: April 10, 2023
Revised: May 2, 2023
Accepted: May 12, 2023
Article in press: May 12, 2023
Published online: July 27, 2023
Abstract
BACKGROUND

Currently, pediatric surgeons are challenged by a lack of consensus on the optimal management strategy (conservative or surgical) for children with Bell’s stage II necrotizing enterocolitis (NEC).

AIM

To evaluate the clinical efficacy of peritoneal drainage in very-low-birth-weight (VLBW) neonates with modified Bell’s stage II NEC.

METHODS

This was a retrospective analysis of 102 NEC (modified Bell’s stage II) neonates born with VLBW who were treated at the Fujian Children’s Hospital (Fujian Branch of Shanghai Children’s Medical Center) between January 2017 and January 2020; these included 24 cases in the peritoneal drainage group, 36 cases in the exploratory laparotomy group, and 42 cases in the conservative treatment group.

RESULTS

The general characteristics were comparable in the three groups (P > 0.05). Compared with conservative treatment, peritoneal drainage was associated with significantly shorter fasting time, abdominal distension relief time, fecal occult blood (OB) negative conversion time, and reduced hospital length of stay (HLOS) (P < 0.05 for all). Despite some advantages of peritoneal drainage over conservative treatment in terms of cure, conversion to laparotomy, intestinal perforation, intestinal stenosis, and abdominal abscess rates, the differences were not statistically significant (P > 0.05). Compared to exploratory laparotomy, the fecal OB negative conversion time was significantly shorter in the peritoneal drainage group (P < 0.05); similarly, the exploratory laparotomy group showed longer fasting time, abdominal distension relief time, HLOS, and higher complication rate compared to peritoneal drainage group, but the between-group differences were not statistically significant (P > 0.05).

CONCLUSION

Peritoneal drainage, an easy-to-operate procedure, can improve the clinical symptoms of VLBW neonates with Bell’s stage II NEC and help reduce the HLOS.

Keywords: Stage II necrotizing enterocolitis, Enterocolitis, Very-low-birth-weight, Peritoneal drainage, Hospital length of stay

Core Tip: Peritoneal drainage, a procedure simple to operate and easy to popularize, can reduce abdominal pressure and monitor intraperitoneal conditions, which is expected to be a third treatment option for very-low-birth-weight neonates with modified Bell’s stage II necrotizing enterocolitis. This study validated the efficacy of peritoneal drainage from the perspectives of clinical symptom improvement, prognosis and neonatal complications.