S. Amin1, N. R. Shah1, K. Maselli1, D. Wieczorek1, Z. Lutrzykowska1, R. B. Hirschl1, K. Speck1, S. K. Gadepalli1 1University Of Michigan, Section Of Pediatric Surgery, Ann Arbor, MI, USA
Introduction: Neonatal pneumoperitoneum is a critical finding requiring emergent surgical intervention. Peritoneal drain placement has historically been the mainstay of initial therapy for very low (VLBW) and extremely low birthweight (ELBW) neonates, despite recent studies that differentiate management based on disease process (necrotizing enterocolitis (NEC) or spontaneous intestinal perforation (SIP)). This study aims to identify responders to drainage to augment surgical decision-making for neonatal pneumoperitoneum.
Methods: This is a single-center retrospective study of all neonates <1500g who underwent peritoneal drainage (PD) for pneumoperitoneum between 1/2015 –12/2021, as per a multidisciplinary institutional protocol. Neonates were separated into two cohorts: those managed definitively with PD (drain responders) and those requiring subsequent interventions after PD (drain non-responders). Antenatal/postnatal characteristics, periprocedural data, and clinical outcomes were analyzed. Bivariate analysis was performed, with significance set at p<0.05.
Results: During the study period, 70 neonates were diagnosed with pneumoperitoneum due to NEC or SIP, of which 53 (76%) were <1500g and underwent initial peritoneal drainage. Twenty-five (47%) were drain responders (DR) while twenty-eight (53%) were drain non-responders (NR). No differences in sex, gestational age, race, birth weight, or incidence of pre-drainage enteral feeds were identified (Table 1). Patients in the NR cohort more commonly had comorbid cardiac diagnoses (4 vs 25%, p=0.03), antenatal antibiotic exposure (24 vs 54% ,p=0.028), postnatal non-steroid anti-inflammatory medication exposure (16 vs 41%, p=0.049), and weighed more at time of procedure (740 vs 910g, p=0.028). Interestingly, 36% of patients ultimately diagnosed with NEC responded to PD while 39% of patients with SIP were non-responders. While there was no difference in in-hospital mortality (24 vs 32%, p=0.51), the DR cohort had a significantly shorter intensive care (87 vs 125 days, p=0.024) and overall hospital (91 vs 151 days, p<0.001) length of stay.
Conclusion: Peritoneal drain placement for initial management of pneumoperitoneum was successfully in nearly half of neonates, independent of final diagnosis (NEC or SIP). Drainage alone resulted in shorter in-hospital recovery by nearly 2 months.
