Peritoneal drainage vs. laparotomy as initial surgery for perforated necrotising enterocolitis or spontaneous intestinal perforation: experience from a level III Neonatal Intensive Care Unit in the largest paediatric hospital in southern Poland

Introduction
This retrospective cohort study was performed to compare the outcomes of primary peritoneal drainage (PD) vs. laparotomy (LAP) in patients with intestinal perforation due to necrotising enterocolitis (NEC) or spontaneous intestinal perforation. Additionally, it aims to identify demographic and clinical characteristics of eligible infants.

Material and methods
We identified infants hospitalised in the Neonatal Intensive Care Unit of the University Children’s Hospital of Kraków between November 2014 and April 2022 and diagnosed with intestinal perforation due to NEC or spontaneous intestinal perforation. These infants underwent surgical intervention with either PD or LAP . The primary outcomes were death, short bowel syndrome (SBS), and combined outcome of death and/or short bowel syndrome. Odds ratios (OR) were calculated for these outcomes. Statistical significance was determined by a p-value < 0.05, with a 95% confidence interval (CI) other than 1.0.

Results
The primary outcome of death occurred in 8 (21%) of patients who had PD and in one (5.8%) of patient who had LAP as the initial surgery (OR = 0.23, 95% CI: 0.02–2). Short bowel syndrome occurred in 14 (36.8%) and 6 (35%) babies who had drainage and LAP, respectively (OR = 0.93, 95% CI: 0.28–3.0). Composite outcome of death and/or SBS occurred in 19 (50%) and 7 (41%) babies who had drainage and LAP as the initial surgery, respectively (OR = 0.70, 95% CI: 0.22–2.2).

Conclusions
Our findings indicate that the choice of initial surgical procedure does not significantly impact the combined outcome of death and/or short bowel syndrome. Further studies are necessary to assess the impact of initial surgery on survival, intestinal function, and long-term neurodevelopmental outcomes.