From
StayCurrentMD
Update Course Rewind: Laparotomy Over PPD 2022
With Dr. Paul Yak · hosted by Dr. Ellen Encisco
Chapter 1 of 5 · Fundamentals
Introduction
Introduction to NEC management controversy
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
The NEST trial cutoff was around a kilogram for laparotomy safety
Surgeons are offering surgery to patients at lower and lower gestational age and size every year
For survival outcomes in NEC, the difference between laparotomy and drainage is still not 100% clear based on NEST trial and other evidence
For neurodevelopmental outcomes in NEC, the evidence favoring laparotomy over drainage is clearer than for survival
A drain can buy time for further discussions and decision-making in borderline cases
Working with the neonatology team on the decision to operate is prudent
At a hospital set up for neonatal surgery, presence of free air would not change management approach between drain and laparotomy because the baby could be transferred after either treatment
Neonatology is surviving younger and younger infants, creating a widening gap between what neonatology can survive and what surgery should be doing
More recent data from a prospective but non-randomized cohort study from the NICHD Neonatal Research Network showed no difference in survival, intestinal strictures, or intra-abdominal abscesses between laparotomy and drainage
NICHD data showed a potential improvement in long-term neurodevelopmental outcomes with laparotomy over drainage
About 38% of patients who underwent initial laparotomy developed neurodevelopmental impairment
About 68% of patients who underwent primary peritoneal drainage developed later neurodevelopmental impairment