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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. [ABSTRACT FROM AUTHOR]

Introduction: Necrotising enterocolitis (NEC) is one of the most serious conditions in newborn infants, affecting up to 10% of very low birth weight (VLBW) infants. Mortality rates can rise as high as 60%.The suspected diagnosis is confirmed with typical findings on abdominal radiography (AR) such as pneumatosis intestinalis (PI), portal vein gas (PVG) and in extreme cases pneumoperitoneum. Abdominal ultrasound (AUS) can depict PI, PVG and pnuemoperitoneum (in some cases ahead of AR), but it also provides other crucial information such as bowel wall viability (thickness or thinning) and free abdominal fluid. These additional findings are helpful in diagnosing and managing NEC., Methods and Analysis: The hypothesis being tested is that preforming an AR in patients with clinical symptoms of NEC, but inconclusive/normal AR will enhance detection rates, and expedite treatment in infants born at <32 weeks. Additionally, the time needed to initiate treatment, according to decision made based on AR or AR and AUS will also be compared. The use of AUS together with AR as an add-on test may increase the accuracy of diagnosing NEC and expedite life-saving treatment. We plan to recruit 200 VLBW infants, who are most prone to NEC. It will also be the first multicentre study evaluating the use of AUS as an add-on test, enabling us to recruit a significantly higher number of patients compared with published studies., Ethics and Dissemination: The Bioethical Committee of the Medical University of Warsaw has approved the study (KB 130/2017). We plan to submit our findings to international peer-reviewed journals. Abstract will be submitted to local and international conferences., Trial Registration Number: NCT03188380; Protocol version: V.2.08.2019; Pre-results., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)