Key messages

• Abdominal (peritoneal) drainage may not be better than abdominal surgery (laparotomy) in treating premature babies with very low birth weight who develop severe inflammation or holes in their intestines.

• Many such premature babies undergoing abdominal drainage end up needing abdominal surgery anyway.

• Premature babies undergoing abdominal drainage are likely to be at a higher risk of developing cerebral palsy compared to those who undergo abdominal surgery.

What are intestinal problems?

The intestines allow us to digest food and absorb nutrients. Once food is digested and nutrients absorbed, the intestines help rid our bodies of food waste (by pooping). Intestine problems in premature infants include necrotising enterocolitis and spontaneous intestinal perforation. Necrotising enterocolitis is a condition where the intestines are inflamed and sometimes develop holes. In spontaneous intestinal perforation, the intestines also develop holes, but without being inflamed.

How are necrotising enterocolitis and intestine perforations treated?

One way to treat them is by laparotomy (a surgical incision of the abdomen), in order to remove unhealthy or dead parts of the intestine. Once the dead or damaged parts of the intestine are removed, the intestine should heal and become healthy.

Another treatment is to insert a drainage tube into the abdomen (peritoneal drainage) to remove air and fluid that builds up due to necrotising enterocolitis or spontaneous intestinal perforation. Once air and fluid are drained from the abdominal cavity, the expectation is that the intestine heals, and the holes close on their own.

Why is it important to treat surgical necrotising enterocolitis or spontaneous intestinal perforation?

Either of these conditions endanger the infant by allowing germs to move from the intestine into the abdominal cavity and bloodstream and cause severe infection. They can also markedly reduce the ability of the intestines to digest and absorb nutrients from milk.

What did we want to find out?

We wanted to find out which treatment, peritoneal drainage or laparotomy, was better at reducing negative outcomes in preterm infants (born before 37 weeks of pregnancy) who have very low birth weight (less than 1500 g) with necrotising enterocolitis or spontaneous intestinal perforation. We wanted to know if negative outcomes were present by the time infants reach 18 to 24 months of age. Negative outcomes included:

• overall neurodevelopmental impairments (learning disabilities, cerebral palsy, motor disorders (physical co-ordination difficulties), visual or hearing loss);

• specific neurodevelopmental impairments (mental or physical);

• the need for a subsequent operation (laparotomy);

• death.

We also wanted to find out if infants were more likely to die before leaving the hospital.

What did we do?

We searched for studies that compared peritoneal drainage to laparotomy in premature infants with a birth weight of less than 1500 g to see if one or the other led to fewer negative outcomes. We summarised the results of the studies, and rated our confidence in the evidence based on factors such as study methods and number of infants studied.

What did we find?

We found three studies that included 496 infants. All studies included infants with, or with symptoms of, necrotising enterocolitis with perforation or spontaneous intestinal perforation. All studies compared peritoneal drainage with laparotomy.

Main results

In infants who had treatment for surgical necrotising enterocolitis or spontaneous intestinal perforation, peritoneal drainage compared to laparotomy:

• likely results in little to no difference in death (1 study, 308 infants) or mental impairments among survivors (1 study, 206 infants) at 18 to 24 months of age;

• likely results in an increase in the diagnosis of moderate to severe cerebral palsy (1 study, 210 infants);

• likely results in little to no difference in mortality before leaving hospital (2 studies, 378 infants);

• infants in the peritoneal drainage group are more likely to need subsequent laparotomy during the first hospital stay.

What are the limitations of the evidence?

We found only three studies and the number of infants studied was small. Hence, our confidence in these results was moderate.

How up-to-date is this evidence?

We searched for studies up to 17 December 2024.