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  • Letter to the Editor
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Response to Swanson et al.

Journal of Perinatology volume 29, pages 257–258 (2009)Cite this article

We appreciate the comments of Swanson et al. regarding our findings. They raise the challenging question as to whether premature infants at risk for necrotizing enterocolitis (NEC) with a focal area of perforation have a disease entity that is distinct from NEC. This has long been a subject of debate among physicians caring for such patients. We acknowledge the extensive work by Swanson and colleagues contending that spontaneous intestinal perforation (SIP) is a unique disease entity. Our study was not designed to address this issue.

Whether or not one views SIP as a unique entity or part of a spectrum of presentation of NEC, the clinical reality is that it cannot be reliably distinguished pre-operatively from more extensive NEC by currently available tests. SIP is commonly defined by the radiographic finding of free intraperitoneal air in the absence of pneumatosis or other bowel abnormalities. In the largest reported prospective evaluation of this question Blakely et al. found that 44% of patients with confirmed extensive NEC at laparotomy presented with free intraperitoneal air in the absence of pneumatosis.1 In a multicenter clinical trial, Moss et al. found that the presence or absence of pneumatosis did not predict extent of disease or response to therapy.2 Many patients with intestinal perforation are treated with peritoneal drainage, which does not reveal the extent of disease.

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References

  1. Blakely ML, Lally KP, McDonald S, Brown RL, Barnhart DC, Ricketts RR et al. Postoperative outcomes of extremely low birth-weight infants with necrotizing enterocolitis or isolated intestinal perforation. Ann Surg 2005; 241 (6): 984–994.

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  2. Moss RL, Dimmitt RA, Barnhart DC, Sylvester KG, Brown RL, Powell DM et al. Laparotomy versus peritoneal drainage for necrotizing enterocolitis and perforation. N Engl J Med 2006; 354: 2225–2234.

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Authors and Affiliations

  1. Department of Surgery, Yale University School of Medicine, New Haven, CT, USA

    R L Moss, L A Kalish, C Duggan, P Johnston, M L Brandt, J C Y Dunn, R A Ehrenkranz, T Jaksic, K Nobuhara, B J Simpson, M C McCarthy & K G Sylvester

Authors
  1. R L Moss
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  2. L A Kalish
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  3. C Duggan
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  4. P Johnston
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  5. M L Brandt
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  6. J C Y Dunn
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  7. R A Ehrenkranz
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  8. T Jaksic
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  9. K Nobuhara
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  10. B J Simpson
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  11. M C McCarthy
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  12. K G Sylvester
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Corresponding author

Correspondence to R L Moss.

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Moss, R., Kalish, L., Duggan, C. et al. Response to Swanson et al.. J Perinatol 29, 257–258 (2009). https://doi.org/10.1038/jp.2008.243

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