NEC remains an important cause of mortality and morbidity, however decisions regarding timing and type of surgery remain unclear. Objectives: 1. To examine the results of peritoneal drainage (PD) in the management of NEC and 2. To compare the outcome of early vs. late laparotomy (lap). Methods: A retrospective review of all infants with NEC admitted during 1989-94 to a tertiary NICU was carried out. Patients were grouped according to type of surgery (Group 1: PD + lap and Group II: lap alone) and timing of lap following diagnosis- Early (≤48h) or Late (>48h). Indications for surgery (clinical deterioration vs. perforation), mortality rates, complications (adhesions, strictures, malabsorption), extent of gut involvement (diffuse vs. localized) and duration of hospital stay were analyzed. Mortality stratified by birthweight(BW≤1000g vs. >1000g) was also examined. Data was analyzed by Student's t-test and chi-square.

Results: 56 of 128 infants with Bell's Stage II or III NEC required surgical intervention. 12 patients were excluded from the analysis, 4 had PD only and 8 had lap for late sequelae. There was no difference in mortality or other sequelae for type of surgery - group I (n=15) and II (n=29) including infants <1000g. 79% of patients with initial PD, later required lap. A significant increase was observed in mortality, but not in morbidity, in the late lap group. When stratified for BW, this difference was not significant for <1000g infants, their mortality remained high irrespective of timing of laparotomy. All 6/6 infants with lap within 24 hr. of diagnosis survived. Table

Table 1
Full size table

Conclusion: Improved survival was found following early laparotomy in infants requiring surgical intervention for NEC with birthweight>1000g. In this series no benefit was found for peritoneal drainage over laparotomy, even for <1000 g infants.