However, the study detected a major difference in outcomes based on preoperative diagnosis. Akin to previous results, rates of mortality or neurodevelopmental impairment at 18 to 22 months were similar between the groups (69 and 70 percent, respectively).
Nearly two decades later, guidance is emerging from another Blakely study in which the team identified 992 eligible infants and randomly selected 310 to receive either laparotomy or drainage. “The findings shine a light on the need to discriminate the two conditions prior to surgery.” Outcomes Hinge on Diagnosis Another study by Blakely and colleagues found similar mortality rates at 18 to 22 months for both laparotomy and drainage, and sought larger studies to more deeply investigate the issue. Blakely’s own research has shown more than half of extremely low birthweight infants with necrotizing enterocolitis or isolated intestinal perforation die in the hospital regardless of the surgical repair. “This level of study is extremely rare and almost never done.” “We needed to engage in a scientifically rigorous, valid study design that might change practice,” he said. Vulnerable Populationīlakely was one of more than 70 investigators across 20 centers in the United States who sought to settle the debate through a randomized clinical trial. There has been much debate about these two treatments,” said first author Martin Blakely, M.D., a professor of pediatric surgery at Monroe Carell Jr. “Very few of our neonatal surgical treatments have been studied properly and extensively. Results were published in Annals of Surgery.īoth surgical strategies are commonly used to treat life-threatening necrotizing enterocolitis and isolated intestinal perforation, with little consensus to favor one approach over the other. A landmark study has paved the way for improved, evidence-based decisions in the neonatal surgery suite for treatment of low birthweight infants undergoing either initial laparotomy or peritoneal drainage.
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