weekly_question 14/8/2022

[Admin]

A 26-week gestational age 900-gram infant, now 21 days of age, has pneumoperitoneum, extensive pneumatosis, portal vein gas and is on two vasopressors. He is on maximum support with the conventional ventilator, has been resuscitated, and is optimized for surgical treatment according to the neonatology team.

Which statement is true regarding his survival and 2-year neurodevelopmental status?

A The likelihood for neurodevelopmental impairment in infants with NEC with initial laparotomy or initial peritoneal drain placement is equivalent.

B With this gestational age and surgical condition, he has a 90% probability of having some degree of neurodevelopmental impairment.

C There are currently no data from randomized clinical trials addressing this question.

D Initial laparotomy doubles the rate of survival without impairment at 2-years compared to initial drain placement for infants with presumed NEC.

E Initial drain placement with subsequent laparotomy if needed has been shown to increase survival without impairment in high-risk NEC infants.

[Admin]

correct answer
D Initial laparotomy doubles the rate of survival without impairment at 2-years compared to initial drain placement for infants with presumed NEC.

There has been one randomized trial comparing initial laparotomy versus peritoneal drainage that measured neurodevelopmental outcomes at approximately 2 years (the NEST trial). When investigated in overall treatment groups (laparotomy versus drainage), without considering the preoperative diagnosis, there was no difference in the rate of death or neurodevelopmental impairment. However, when the preoperative diagnosis is considered, there are important differences. In those with a preoperative diagnosis of NEC, infants with initial laparotomy had a rate of survival without impairment of 37% compared to 15% with drainage.

[Ahmed Nabil]

D

[Admin]

correct answer
D Initial laparotomy doubles the rate of survival without impairment at 2-years compared to initial drain placement for infants with presumed NEC.

There has been one randomized trial comparing initial laparotomy versus peritoneal drainage that measured neurodevelopmental outcomes at approximately 2 years (the NEST trial). When investigated in overall treatment groups (laparotomy versus drainage), without considering the preoperative diagnosis, there was no difference in the rate of death or neurodevelopmental impairment. However, when the preoperative diagnosis is considered, there are important differences. In those with a preoperative diagnosis of NEC, infants with initial laparotomy had a rate of survival without impairment of 37% compared to 15% with drainage.