A very low bih weight preterm baby is on ventilator for respiratory distress. Baby presents with clinical features of necrotizing enterocolitis with perforation. What will be the appropriate management?
Surgical intervention is the most definitive treatment of perforated necrotising enterocolitis. However the patient mentioned in the above question is premature with very low bih weight. Such critically ill preterm babies are extremely unstable for surgery and are unlikely to tolerate major resective procedure. Peritoneal drainage will deflate the distended abdomen, allow better movement of diaphragm and improve respiration. Removal of feculent fluid would also reduce chances of sepsis syndrome. Ref: Nelson 18th Edition, Page 54; O P Ghai 6th Edition, Page 164; Case studies in Pediatric surgery by Moss (2000), Page 121, 122
Conservative management
Immediate laparotomy
Extra corporeal membrane oxygenation with surgery after stabilization
Peritoneal drainage