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• W4242059146 abstract "First, we would like to thank the authors for this article entitled “Long term outcome of preterm infants with isolated intestinal perforation: A comparison between primary anastomosis and ileostomy” [ [1] de Haro JI Prat Ortells J Albert Cazalla A et al. Long term outcome of preterm infants with isolated intestinal perforation: A comparison between primary anastomosis and ileostomy. J Pediatr Surg. 2016; 51: 1251-1254https://doi.org/10.1016/j.jpedsurg.2016.02.086 Abstract Full Text Full Text PDF Scopus (15) Google Scholar ]. Their conclusion is supported by the results and the higher complication rate in the Primary Anastomosis (PA) group versus the Ileostomy (I) group. The authors advocate ileostomy when isolated intestinal perforation is diagnosed.This position leads to some questionable comments that must be raised in light of this article: -Isolated intestinal perforation (IIP) occurs in very low birth weight preterm infants, usually during the first days of life. In this series, seven infants presented with IIP after 10 days of life, and two at 19 and 22 days, making the diagnosis unclear whether it was necrotizing enterocolitis (NEC) or IIP. -Indomethacin has been used for the treatment of patent ductus arteriosus. How long was the treatment? It has been reported that prolonged treatment with indomethacin increased the risk of NEC which could be a factor playing a role when NEC occurs in patients already treated for IIP [ [2] Herrera C Holberton J Davis P Prolonged versus short course of indomethacin for the treatment of patent ductus arteriosus in preterm infants. Cochrane Database Syst Rev. 2007; : CD003480https://doi.org/10.1002/14651858.CD003480.pub3 Crossref PubMed Scopus (98) Google Scholar ]. -Regarding enteral feeding, the authors did not mention anything about what type of enteral feeding was used between trophic or regular advanced enteral feeding. This might have an importance impact on the post-operative NEC occurrence. -The type of bacteria and/or virus involved in the perforation is not mentioned, especially for patients 12, 15, 18 and 21 who presented with a perforation within two days of life. Cytomegalovirus (CMV) has been reported as a possible underlying factor in such surgical conditions in preterm infant [ [3] Bonnard A Le Huidoux P Carricaburu E et al. Cytomegalovirus infection as a possible underlying factor in neonatal surgical conditions. J Pediatr Surg. 2006; 41: 1826-1829https://doi.org/10.1016/j.jpedsurg.2006.06.009 Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar ]. Do the authors look for the CMV status of these patients? Most important, invasive candidiasis has been reported and is also well known to be under diagnosed. Candidiasis is a very important factor of primary anastomosis failure and this could be a factor to identify if possible prior to any surgical procedure [ [4] Barton M O'Brien K Robinson JL et al. Invasive candidiasis in low birth weight preterm infants: Risk factors, clinical course and outcome in a prospective multicenter study of cases and their matched controls. BMC Infect Dis. 2014; 14: 327https://doi.org/10.1186/1471-2334-14-327 Crossref PubMed Scopus (51) Google Scholar ]. -Management of intestinal function in such patients is also important and contrast enema has been reported to be effective [ [5] Koshinaga T Inoue M Ohashi K et al. Therapeutic strategies of meconium obstruction of the small bowel in very-low-birthweight neonates. Pediatr Int. 2011; 53: 338-344https://doi.org/10.1111/j.1442-200X.2010.03231.x Crossref PubMed Scopus (12) Google Scholar ]. After a primary anastomosis, this can be done safely after eight to ten days after surgery helping to recover normal bowel movement decreasing the risk of PA leakage. How did the authors manage the post-operative bowel function in this series? -Simple suturing of the perforation is also effective avoiding a complete resection and anastomosis making the surgical procedure faster which is important in this kind of patients. -The ileostomy complication rate has been reported to be much higher in very low birth weight babies. Stomal complication rate up to 68% have been reported including excoriation of the surrounding tissue, prolapse, stenosis, necrosis, and electrolyte disorders, inversely proportional to gestational age and birth weight [ [6] Singh M Owen A Gull S et al. Surgery for intestinal perforation in preterm neonates: Anastomosis vs stoma. J Pediatr Surg. 2006; 41 ([discussion 725–9]): 725-729https://doi.org/10.1016/j.jpedsurg.2005.12.017 Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar ]. Additionally, stoma closure may lead to an additional bowel resection and a second general anesthesia on these very fragile patients [ [7] Nasr VG Davis JM Anesthetic use in newborn infants: The urgent need for rigorous evaluation. Pediatr Res. 2015; 78: 2-6https://doi.org/10.1038/pr.2015.58 Crossref PubMed Scopus (34) Google Scholar ]. Thus, a decision to perform an ileostomy should be done based mainly on the extension of the disease on the small bowel and independently of age, weight, surgical conditions and peritoneal contamination [ [8] Rao SC Basani L Simmer K et al. Peritoneal drainage versus laparotomy as initial surgical treatment for perforated necrotizing enterocolitis or spontaneous intestinal perforation in preterm low birth weight infants. Cochrane Database Syst Rev. 2011; : CD006182https://doi.org/10.1002/14651858.CD006182.pub2 Crossref PubMed Google Scholar ]." @default.
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• W4242059146 date "2016-08-01" @default.
• W4242059146 modified "2023-10-01" @default.
• W4242059146 title "Letter to the Editor" @default.
• W4242059146 doi "https://doi.org/10.1016/j.jpedsurg.2016.04.022" @default.
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