Initial Laparotomy versus Peritoneal Drainage in Extremely Low–Birth-Weight Infants with Surgical Necrotizing Enterocolitis or Spontaneous Intestinal Perforation

Abstract Necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) are disastrous complications in extremely lowbirthweight (ELBW) neonates, yet the optimal first operation remains unsettled. Together, these conditions account for a disproportionate share of neonatal surgical mortality. We retrospectively studied ELBW infants (< 1000 g) treated for surgical NEC or SIP at two tertiary UAE centers between 2019 and 2023, comparing outcomes of initial bedside peritoneal drainage (PD)—usually performed under minimal sedation—with exploratory laparotomy (LAP). Twentynine infants qualified; 26 received PD and 3 LAP. Ninetyday survival wa 85 % after PD versus100 % after LAP. However, severe intraventricular hemorrhage developed in ony 4 % of PD infants compared wit 67 % after LAP, and neurodevelopment at oneyear corrected age was normal n 75 % of PD survivors but in none following LAP. Median neonatalintensivecare stay and dependence on parenteral nutrition were similar between strategies. These findings suggest that, for the frailest ELBW population, PD achieves survival equivalent to LAP while potentially reducing cerebral injury and supporting earlier functional recovery. Prospective multicenter trials with adequate power, standardized neurodevelopmental assessment, and longer followup are needed to confirm these signals and guide individualized surgical decisionmaking.