Results
Twenty infants were found to have had NPWT between January 2002 and December 2010. Two patients were excluded because NPWT was not used to treat abdominal
wounds.
The median gestational age at birth of the abdominal wound cohort was 35.1 ± 5.5 weeks (range, 24-40 weeks), with 66% of the infants born prematurely
(gestational age younger than 37 weeks).
A summary ofdemographics is displayed in Table 1. Diagnoses varied, as shown in Table 2, with the 2 most common diagnoses being necrotizing enterocolitis (NEC) (5) and gastroschisis (3).
Overall, the median corrected gestational age at initiation of NPWT was 45.2 ± 17.2 weeks (range, 37-92 weeks).
The median duration of NPWT treatment was 34.0 ± 92.1 days (range, 1-310 days). The 3 patients with more than 90 days of NPWT treatment died of causes unrelated to their NPWT or their abdominal wound.
Forty-four percent of the infants (8) had a stoma before initiation of NPWT, and 22% of the patients (4) had an EC fistula before use of NPWT.
There was no need for reoperation for wound-related complications attributable to
the use of NPWT.
Fistula effluent was collected via the NPWT system, thereby protecting the skin and facilitating wound healing. An example of this is shown in Fig. 2.
Two new fistulae developed in conjoined omphalopagus twins during the use of NPWT after massive staple line failure after the Bianchi procedure used to divide their shared small bowel.
Negative pressure wound therapy was used as their temporary abdominal closure. By postoperative day 5, both infants had breakdown of the staple line and developed
multiple fistulae. Although NPWT was continued, despite the presence of multiple fistulae, the association between NPWT and the staple line failures was unclear in these patients with significant comorbidities and risk factors for catastrophic complications.
The fistulae were included in the NPWT, andthe fistulae never healed. Both of these patients died.
Of 18 infants, 12 (66%) survived, demonstrating the high acuity of illness in this cohort.
The median interval between discontinuation of NPWT and discharge was 66 days (range, 16-256), whereas the median time between discontinuation of NPWT and death was 0 days because 4 of 6 of the patients who died had NPWT in place at the time of death.
All deaths were unrelated to the use of NPWT. Of 6 of the patients who did not survive, 5 had their care withdrawn because of overwhelming multiorgan system failure, with 3 having significant intracranial hemorrhage.