Negative pressure wound therapy (NPWT) in the open abdomen in a preterm newborn with necrotizing enterocolitis: case report

Necrotizing enterocolitis (NEC) totalis is a devastating intestinal disease that affects ~ 5% of preterm neonates; its appropriate surgical management is still controversial. Although the temporary open abdomen associated with negative pressure wound therapy (NPWT) has become an increasingly used therapeutic option, its use is still relatively limited in premature babies with NEC. On the 6th day of life a male preterm neonate born at 32 + 3 weeks of gestational age (1570 g) developed bowel perforation. He underwent a bed-side laparotomy and a NEC totalis was found with three intestinal perforations (one jejunal and two contiguous ileal perforations). In order to re-esplore the baby, an open abdomen NPWT was applied (Suprasorb CNP P3-Lohmann-Rauscher), with an intrabdominal drainage film, setting the pressure at -20 mmHg. After 72 h a second surgery was performed. The entire bowel showed a good trophism; no new perforations were found. The two ileal perforations were closed with running sutures and a jejunostomy was performed. The postoperative course was uneventful and the oral feeding started on the fifth postoperative day. Two months later a barium enema through the mucous fistula showed a normal intestinal progression of the contrast medium, and the jejunostomy was closed. The temporary open abdomen associated with NPWT is a valuable resource in critical premature neonates; it allows the creation of a “artificial third space” which is crucial in lowering bowel edema and intrabdominal pressure. Moreover, the use of an intrabdominal film may represent a new perspective whose effectiveness needs further studies.