This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Pediatrics
[{'content': 'A newborn suffering from perforated necrotizing enterocolitis is having the very poor general condition. He is currently stabilized on a ventilator. Which of the following should be done in the management of this patient – \nSelect and explain. \nA. Conservative treatment, B. Resection and anastomosis, C. Stabilization with membrane oxygenator and defer surgery, D. Peritoneal drainage by putting drains in the flanks', 'role': 'user'}, {'content': 'Answer: D \nExplanation: Necrotizing enterocolitis (NEC) is the most common life-threatening emergency of the GIT in the newborn period.\n\nManagement of necrotizing enterocolitis\n\nMedical treatment of NEC include\nCessation of feeding\nNasogastric decompression\nAdministration of i.v. fluids\nSystemic antibiotic against both gram +ve as well as gram -ye bacteria (after taking samples for blood culture).\nVentilation should be assisted if distention is contributing to hypoxia.\nEarly surgery consultation\n\nSurgical interventions in NEC\n\nEvidence of perforation is an indication for laparotomy and resection of necrotic bowel.\nFailure to respond to medical management, a single fixed bowel loop, erythema of the abdominal wall and a palpable mass are additional indications of exploratory laparotomy, resection of necrotic bowel and external ostomy diversion.\nPeritoneal drainage may be helpful for patients with peritonitis who are too unstable to withstand surgery. It is more successful in patients with isolated intestinal perforation. In many patients, no further surgical procedure is required.\nPeritoneal drainage is performed under local anaesthesia. Alpenrose drain is placed in the right lower quadrant and permitted to drain peritoneal contents and decompress the abdomen. This procedure is employed predominantly in infants less than 1000g who have severe SIRS and are viewed as too unstable to be transported or to undergo laparotomy. In experienced hands, one-third of the patients require only drain placement.\nA primary anastomosis at the time of initial surgery is indicated in patients with limited localized disease who have no distal bowel involvement and in patients who have demonstrated a walled-off perforation who are no longer manifesting the SIRS.\n\nFrom this discussion, we choose the answer to be peritoneal drainage because:\n\nPatients are on a ventilator (too unstable).\nSurgery for NEC is resection and creation of an ileostomy, which is not given in the options.\nPrimary anastomosis is done only in stable patients with walled-off perforation.', 'role': 'assistant'}]