Necrotizing enterocolitis (NEC) is a devastating intestinal disease that affects ~5% of preterm neonates, and a proportion of medically managed NEC infants require acute surgical intervention due to clinical deterioration or intestinal perforation. A laparotomy in high-risk neonates, especially if born with an extremely low weight, can result in serious morbidity or even mortality. To avoid this risk, in 1977 Ein et al. first described the percutaneous insertion of a peritoneal drain in five neonates with bowel perforation as a temporizing measure to delay laparotomy (see {1}). The authors noticed a clinical improvement of these infants within a week, so they advocated the peritoneal drainage of small infants with perforated NEC. In support of this approach, a few years later the same authors published a bigger series where they showed that 40% of neonates <1500g treated with the peritoneal drain had complete resolution of their disease without requiring further surgery (see {2}). A similar experience with the peritoneal drain was later reported by other authors (see {3-5}). However, this surgical approach has been very controversial, and this prospective randomized controlled trial, together with {6}, comparing the use of peritoneal drain vs. laparotomy in infants with perforated NEC was carried out. Interestingly, neither of the two trials was able to demonstrate an advantage of one treatment modality over the other. Moreover, Rees et al. demonstrated that in neonates with <1000g body weight and perforated NEC, peritoneal drainage was not an effective definitive procedure, as 74% of the infants required a rescue laparotomy {7}. It is still debatable whether there is a role for peritoneal drainage in the stabilization of a critically unwell child with perforated NEC and/or respiratory compromise prior to transfer to another center for laparotomy. This Recommendation is of an article referenced in an F1000 Faculty Review also written by Agostino Pierro and Augusto Zani.