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The timing of ostomy closure in infants with necrotizing enterocolitis: a systematic review

Marie-Chantal Struijs1, Cornelius E J Sloots, Wim C J Hop

  • 1Department of Pediatric Surgery, Erasmus MC-Sophia, Rotterdam, The Netherlands.

Pediatric Surgery International
|April 25, 2012
PubMed

Insights

This systematic review found scarce evidence on optimal ostomy closure timing in infants with necrotizing enterocolitis. There was no significant difference in complication rates between early and late ostomy closure.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Neonatal Care

Background:

  • Necrotizing enterocolitis (NEC) is a serious condition in premature infants.
  • Ostomy closure is a common surgical procedure following NEC treatment.
  • The optimal timing for ostomy closure remains debated.

Purpose of the Study:

  • To systematically review and compare outcomes of early ostomy closure (EC, ≤8 weeks) versus late ostomy closure (LC, >8 weeks) in infants with NEC.
  • To evaluate the impact of closure timing on time to full enteral nutrition and complication rates.

Main Methods:

  • Systematic literature search of PubMed, EMbase, Web-of-Science, and Cinahl.
  • Inclusion of studies reporting time to ostomy closure, time to full enteral nutrition (FEN), or complications.
  • Exclusion of patients with Hirschsprung's disease or anorectal malformations.

Main Results:

  • Five studies met inclusion criteria, with a median quality score of 9/32.
  • One study showed significantly faster time to FEN after LC (7.2 days) compared to EC (19.1 days; P=0.027).
  • Complication rates were similar between EC (27%) and LC (23%), with an odds ratio of 1.1 (95% CI 0.5, 2.5).

Conclusions:

  • Evidence regarding optimal ostomy closure timing in NEC is limited and of poor quality.
  • No significant difference in complication rates was observed between early and late ostomy closure.
  • This review does not support a preference for either early or late ostomy closure based on current evidence.
Abstract

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