Timing of ostomy reversal in neonates with necrotizing enterocolitis

Most neonates with necrotizing enterocolitis (NEC) requiring laparotomy have bowel resection and intestinal diversion. At present, there is no consensus regarding the best time for enterostomy reversal. Our aim is to determine if there is any difference in outcomes of infants whose enterostomy was reversed early versus late.

We retrospectively reviewed medical records of patients with NEC admitted to the neonatal intensive care unit at a large urban children's hospital from 2002 to 2010. The patients underwent operative intervention with creation and subsequent reversal of stomas. Patient characteristics, operative characteristics, and postoperative care were recorded.

A total of 206 neonates were diagnosed with NEC and 44 met the inclusion criteria. Seven had ostomies reversed within 8 weeks, 20 underwent reversal 8 to 12 weeks after initial operation, and 17 underwent ostomy reversal greater than 12 weeks from creation. Early reversal did not affect the incidence of total parenteral nutrition-associated cholestasis (p = 0.16), length of parenteral nutrition (p = 0.12), or ability to reach full enteral nutrition (p = 0.30). Ventilator days were not different (p = 0.08). We found no difference in contamination at laparotomy (p = 0.61) or adhesions at reversal (p = 0.73). Mortality rate (p = 0.15) and complications following reversal (p = 0.25) were not different.

There is no advantage to early or late enterostomy reversal in the endpoints studied.