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Published on: April 17, 2020
Enterostomy-related complications and growth following reversal in infants
George Bethell1,2, Simon Kenny1,2, Harriet Corbett1
1Department of Paediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK.
Insights
Infant enterostomies can lead to complications in about 40% of cases. However, most infants gain weight and thrive after enterostomy reversal, regardless of initial health factors.
Area of Science:
- Neonatal surgery
- Pediatric gastroenterology
- Surgical outcomes
Background:
- Infant enterostomies manage neonatal surgical conditions when primary anastomosis is unsafe.
- Complications are frequent, with no consensus on optimal reversal timing.
- Stoma reversal is presumed to aid infant thriving but lacks robust evidence.
Purpose of the Study:
- Identify risk factors for enterostomy-related complications in infants.
- Determine the relationship between complications, reversal, and infant weight gain.
Main Methods:
- Retrospective review of 58 infants undergoing enterostomy formation and reversal over 6 years.
- Collected demographic data, diagnoses, complications, and serial weights.
- Calculated z scores using standardized growth charts.
Main Results:
- 41% of infants experienced enterostomy-related complications.
- Low birth weight and gestational age were significant risk factors for complications.
- Infants with complications had longer hospital stays and higher parenteral nutrition dependence.
- Mean z scores improved significantly post-enterostomy closure (-0.747 to +0.892).
Conclusions:
- Approximately 40% of infants with enterostomies develop complications.
- Most infants demonstrate improved weight gain after enterostomy closure.
- Timing of stoma reversal should consider the benefits of closure for infant growth.
Background:
Infant enterostomies are used to manage various neonatal surgical conditions where it is not suitable or safe to form a primary anastomosis. Complications are common and there is no consensus regarding optimal timing of enterostomy reversal. Stoma reversal is thought to allow patients to thrive; however, this has not been demonstrated robustly.
Aim:
The study aimed to identify risk factors for enterostomy-related complications and to determine the relationship between enterostomy complications, enterostomy reversal and weight gain in infants with enterostomies.
Methods:
A retrospective case note review of 58 infants who underwent enterostomy formation and reversal during a 6-year period was undertaken; demographic data, diagnosis, enterostomy complications and serial weights were noted. Standardised growth charts were used to calculate z scores.
Results:
Enterostomy complications were documented in 24 infants (41%). Infants of low birth weight and low gestational birth age were significantly more likely to have an enterostomy-related complication (1110 vs 2125 g, 28.5 vs 35 weeks, respectively); they were more likely to have longer inpatient stays and remain dependent on parenteral nutrition prior to closure (median 92.5 vs 52 days, 40% vs 16%, respectively). Irrespective of diagnosis, gestation and presence of an enterostomy complication, the mean z score prior to enterostomy closure was -0.747 vs +0.892 following closure.
Conclusions:
Around 40% of infants with an enterostomy will have an enterostomy-related complication. Whatever their weight, gestation or underlying pathology, most infants thrive after enterostomy closure and this should be considered when planning the optimal timing for this procedure.
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