The Outcome of Late versus Early Ileostomy Closure at Low Body Weight (<1500 g) in Babies with Necrotizing...

Area of Science:

• Pediatric Surgery
• Neonatal Care
• Gastrointestinal Surgery

Background:

• Necrotizing enterocolitis (NEC) frequently necessitates ileostomy in neonates.
• Optimal timing for ileostomy reversal in low-birth-weight infants remains a clinical question.
• Surgical outcomes and growth patterns following ileostomy closure require further investigation.

Purpose of the Study:

• To evaluate the surgical outcomes of ileostomy closure in infants weighing less than 1500 g.
• To compare complications and growth between early (4-6 weeks) and late (8-10 weeks) ileostomy reversal.
• To determine the safety and efficacy of early stoma reversal in this vulnerable population.

Main Methods:

• A prospective comparative study included 31 infants undergoing ileostomy reversal for NEC.
• Patients were divided into two groups: early closure (4-6 weeks) and late closure (8-10 weeks).
• Primary outcomes assessed included anastomotic leak, obstruction, wound infection, sepsis, mortality, and weight gain at 90 days.

Main Results:

• No statistically significant differences in mortality or major complications were observed between early and late reversal groups.
• Infants undergoing early ileostomy reversal demonstrated significantly greater weight gain at 90 days (895 ± 85.2 g vs. 455 ± 34.6 g; P < 0.00001).
• Mean weight at reversal was comparable between groups (1435.5 ± 163.8 g vs. 1405 ± 99.93 g).

Conclusions:

• Ileostomy reversal in low-birth-weight infants at <1500 g, even when performed early (4-6 weeks), is not associated with increased surgical complications.
• Early stoma reversal may promote improved post-operative weight gain in neonates recovering from NEC.
• These findings support considering earlier ileostomy closure to potentially enhance infant growth and development.