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Updated: Jul 11, 2025

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Exploring Growth Failure in Neonates With Enterostomy.

Joseph R Davidson1, Kareem Omran2, Clara K L Chong3

  • 1Department of Paediatric Surgery, Evelina London Children's Hospital, London, UK; Stem Cells and Regenerative Medicine Section, GOS-UCL Institute of Child Health, London, UK; Prenatal Cell and Gene Therapy, Elizabeth Garrett Anderson UCL Institute for Women's Health, London, UK.

Journal of Pediatric Surgery
|November 8, 2023
PubMed
Summary

Neonatal enterostomy patients experiencing more frequent and severe uremia (a sign of catabolism) showed worse growth failure. Inflammation, indicated by C-reactive protein (CRP), commonly coincided with urea disturbances, highlighting its role in growth impairment.

Keywords:
Growth failureNecrotizing enterocolitisStoma

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Area of Science:

  • Neonatal surgery
  • Pediatric gastroenterology
  • Biochemistry

Background:

  • Neonatal enterostomy is associated with significant growth failure.
  • Inflammatory processes may contribute to a catabolic state in these patients.

Purpose of the Study:

  • To investigate the relationship between serum biochemistry, inflammation markers, and growth trajectory in infants with neonatal enterostomy.
  • To determine if inflammatory episodes drive a catabolic state impacting growth.

Main Methods:

  • Retrospective analysis of 79 infants with necrotizing enterocolitis (NEC) undergoing enterostomy.
  • Calculation of weight-for-age Z-score change (ΔZ) between stoma formation and closure.
  • Monitoring of serum C-reactive protein (CRP), urea, and creatinine levels, calculating Area Under Curve (AUC) for elevated durations.
  • Analysis of biomarker trends and correlation with ΔZ using Spearman's and multivariable linear regression.

Main Results:

  • A significant negative correlation was found between urea AUC and ΔZ (p=0.022), indicating higher uremia with poorer growth.
  • Increased frequency of biomarker peaks (urea and CRP) correlated significantly with decreased ΔZ (p≤0.025).
  • Coinciding peaks of multiple biomarkers were consistently associated with negative ΔZ (p≤0.016).

Conclusions:

  • Infants with more severe growth failure exhibited more frequent and severe uremia, suggesting a catabolic state.
  • Urea disturbances frequently coincided with CRP elevations, implicating inflammation as a key factor in growth failure.
  • Findings support aggressive sepsis management and suggest earlier stoma closure to minimize the at-risk period.