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Evaluation of Postoperative Outcomes After Enterostomy Closure in Low Body Weight Infants: A Multi-Center
William G Lee1,2, MaKayla L O'Guinn2, Olivia A Keane2
1Division of Pediatric Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Insights
Enterostomy closure (EC) in infants under 2 kg is safe, with outcomes comparable to larger infants. This suggests EC timing should prioritize physiologic status over a strict weight cutoff for better infant care.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Surgical Outcomes Research
Background:
- The minimum weight for enterostomy closure (EC) in infants is debated, with a common cutoff of >2 kg.
- Infants with enterostomy-related complications or high output may not reach 2 kg, necessitating evaluation of EC safety in lower-weight infants.
Purpose of the Study:
- To evaluate postoperative outcomes in low body weight (<2 kg) infants undergoing EC compared to larger infants.
- To determine if a lower weight threshold for EC is associated with increased complications or mortality.
Main Methods:
- Multi-center retrospective analysis of infants (<1 year, <4 kg at EC) from 2012-2022.
- Primary outcomes included postoperative complications and 30-day mortality.
- Statistical analysis included Kruskal-Wallis, chi-square tests, and univariable logistic regression.
Main Results:
- Infants <2 kg at EC showed higher rates of hyperbilirubinemia, neurologic comorbidities, and high enterostomy output.
- No significant differences in postoperative complications or 30-day mortality were observed between the <2 kg group and larger weight groups.
- Low body weight was not associated with an increased risk for postoperative complications (OR: 1.001, P = .032).
Conclusions:
- Enterostomy closure in infants <2 kg appears safe, with outcomes comparable to those of larger infants.
- The findings support basing EC timing on an infant's physiologic status rather than a fixed minimum weight.
- This approach may optimize surgical timing and outcomes for vulnerable infant populations.
Background:
The minimum weight for enterostomy closure (EC) in infants remains debated with the current acceptable cut-off of >2 kg. As enterostomy-related complications or high enterostomy output (>30cc/kg/d) may prohibit a premature infant from reaching 2 kg, additional data is needed to evaluate the safety of EC in infants <2 kg. The objective of this study was to evaluate postoperative outcomes in low body weight (<2 kg) infants undergoing EC compared to larger infants.
Methods:
We performed a multi-center retrospective analysis from 1/1/2012-12/31/2022 of all infants (age <1 year) who were <4 kg at time of EC. Primary outcomes included postoperative complications and 30-day mortality. Non-parametric analysis was performed using the Kruskal-Wallis one-way analysis of variance and chi-square tests. Univariable logistic regression was performed to identify factors associated with postoperative complications.
Results:
Of 92 infants, 15 infants (16.3%) underwent EC at <2 kg, 16 (17.4%) at 2-2.49 kg, 31 (33.7%) at 2.5-2.99 kg, and 30 (32.6%) at ≥3 kg. Infants <2 kg at time of EC exhibited higher rates of hyperbilirubinemia (P = .030), neurologic comorbidities (P = .030), and high enterostomy output (P = .041). There was no difference in postoperative complications (P = .460) or 30-day mortality (P = .460) between the <2 kg group and larger weight groups. Low body weight was not associated with an increased risk for developing a postoperative complication (OR: 1.001, 95% CI: 1.001-1.001; P = .032).
Conclusion:
Our findings suggest that EC in infants <2 kg may be safe with comparable postoperative outcomes to larger weight infants. Thus, the timing of EC should be based on the infant's physiologic status, in contrast to a predetermined minimum weight cut-off.
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