Optimal Timing of Stoma Closure in Premature Infants Affected by Necrotizing Enterocolitis

Necrotizing enterocolitis (NEC) represents a severe gastrointestinal condition predominantly affecting premature neonates, often requiring surgical intervention involving ostomy or stoma formation. Our study aims to evaluate the outcomes associated with different timing and weights at stoma closure following surgery for NEC in infants.

We conducted a retrospective review of premature infants with NEC at a tertiary children's hospital from 2011 to 2022. The study included patients who have required operative intervention with the creation and subsequent closure of a stoma. Patient characteristics and clinical outcomes were reviewed and compared based on the timing and weight at the time of stoma closure.

There were 37 patients (64.9% male, gestational age at birth 27.4 ± 3.6 wks) with NEC who met the inclusion criteria. Patients were initially stratified by timing at stoma closure as follows: <8 wks (n = 10), 8-12 wks (n = 12), and >12 wks (n = 15). The primary surgical indication was perforation (54.1%), with ileostomy being the predominant diversion method (70.3%). Infants who underwent earlier closure were of lower weight compared to those closed later (<0.001). Length of stay (LOS) after closure was longer for patients closed at <8 wks (Coef. 24.03, P = 0.039) and <2 kg (Coef. 32.95, P = 0.019); however, there was no difference in the total LOS between the times or weights. There was no difference in postoperative complications based on timing or weight at stoma closure.

While early closure was associated with a longer postoperative LOS, total LOS and overall complications were comparable between timing and weights at ostomy closure.