Septic Shock Due to Chyme Recycling in an Extremely Low-Birth-Weight Infant

Chyme recycling (CR) is an effective therapeutic approach that involves reintroducing bowel contents from the proximal to the distal enterostomy limb and is recognized for its ability to reduce or prevent enterostomy-related complications. Although the benefits of CR are well documented, reports on its potential adverse events remain limited. We report the case of an extremely low-birth-weight infant (ELBWI) who developed septic shock caused by Klebsiella pneumoniae immediately after the first CR. The male infant, born at 22 weeks' gestation via emergency cesarean section, had a birth weight of 496 g. On day 7, he developed focal intestinal perforation and underwent an emergency double-barrel ostomy. CR into the distal bowel was initiated on day 27, after which he developed septic shock. The patient was promptly treated with antibiotic therapy and intensive circulatory support. Blood cultures subsequently confirmed K. pneumoniae infection. After a 14-day course of antibiotics, repeat blood cultures were negative. Probiotic infusion into the distal bowel resumed on day 30, and CR was reintroduced on day 70. CR was then continued until ostomy closure on day 123 without further complications. Overall, sepsis may be associated with CR in ELBWIs, necessitating close monitoring after its initiation. Additionally, because of the risk of bacterial proliferation in chyme within the stoma, it is advisable to use freshly collected chyme in the neonatal intensive care unit setting.