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Malnutrition in Enterostomy Infants in the Neonatal Intensive Care Unit: Prevalence, Risk Factors and Impact on
Zeyao Shi1,2, Zhaolan Zeng1,2, Xiaowen Li1,2
1Department of Neonatology Nursing, West China Second University Hospital, Sichuan University, Chengdu, China.
Insights
Infants with small intestinal stomas experience significant malnutrition, unlike those with colonic stomas. Early identification of malnutrition risk factors is crucial for better clinical outcomes in enterostomy patients.
Area of Science:
- Neonatal intensive care unit (NICU) research
- Pediatric surgery outcomes
- Nutritional science in infants
Background:
- Enterostomy in infants is linked to underweight conditions.
- Limited data exists on nutritional status and growth failure in infants post-stoma formation.
- Nutritional status of enterostomy infants requires further investigation.
Purpose of the Study:
- To determine the prevalence of malnutrition in infants undergoing enterostomy in the NICU.
- To identify risk factors associated with malnutrition in these infants.
- To assess the impact of malnutrition on clinical outcomes.
Main Methods:
- Retrospective cohort study of surgical infants with gastrointestinal disease.
- Analysis of nutritional status using line and violin plots for small bowel vs. colonic stomas.
- Logistic analysis to identify malnutrition risk factors and Chi-squared/t-tests for clinical outcome assessment.
Main Results:
- Malnutrition prevalence was 61.7% in the study cohort.
- Small intestinal stoma infants showed declining Z-scores, while colonic stoma infants maintained stable nutrition.
- Low birth weight, short bowel syndrome, and postoperative hypoalbuminemia were significant risk factors for malnutrition.
Conclusions:
- Infants with small intestinal stomas exhibit poorer nutritional status compared to those with colonic stomas.
- Malnutrition negatively impacts hospital length of stay and increases stoma-related complications.
- Findings emphasize the need for targeted nutritional assessments and interventions in enterostomy infants.
Background:
Infants living with an enterostomy were commonly reported as underweight. However, the nutritional status of enterostomy infants after stoma formation has not been given due attention, and there is limited evidence to demonstrate infant growth failure before stoma closure.
Aim:
To identify the prevalence, risk factors and the effect on clinical outcome of malnutrition in infants undergoing enterostomy in the neonatal intensive care unit (NICU).
Study Design:
The design was a retrospective cohort study. We retrospectively analysed surgical infants with gastrointestinal disease from November 2021 to July 2025 at our NICU. Line plot and violin plot were used to show the nutritional status at different times between infants with a small bowel stoma and a colonic stoma. Risk factors of malnutrition after 30 days of surgery were assessed by logistic analysis and presented through the forest plot. Chi-squared tests and t-tests were used to evaluate the effect of malnutrition on clinical outcomes.
Results:
The total prevalence of malnutrition was 61.7%. The infants with a small intestine stoma experienced a continuous decline in Z-score (< -2) after surgery, while the colonic stoma group underwent a relatively stable nutritional status and displayed normal growth after stoma formation. The small intestine stoma group had a worse nutritional status than the colonic stoma group at 1 month postoperatively (p = 0.0019). Low birth weight [OR = 10.56(95% CI: 1.84-60.68), p = 0.008], short bowel syndrome [OR = 6.71(95% CI: 1.08-41.88), p = 0.041] and postoperative hypoalbuminemia [OR = 5.04(95% CI: 1.44-17.64), p = 0.011] were identified as risk factors of undernutrition. Additionally, malnutrition had an influence on the length of stay in the hospital (p < 0.001) and the prevalence of stoma-related complications (p = 0.018).
Conclusion:
We observed that infants with a small intestinal stoma had a worse nutritional status than infants with a colonic stoma. Nutritional status may be influenced by the patient's birth weight and other clinical factors. Malnutrition had a negative effect on clinical outcomes.
Relevance To Clinical Practice:
This study's findings on malnutrition in enterostomy infants within the NICU have profound and direct implications for nursing practice. Understanding the specific risk factors of malnutrition enables nurses to perform more targeted and vigilant assessments. Besides, nurses can provide prevention to avoid worse clinical outcomes.
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