Neonates living with enterostomy following necrotising enterocolitis are at high risk of becoming severely underweight

Abstract

Necrotising enterocolitis (NEC) is often managed with a temporary enterostomy. Neonates with enterostomy are at risk of growth retardation during critical neurodevelopment. We examined their growth using z-score. We identified all patients with enterostomy from NEC in two neonatal surgical units (NSU) during January 2012–December 2016. Weight-for-age z-score was calculated at birth, stoma formation and closure, noting severely underweight as z < − 3. We compared those kept in NSU until stoma closure with those discharged to local units or home (LU/H) with a stoma. A total of 74 patients were included. By stoma closure, 66 (89%) had deteriorated in z-score with 31 (42%) being severely underweight. There was no difference in z-score at stoma closure between NSU and LU/H despite babies sent to LU/H having a more distal stoma, higher birth weight and gestational age. Babies in LU/H spent a much shorter period on parenteral nutrition while living with their stoma for longer, many needing readmission.Conclusion: Growth failure is a common and severe problem in babies living with enterostomy following NEC. z-score allowed growth trajectory to be accounted for in nutrition prescription and timing of stoma closure. Care during this period should be focused on minimising harm.What is Known:• Necrotising enterocolitis (NEC) is a life-threatening condition affecting predominately premature and very low birth weight neonates. Emergency treatment with temporary enterostomy often leads to growth failure.• There is no consensus on the optimal timing for stoma reversal, hence prolonging impact on growth during crucial developmental periods. Both malnutrition and surgical NEC are independently associated with poor neurodevelopment outcome.What is New:• Our study found growth in 89% of babies deteriorated while living with a stoma, with 42% having a weight-for-age z-score < − 3, meeting the WHO criteria of being severely underweight, despite judicial use of parenteral nutrition. Applying z-score to weight measurements will allow growth trajectory to be accounted for in clinical decisions, including nutrition prescription (both enteral and parenteral), and guide timing of stoma closure.• Surgeons who target stoma closure at a certain weight risk waiting for an indefinite period of time, during which babies’ growth may falter.

Major stoma related morbidity in young children following stoma formation and closure: A retrospective cohort study

“…[15,16] It is reported that in the presence of a stoma, up to 90% of the young children are declining on the growth chart, which is why some advocate early stoma closure. [17][18][19][20] This opinion is supported by the finding that most young children thrive after stoma closure, irrespective of morbidity, weight, or underlying pathology. [17] Considering the increased risk of malnutrition due to stoma morbidity and its impact on growth, it is interesting to see that weight at stoma closure and days until stoma closure were not significantly associated with morbidity following closure in our cohort.…”

Grow In Adaptation: Family Caregivers' Experiences Of Caring For Neonates Undergoing Enterostomy In China—A Qualitative Study

“…Neonate enterostomy is a common surgical method for treating acute and severe neonatal intestinal diseases [1]. It refers to a surgical opening into the intestine through the abdominal wall, creating a temporary arti cial anus to treat acute abdomen caused by neonatal necrotising enterocolitis, intestinal perforation, intestinal necrosis, intestinal atresia, poor intestinal rotation, intestinal volvulus, and anal atresia [2].…”

Influence of birth weight on surgical outcomes in infants with necrotizing enterocolitis.

“…Stoma formation may involve complications associated with poor weight gain and electrolyte imbalance due to high intestinal output, stenosis, prolapse, stula formation, and excoriation of the surrounding skin. The metabolic or functional problems may, in some cases, demand surgical intervention before the planned stoma reversal, which may further increase the risk of complications (11,12).…”

“…Preoperative and operative characteristics are shown in Table2. After the surgery, initiation of enteral nutrition was possible after a median of 7.4 (range, 3-13) days in ELBW group and 5.7 (range,[3][4][5][6][7][8][9][10][11] days in VLBW group (p > 0.999). .669-77.09]; p 0.0001).…”