Enterostomy-related complications and growth following reversal in infants

Bethell, George; Kenny, Simon E.; Corbett, Harriet J.

doi:10.1136/archdischild-2016-311126

Cited by 38 publications

(55 citation statements)

References 14 publications

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“…The number of complications present in one infant is rarely reported[6]. If mentioned, the rates varied between 1 and a maximum of 4 complications per patient[12,13]. In our study, the most common complication after formation was skin excoriation, which occurred in almost half of all the neonates.…”

Section: Discussionmentioning

confidence: 60%

“…In most cases, more than one complication occurred, and sometimes, even three, four or five complications were observed in one patient. Previous studies also found enterostomy complications after formation to be fairly frequent, with reported rates varying between 34% and 66%[4,12,13,15-17]. The number of complications present in one infant is rarely reported[6].…”

Section: Discussionmentioning

confidence: 99%

“…Here, the related complications are observed just as often[12-15]. The frequent complications associated with enterostomy formation are prolapse, retraction, stenosis or necrosis of the stoma, parastomal hernia and breakdown of the skin[11-13,15]. After enterostomy closure, complications such as anastomotic leakage and bowel obstruction might occur[12-14,17].…”

Section: Introductionmentioning

confidence: 99%

“…After enterostomy closure, complications such as anastomotic leakage and bowel obstruction might occur[12-14,17]. Enterostomy can further prolong the need for parenteral nutrition, and in cases of high-output enterostomies, can make sufficient growth of the neonate more difficult[12,13,18]. Because the observed complications seem to vary in severity, a differentiated consideration of enterostomy formation is necessary.…”

Section: Introductionmentioning

confidence: 99%

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Complications of newborn enterostomies

Wolf¹,

Gfroerer²,

Fiegel³

et al. 2018

WJCC

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AIMTo evaluate the occurrence and severity of enterostomy complications in newborns suffering from different intestinal disorders.METHODSA 10-year retrospective cohort study (2008-2017) investigated newborns that underwent enterostomy formation and reversal for different intestinal disorders. Only infants less than 28 d old at the time of enterostomy creation were included in the study (corrected age was applied in the cases of preterm neonates). The patients were divided into two groups according to their underlying diseases. Group 1 included infants suffering from necrotizing enterocolitis (NEC), whereas Group 2 included newborns diagnosed with intestinal disorders other than NEC, such as meconium obstruction, anorectal malformation, focal intestinal perforation, ileus, intestinal atresia and volvulus. The primary outcome measure was enterostomy-related morbidity. The data were analyzed statistically using Pearson’s χ2 test or Fisher’s exact test for categorical variables and the Wilcoxon-Mann-Whitney U-Test for continuous variables.RESULTSIn total, 76 infants met the inclusion criteria and were evaluated for enterostomy-related complications. Neither group showed significant differences regarding gender, gestational age, weight at birth or weight at enterostomy formation. Infants suffering from NEC (Group 1) were significantly older at enterostomy formation than the neonates of Group 2 [median (range), 11 (2-75) d vs 4 (1-101) d, P = 0.004)]. Significantly more ileostomies were created in Group 1 [47 (92.2%) vs 16 (64.0%), P = 0.007], whereas colostomies were performed significantly more often in Group 2 [2 (3.9%) vs 8 (32.0%), P = 0.002]. The initiation of enteral nutrition after enterostomy was significantly later in Group 1 infants than in Group 2 infants [median (range), 5 (3-13) vs 3 (1-9), P < 0.001]. The overall rate of one or more complications in patients of both groups after enterostomy formation was 80.3%, with rates of 86.3% in Group 1 and 68.0% in Group 2 (P = 0.073). Most patients suffered from two complications (23.7%). Four or more complications occurred in 21.6% of the infants in Group 1 and in 12.0% of the infants in Group 2 (P = 0.365). Following enterostomy closure, at least one complication was observed in 26.0% of the patients (30.6% in Group 1 and 16.7% in Group 2, P = 0.321). The occurrence of complications was not significantly different between neonates with NEC and infants with other intestinal disorders. 48 (65.8%) patients required no treatment or only pharmacological treatment for the complications that occurred [Clavien-Dindo-Classification (CDC) < III], while 25 (34.2%) required surgery to address the complications (CDC ≥ III). Early reversal of the enterostomy was performed significantly more often (P = 0.003) and the time to full enteral nutrition after closure was significantly longer [median (range), 7 (3-87) d vs 12 (5-93) d, P = 0.006] in infants with a CDC grading ≥ III than in infants with a CDC grading < III.CONCLUSIONComplications occur in almost all infants with entero...

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Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Complications of newborn enterostomies

Wolf¹,

Gfroerer²,

Fiegel³

et al. 2018

WJCC

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“…Bethell G et al . divided patients according to complications or no complications 14 and reported that 24 patients with complications weighed less than 34 patients without complications (3655 g vs 5185 g, respectively). Older for GA and older corrected age at EF was seen in the no complications group (35 weeks vs 28.5 weeks, p = 0.01; and 36.3 weeks vs 32.6 weeks, p = 0.011).…”

Section: Discussionmentioning

confidence: 99%

The Optimal Timing of Enterostomy Closure in Extremely Low Birth Weight Patients for Acute Abdomen

Yang

Han

Youn

et al. 2018

Sci Rep

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There are few reports on enterostomy closure (EC) timing for acute abdomen in extremely low birth weight (ELBW) patients. We retrospectively reviewed ELBW patients who underwent enterostomy formation (EF) and subsequent EC. We investigated baseline characteristics, surgical outcomes, and follow-up data of 55 patients and analyzed optimal timing by age at EC, enterostomy duration, and body weight (Bwt) at EC. The minimum p-value approach (MPA) using the Chi-squared test was used to determine each cut-off value. Mean gestational age was 25+3 weeks, while mean age and Bwt at EF were 10 days and 660 g. Enterostomy duration and Bwt at EC were 102 days and 2400 g. Fourteen surgical complications were related to EC. The MPA identified a cut-off of 2100 g (p = 0.039) at EC but no significant cut-off age or enterostomy duration. The 18 patients <2100 g had more enterostomy-related problems at EC than the >2100 g group (66.7% vs 10.8%, p < 0.001). No other characteristics were significantly different. Operation time, ventilator period, hospital stay, parenteral nutrition duration, and full feeding day were significantly longer in <2100 g patients. Follow-up Bwt did not differ (11.55 kg vs 13.95 kg, p = 0.324). Our findings suggest EC can be safely performed when Bwt is over 2100 g.

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