Stoma Closure Improves Head Circumference Growth in Very Preterm Infants after Necrotizing Enterocolitis

Abstract

Introduction Very preterm infants (VPIs) surgically treated for necrotizing enterocolitis (NEC) are at risk of growth retardation. The aim of this study was to demonstrate and compare growth during the first 6 years of life in VPIs with stoma after NEC surgery with VPIs without NEC surgery. Materials and Methods We included all VPIs surgically treated due to NEC at the Odense University Hospital from August 1, 2004, to July 31, 2008. Outcome on growth was compared with a group of VPIs without NEC. The VPIs with NEC were identified searching the local database using the International Classification of Diseases, 10th Revision diagnosis of NEC (DP77.9). Data on growth were collected from medical files and if not present, the parents reported the data. Results Nineteen VPIs, surgically treated due to NEC, survived to 6 years of age. Median gestational age was 283/7 weeks (245/7–313/7). Median age at NEC surgery and stoma formation was 2.3 weeks (0.1–6.3) and median age at stoma closure was 2.5 months corrected age (CA) (postmenstrual age 36 weeks to CA 6.7 months). Compared with the non-NEC group, VPIs with NEC and stoma demonstrated poor growth, especially in head circumference (HC) with no increase in growth velocity before the time of stoma closure between 2.5- and 3-month CAs. Conclusion Our findings demonstrate poor growth in VPIs after NEC surgery and improved HC growth after stoma closure.

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.…”

IQ Was Not Improved by Post-Discharge Fortification of Breastmilk in Very Preterm Infants

“…Further studies are needed to elucidate whether fortification of breast milk with extra protein and calories improves cognitive outcome in infants with more morbidities or impaired growth during hospitalisation. Among infants with NEC excluded from our RCT, Honore et al found HC to be significantly smaller up to 6 month CA [27], stressing the importance of future studies to include groups of severely ill very preterm infants.…”

Necrotizing Enterocolitis in Very Low Birth Weight Neonates: A Natural History Study

“…Severe restriction (< 3 rd percentile) in weight was most prevalent among surgical NEC patients. We attribute this finding to the high prevalence of intestinal stoma in our cohort (17%), 47 but cannot resolve whether this factor per se contributes to the adverse neurodevelopmental outcomes observed in patients with surgical NEC. 42 Nevertheless, the observed restriction in postnatal growth is especially concerning considering the high rates of treated retinopathy of prematurity, chronic lung disease, and serious brain injury (severe intraventricular hemorrhage, periventricular leukomalacia) among surgical NEC patients.…”