Stomal complications in the newborn with necrotizing enterocolitis.

BACKGROUND: Infants who develop necrotizing enterocolitis (NEC) are usually managed with fecal diversion. The integrity of the bowel being diverted is often suboptimal. Our clinical impression is that stomas created in this circumstance are fraught with complications. The purpose of this study is to quantify the rate of these complications and identify risk factors.
METHODS: A retrospective data collection from May 1999 to May 2008 on infants undergoing laparotomy for NEC was conducted. Data collected included gestational age, birth weight, age, and weight at operation, indications for surgical therapy, procedure performed, time to stoma output, time to takedown of stoma, complication directly related to the ostomy, and mortality. Data comparisons were analyzed statistically using chi(2), Pearson's correlation, Fisher's exact test, or a 2-tailed Student's t-test with significance reported for P<0.05.
RESULTS: A total of 73 patients were identified. Mean gestational age was 28 (+/-4) wk, mean birth weight was 1247 (+/-713) g. Mean age at the time of surgery was 23 (+/-27) d, and mean weight at operation was 1513 (+/-1306) g. The most common indication for surgical intervention was pneumoperitoneum (n=43, 58%). The most common level of intestinal diversion was the ileum (n=63, 85%). In-house mortality was 13%. There were 31 patients (42%) who developed 32 stoma-related complications. Demographic or preoperative variables that were a significant predictor of stoma-related complications were gestational age (P=0.003) and preoperative weight (P=0.024).
CONCLUSION: Premature infants carry a risk for developing stoma-related complications. Within that cohort, there is significantly increased risk of stoma-related complications in patients who are younger in gestational age and who have low preoperative weight. Future prospective studies may allow insight into preventative practices.