Evaluation of Postoperative Outcomes After Enterostomy Closure in Low Body Weight Infants: A Multi-Center Retrospective Analysis.

Abstract

The minimum weight for enterostomy closure (EC) in infants remains debated with the current acceptable cut-off of >2kg. As enterostomy-related complications or high enterostomy output (>30cc/kg/d) may prohibit a premature infant from reaching 2kg, additional data is needed to evaluate the safety of EC in infants <2kg. The objective of this study was to evaluate postoperative outcomes in low body weight (<2kg) infants undergoing EC compared to larger infants. We performed a multi-center retrospective analysis from 1/1/2012-12/31/2022 of all infants (age <1 year) who were <4kg at time of EC. Primary outcomes included postoperative complications and 30-day mortality. Non-parametric analysis was performed using the Kruskal-Wallis one-way analysis of variance and chi-square tests. Univariable logistic regression was performed to identify factors associated with postoperative complications. Of 92 infants, 15 infants (16.3%) underwent EC at <2kg, 16 (17.4%) at 2-2.49kg, 31 (33.7%) at 2.5-2.99kg, and 30 (32.6%) at ≥3kg. Infants <2kg at time of EC exhibited higher rates of hyperbilirubinemia (P = .030), neurologic comorbidities (P = .030), and high enterostomy output (P = .041). There was no difference in postoperative complications (P = .460) or 30-day mortality (P = .460) between the <2kg group and larger weight groups. Low body weight was not associated with an increased risk for developing a postoperative complication (OR: 1.001, 95% CI: 1.001-1.001; P = .032). Our findings suggest that EC in infants <2kg may be safe with comparable postoperative outcomes to larger weight infants. Thus, the timing of EC should be based on the infant's physiologic status, in contrast to a predetermined minimum weight cut-off.