Intestinal stomas: A 4-year experience in a neonatal intensive care unit

Abstract

Background: In term and preterm newborns intestinal stoma creation may be required for the treatment of congenital anomalies as well as of acquired pathology related to prematurity. The procedure can be associated with significant complications. Patients and methods: A retrospective evaluation was conducted in all infants admitted to the Neonatal Intensive Care Unit (NICU) of Ancona, Italy, between Jan-2008 and Dec-2012, who underwent an intestinal stoma creation during hospitalization. Results: Twenty-four infants underwent intestinal stoma creation during the study period. Median gestational age was 216 days (IQR 190–237 d) and median birth weight was 1157 g (IQR 912–2132 g). The underling pathologies which required surgical intervention were necrotizing enterocolitis (16 patients), intestinal obstruction (4 patients), intestinal atresia (2 patients), meconium peritonitis (1 patient) and an intestinal vulvulus complicating a cystic lymphangioma (1 patient). Surgery was performed at a median postnatal age of 7 days (IQR 2–31). Sixteen patients underwent intestinal resection with stoma creation, eight a primary (protective) stoma creation. Nineteen were ileal-stomas, 1 was a proximal digiunal-stomas and 4 were double-stomas (digiunal, ileal or colonic). Sixteen patients were discharged or referred to a sub-intensive unit before stoma closure. Median duration of stoma care during hospitalization in NICU was 60 days (IQR 47–89 d). Median duration of parenteral nutrition was 58 days (IQR 24–80) and enteral nutrition was initiated using an amino acid-based formula in patients with NEC and human milk in those with gastrointestinal malformation. Cholestasis was diagnosed in 12 patients. Three patients developed stoma-related complications: two prolapses and one stenosis requiring dilatation. Nine patients presented sepsis during the stoma-care period. In each patient, daily stoma output and electrolyte balance were evaluated, and no hydro-electrolyte disorder occurred. Conclusions: Intestinal stoma care is not a rare circumstance in NICU. NEC is the most common gastrointestinal emergency requiring stoma creation. The procedure is associated with short- and long-term surgical and medical complications, which may be minimized with careful management.