Eur J Pediatr Surg 2021; 31(06): 504-508
DOI: 10.1055/s-0040-1718407
Original Article

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

Karina Dyrvig Honoré
1   Department of Neonatology, Odense University Hospital, Odense, Denmark
,
Malene Nygaard Johansen
1   Department of Neonatology, Odense University Hospital, Odense, Denmark
,
Lars Rasmussen
2   Department of Surgery, Odense University Hospital, Odense, Denmark
,
Gitte Zachariassen
1   Department of Neonatology, Odense University Hospital, Odense, Denmark
› Author Affiliations
Funding None.

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.



Publication History

Received: 27 April 2020

Accepted: 27 August 2020

Article published online:
20 October 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
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  • References

  • 1 Pike K, Brocklehurst P, Jones D. et al. Outcomes at 7 years for babies who developed neonatal necrotising enterocolitis: the ORACLE Children Study. Arch Dis Child Fetal Neonatal Ed 2012; 97 (05) F318-F322
  • 2 Chong C, van Druten J, Briars G. et al. Neonates living with enterostomy following necrotising enterocolitis are at high risk of becoming severely underweight. Eur J Pediatr 2019; 178 (12) 1875-1881
  • 3 Cole CR, Hansen NI, Higgins RD, Ziegler TR, Stoll BJ. Very low birth weight preterm infants with surgical sort bowel syndrome: incidence, morbidity and mortality, and growth outcomes at 18 to 22 month. Paediatrics 2008; 122: 573-582
  • 4 Banerjee DB, Vithana H, Sharma S, Tsang TTM. Outcome of stoma closure in babies with necrotising enterocolitis: early vs late closure. Pediatr Surg Int 2017; 33 (07) 783-786
  • 5 Struijs MC, Sloots CEJ, Hop WCJ, Tibboel D, Wijnen RMH. The timing of ostomy closure in infants with necrotizing enterocolitis: a systematic review. Pediatr Surg Int 2012; 28 (07) 667-672
  • 6 Al-Hudhaif J, Phillips S, Gholum S, Puligandla PP, Flageole H. The timing of enterostomy reversal after necrotizing enterocolitis. J Pediatr Surg 2009; 44 (05) 924-927
  • 7 Lin PW, Nasr TR, Stoll BJ. Necrotizing enterocolitis: recent scientific advances in pathophysiology and prevention. Semin Perinatol 2008; 32 (02) 70-82
  • 8 Hansen ML, Jensen IV, Gregersen R, Juhl SM, Greisen G. Gastrointestinal sequelae and growth impairment at school age following necrotising enterocolitis in the newborn period. Acta Paediatr 2019; 108 (10) 1911-1917
  • 9 Hansen ML, Jensen IV, Gregersen R, Juhl SM, Greisen G. Behavioral and neurodevelopmental impairment at school age following necrotizing enterocolitis in the newborn period. PLoS One 2019; 14 (04) 1-11
  • 10 Hintz SR, Kendrick DE, Stoll BJ. NICHD Neonatal Research Network. et al. Neurodevelopmental and growth outcomes of extremely low birth weight infants after necrotizing enterocolitis. Pediatrics 2005; 115 (03) 696-703
  • 11 Ehrenkranz RA, Dusick AM, Vohr BR, Wright LL, Wrage LA, Poole WK. Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants. Pediatrics 2006; 117 (04) 1253-1261
  • 12 Zachariassen G, Faerk J, Grytter C. et al. Nutrient enrichment of mother's milk and growth of very preterm infants after hospital discharge. Pediatrics 2011; 127 (04) e995-e1003
  • 13 Toftlund LH, Halken S, Agertoft L, Zachariassen G. Catch-up growth, rapid weight growth, and continuous growth from birth to 6 years of age in very-preterm-born children. Neonatology 2018; 114 (04) 285-293
  • 14 Niklasson A, Engström E, Hård AL, Wikland KA, Hellström A. Growth in very preterm children: a longitudinal study. Pediatr Res 2003; 54 (06) 899-905
  • 15 Raghuram K, Yang J, Church PT. Canadian Neonatal Network, Canadian Neonatal Follow-Up Network Investigators. et al. Head growth trajectory and neurodevelopmental outcomes in preterm neonates. Pediatrics 2017; 140 (01) e20170216
  • 16 Walsh MC, Kliegman RM, Hack M. Severity of necrotizing enterocolitis: influence on outcome at 2 years of age. Pediatrics 1989; 84 (05) 808-814
  • 17 Rees CM, Pierro A, Eaton S. Neurodevelopmental outcomes of neonates with medically and surgically treated necrotizing enterocolitis. Arch Dis Child Fetal Neonatal Ed 2007; 92 (03) F193-F198
  • 18 Roze E, Ta BDP, van der Ree MH. et al. Functional impairments at school age of children with necrotizing enterocolitis or spontaneous intestinal perforation. Pediatr Res 2011; 70 (06) 619-625
  • 19 Zani A, Lauriti G, Li Q, Pierro A. The timing of stoma closure in infants with necrotizing enterocolitis: a systematic review and meta analyses. Eur J Pediatr Surg 2017; 27 (01) 7-11
  • 20 Rothstein FC, Halpin Jr TC, Kliegman RJ, Izant Jr RJ. Importance of early ileostomy closure to prevent chronic salt and water losses after necrotizing enterocolitis. Pediatrics 1982; 70 (02) 249-253
  • 21 Haricharan RN, Gallimore JP, Nasr A. Primary anastomosis or ostomy in necrotizing enterocolitis?. Pediatr Surg Int 2017; 33 (11) 1139-1145
  • 22 Hall NJ, Eaton S, Pierro A. Royal Australasia of Surgeons Guest Lecture. Necrotizing enterocolitis: prevention, treatment, and outcome. J Pediatr Surg 2013; 48 (12) 2359-2367