14 “IT’S ALWAYS SAFER TO DO A STOMA!”. The Morbidity of Neonatal Intestinal Stoma Formation in Necrotising Enterocolitis
Basil Bekdesh1, Louise Lawrence2, Bernadette Reda1, Oliver Gee1, Suren Arul1
1Birmingham Children's Hospital, Birmingham, United Kingdom. 2Birmingham Children's Hospital

Abstract

Aims of the study:  To assess the morbidity of stoma formation in neonates requiring emergency surgery.

Methods:  Neonatal stomas are managed in our regional clinical network by a neonatal surgical outreach team, comprising of nurse specialists and surgeons.  This continued in-patient review of neonatal stomas is recorded prospectively in a database which was interrogated to quantify the incidence of stoma related complications.

Main results:  A total of 157 neonates with stomas were identified in our neonatal outreach service (2009-2017).  The majority were for emergency indications: necrotising enterocolitis (n=88) or isolated perforation (n=13).  Other indications included volvulus, meconium ileus and atresias (n=14) and anorectal malformation, cloaca or Hirschsprung’s disease (n=43).  We present the results for the NEC & SIP subgroup (n=101).

They had a median birth gestation of 27/40 (inter quartile range (IQR) 5 weeks) and had stoma formation at 3.2 weeks (IQR=3.3w) at a corrected gestational age of 31/40 (IQR=6.1w).  The stomas were closed after a median of 9.6w (IQR=5.9w).There were 7 neonatal deaths with the stoma in-situ.

Stoma problems included practical issues such as leakage and problems with fitting bag(26), significant skin excoriation (11), wound dehiscence (10), stomal stenosis (8) and parastomal hernia (10).  Stoma prolapse occurred in 23 stomas split between proximal and distal limbs. In total 16 patients need further surgical intervention for complications (7 minor surgical procedures, 2 revisions, 7 early closures).

Overall 56/101 patients (55%) had at least one significant stoma-related problem

Conclusions:  Though only 7% of stomas were closed early, significant problems occurred in 55%.  A dedicated, nurse led, neonatal surgical outreach service has identified a much higher rate of complications associated with NEC stomas than most surgeons would be aware of.  Strategies to avoid the need for an emergency stoma may help to reduce the morbidity in this sub-group.


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