ENTEROSTOMY AND ITS CLOSURE IN NEWBORNS

Objectives: To examine the morbidity and mortality in 109 newborns who required enterostomy for intestinal necrosis, perforation, or obstruc tion and to analyze the complications associated with enterostomy clos ure. Design: Data were collected retrospectively from hospital and off ice charts. Follow-up was 1 to 6 years. Setting: Tertiary care, newbor n intensive care unit at a children's hospital. Patients: A referred s ample of 109 newborns (aged 0 to 28 days) with bowel necrosis, obstruc tion, or perforation, who underwent enterostomy as part of their thera py. Interventions: Operative formation of any enterostomy during lapar otomy for bowel necrosis, obstruction, or perforation and subsequent c losure. Main Outcome Measures: Morbidity and mortality associated with newborn enterostomy and its closure. Results: Patients underwent jeju nostomy (n=31), ileostomy (n=62), or colostomy (n=16) for necrotizing enterocolitis (n=79), atresia (n=15), idiopathic perforation (n=8), vo lvulus (n=4), or meconium ileus (n=3). Seventeen (16%) died postoperat ively of sepsis, respiratory distress, further necrotizing enterocolit is, or intraventricular hemorrhage. Complications developed in 10 (34% ) of the remaining 29 patients who underwent jejunostomy whereas in 13 (26%) of 50 patients who underwent ileostomy and three (23%) of 13 pa tients who underwent colostomy, complications requiring revision devel oped. Ninety-two patients underwent enterostomy closure 14 to 65 days after enterostomy. Four later died of continuing respiratory distress and liver failure. Fifteen (56%) of 27 jejunostomies, 28 (57%) of 49 i leostomies, and nine (75%) of 12 colostomies were closed uneventfully, whereas two jejunostomy and eight ileostomy closures dehisced, requir ing repeated enterostomy and secondary closure. All 10 children with a nastomotic dehiscence had necrotizing enterocolitis originally, showed poor weight gain (<30% per month), and had low serum albumin levels ( 22+/-3 g/L) compared with children with successful primary closure (>3 0% weight gain per month; serum albumin level, 37+/-6 g/L; both Ps<.05 ). Conclusion: These data show that enterostomy is a potentially morbi d condition in the newborn and is prone to complications but should be closed only when the child is in satisfactory nutritional condition.