Document resource
We aim to outline the experience of a Level 3 neonatal intensive care unit (NICU) in managing premature patients following small bowel enterostomy formation; to characterise the patient cohort, their respective outcomes and complications. Neonates <37 weeks gestation born between January 2021 and June 2024 undergoing small bowel enterostomy formation were included in the study. Data was collected retrospectively from electronic patient records and Microsoft Excel was used for statistical analysis.28 eligible patients were identified; Table 1 summarises the cohort demographics. Median corrected gestational age (cGA) at stoma formation was 27.5 weeks (IQR 4.54 [25.97–30.5]) and median weight at stoma formation was 841 grams (IQR 398.25[650–1048.25]). Indication for laparotomy was predominantly documented as pneumoperitoneum (15/28; 54%); stoma site was predominantly ileal (21/28; 75%). 6/28(21.4%) patients died on NICU prior to stoma closure (median GA at birth 24.22 weeks (IQR 1.54 [23.61–25.15]); median birth weight 614 grams (IQR 110.5 [552–662.5]); 3/6 (50%) ileostomy, 3/6(50%) jejunostomy). 13/22(59%) surviving patients still had stomas at point of discharge and 2/22(9%) patients died following discharge whilst admitted to the paediatric critical care unit (PCCU) prior to stoma closure.Only 4/22(18%) patients were documented to have achieved enteral autonomy (discontinuation of parenteral nutrition (PN) and effective growth (trajectory within 1 centile line of birth weight) on enteral feeding regime) prior to stoma closure or NICU discharge. Median GA at birth for these patients was 26.43 weeks (IQR 1.18 [25.64–26.75]) while cGA at stoma formation was 27.86 weeks (IQR 1.325 [27.68–29.0]), and median weight at stoma formation was 1015 g (IQR 67.5 [972.5–1040]). All had an ileostomy and 3/4(75%) were discharged from NICU prior to stoma closure. A further 4/22(18%) patients achieved cessation of PN, however growth on enteral regime was not adequate.Patients with small bowel enterostomy represent a significant workload within our NICU; experiencing a protracted inpatient stay, a challenging transition to enteral autonomy, and significant morbidity and mortality. These data support the importance of ongoing research into understanding the outcomes of neonatal patients post intestinal stoma formation and also may aid the prognostication of their likely nutritional course; allowing for effective family counselling and informing the transition to paediatric gastroenterology services.Abstract OC19 Table 1Cohort demographicsMedian Gestational Age at Birth (weeks) 25.79 (IQR 3.54 [24.14–27.68]) Median Birth Weight (grams) 656 (IQR 373 [589.5–962.5]) Location of Birth Inborn 16(57%) Elsewhere 12(43%) Corrected Gestational Age at Stoma Formation (weeks) 27.5 (IQR 4.54 [25.97–30.5]) Weight at Stoma Formation (grams) 841 (IQR 398.25 [650–1048.25]) Indication for Laparotomy Pneumoperitoneum 15(54%) Suspected NEC 9(32%) Suspected intestinal atresia 2(7%) Small bowel obstruction 1(4%) Abdominal mass 1(4%) Location of Stoma Ileal 21(75%) Jejunal 7(25%) Median Unit Days 104 (IQR 78.25 [42.25–120.5]) Median Unit Days Post Stoma 83 (IQR 94.25 [24.75–119]) Median Stoma Days on Unit 80 (IQR 75.5 [21–96.5]) NICU Deaths 6(21%) Discharge Destination PCCU 9(41%) Other Hospital/Ward 10(46%) Home 3(14%) Discharged with Stoma Yes 13(60%) No 9(41%)