Complications of newborn enterostomies

Table 1 Primary disease

		n (%)
Group 1	NEC	51 (67.1)
Group 2	Other gastrointestinal disorders	25 (32.9)
	MI with CF	8 (10.5)
	MI without CF	2 (2.6)
	ARM	7 (9.2)
	FIP	3 (3.9)
	Ileus of unknown origin	2 (2.6)
	Intestinal atresia	2 (2.6)
	Volvulus	1 (1.3)

NEC: Necrotizing enterocolitis; MI: Meconium ileus; CF: Cystic fibrosis.

Table 2 Comparison of group populations n (%)

	Overall population	Group 1	Group 2	P-value
n (%)	76 (100)	51 (67.1)	25 (32.9)
Female	42 (55.3)	29 (56.9)	13 (52.0)	0.877
Gestational age (wk)	27 (22-41)	27 (23-38)	28 (22-41)	0.637
Preterm infants	66 (86.8)	46 (90.2)	20 (80.0)	0.282
Weight at birth (g)	840 (430-3400)	850 (490-3370)	825 (430-3400)	0.709
Deceased patients	3 (3.9)	2 (3.9)	1 (4.0)	1
Comorbidities
Cardiovascular system insufficiency	23 (30.3)	19 (37.3)	4 (16.0)	0.103
Bronchopulmonary dysplasia	17 (22.4)	13 (25.5)	4 (16.0)	0.522
Respiratory insufficiency	54 (71.1)	39 (76.5)	15 (60.0)	0.223
Recurrent sepsis	13 (17.1)	8 (15.7)	5 (20.0)	0.885
Septic shock	9 (11.8)	8 (15.7)	1 (4.0)	0.257
Congenital malformations	12 (15.8)	3 (5.9)	9 (36.0)	0.002
Age at enterostomy formation (d)	9.5 (1-101)	11 (2-75)	4 (1-101)	0.004
Weight at enterostomy formation (g)	1025 (450-3780)	1010 (450-3780)	1310 (480-3360)	0.373

Table 3 Enterostomy formation n (%)

	Overall population	Group 1	Group 2	P-value
Enterostomy location
Jejunostomy	3 (3.9)	2 (3.9)	1 (4.0)	1
Ileostomy	63 (82.9)	47 (92.2)	16 (64.0)	0.007
Colostomy	10 (13.2)	2 (3.9)	8 (32.0)	0.002
Stoma duration (wk)	12.5 (0-90)	12 (0-35)	14 (1-90)	0.468
Days until initiation of enteral nutrition	4 (1-13)	5 (3-13)	3 (1-9)	< 0.001
Requiring PN until closure	15 (21.1)	9 (18.8)	6 (26.1)	0.541
Full enteral nutrition prior to reversal	56 (78.9)	39 (81.3)	17 (73.9)	0.541
Days until full enteral nutrition	24.5 (6-209)	22 (6-87)	29 (8-209)	0.288
Days until stool via enterostomy	4 (2-27)	4 (2-14)	5 (2-27)	0.918

PN: Parenteral nutrition.

Table 4 Complications of enterostomy formation n (%)

	Overall population	Group 1	Group 2	P-value
Patients with ≥ 1 complication	62 (80.3)	44 (86.3)	17 (68.0)	0.073
Complications	152	110	42
Skin excoriation	37 (48.7)	27 (52.9)	10 (40.0)	0.414
Blister	1 (1.3)	1 (2.0)	0 (0.0)	1
Wound discharge	15 (19.7)	12 (23.5)	3 (12.0)	0.359
Wound bleeding	30 (39.5)	21 (41.2)	9 (36.0)	0.854
Prolapse	29 (38.2)	22 (43.1)	7 (28.0)	0.305
Wound dehiscence	1 (1.3)	0 (0.0)	1 (4.0)	0.329
Insufficient circulation of enterostomy	17 (22.4)	10 (19.6)	7 (28.0)	0.595
Necrosis of enterostomy	4 (5.3)	4 (7.8)	0 (0.0)	0.296
Mechanical ileus	8 (10.5)	4 (7.8)	4 (16.0)	0.388
Parastomal hernia	1 (1.3)	1 (2.0)	0 (0.0)	1
Prestomal obstruction/stenosis	10 (13.2)	8 (15.7)	2 (8.0)	0.482
Perforation	1 (1.3)	1 (2.0)	0 (0.0)	1
Abdominal compartment syndrome	1 (1.3)	1 (2.0)	0 (0.0)	1
Failure to thrive under enterostomy	16 (21.9)	10 (20.4)	6 (25.0)	0.885
Patients with ≥ 1 reoperation	9 (11.8)	6 (11.8)	3 (12.0)	1
Mechanical ileus	7 (9.2)	3 (5.9)	4 (16.0)	0.069
Insufficient improvement of health	3 (3.9)	3 (5.9)	0 (0.0)	0.505
Abdominal compartment syndrome	1 (1.3)	1 (2.0)	0 (0.0)	1
Intestinal perforation	2 (2.6)	2 (3.9)	0 (0.0)	1
Colon necrosis	1 (1.3)	1 (2.0)	0 (0.0)	1

Table 5 Onset of most common enterostomy complications

	Overall population	Group 1	Group 2	P-value
Skin excoriation	27 (6-143)	26 (6-103)	31.5 (10-143)	0.098
Wound bleeding	12.5 (2-128)	11 (2-128)	14 (2-71)	0.79
Prolapse	57 (5-165)	60.5 (5-165)	52 (5-119)	0.901

Table 6 Number of enterostomy formation-related complications in one patient n (%)

	Overall population	Group 1	Group 2	P-value
None	15 (19.7)	7 (13.7)	8 (32.0)	0.073
1	16 (21.1)	12 (23.5)	4 (16.0)	0.648
2	18 (23.7)	13 (25.5)	5 (20.0)	0.809
3	13 (17.1)	8 (15.7)	5 (20.0)	0.748
4	10 (13.2)	8 (15.7)	2 (8.0)	0.482
5	3 (3.9)	2 (3.9)	1 (4.0)	1
6	0 (0.0)	0 (0.0)	0 (0.0)
7	1 (1.3)	1 (2.0)	0 (0.0)	1
≥ 4	14 (18.4)	11 (21.6)	3 (12.0)	0.365

Table 7 Enterostomy closure n (%)

	Overall population	Group 1	Group 2	P-value
Early reversal necessary	28 (38.4)	19 (38.8)	9 (37.5)	1
Failure to thrive under enterostomy	12 (16.4)	7 (14.3)	5 (20.8)	0.432
Prolapse	7 (9.6)	4 (8.2)	3 (12.5)	0.646
Stenosis of enterostomy	4 (5.5)	3 (6.1)	1 (4.2)	1
Necrosis of enterostomy	1 (1.4)	1 (2.0)	0 (0.0)	1
Parastomal hernia	1 (1.4)	1 (2.0)	0 (0.0)	1
As part of a not enterostomy-related surgery	3 (4.1)	3 (6.1)	0 (0.0)	0.53
Days until initiation of enteral nutrition	2 (1-18)	2 (1-18)	2 (1-6)	0.151
Days until full enteral nutrition	8 (3-93)	8 (3-93)	7 (4-41)	0.966
Days to rectal stool	3 (1-13)	3 (1-12)	3 (2-13)	0.732

Table 8 Complications of enterostomy closure n (%)

	Overall population	Group 1	Group 2	P-value
Patients with ≥ 1 complication	19 (26.0)	15 (30.6)	4 (16.7)	0.321
Mechanical ileus	8 (11.0)	4 (8.2)	4 (16.2)	0.426
Subcutaneous hematoma	1 (1.4)	1 (2.0)	0 (0.0)	1
Wound dehiscence with intestinal prolapse	1 (1.4)	0 (0.0)	1 (4.2)	0.329
Wound infection	3 (4.1)	3 (6.1)	0 (0.0)	0.546
Postoperative infection	4 (5.5)	4 (8.2)	0 (0.0)	0.299
Seroma of laparotomy wound	1 (1.4)	1 (2.0)	0 (0.0)	1
Anastomotic leakage	2 (2.7)	2 (4.1)	0 (0.0)	1
Patients with ≥ 1 reoperation	10 (13.7)	6 (12.2)	4 (16.7)	0.72
Mechanical ileus	8 (11.0)	4 (8.2)	4 (16.7)	1
Wound dehiscence with intestinal prolapse	1 (1.4)	0 (0.0)	1 (4.2)	0.455
Anastomotic leakage	2 (2.7)	2 (4.1)	0 (0.0)	0.455

Table 9 Clavien-Dindo-Classification n (%)

	Overall population	Group 1	Group 2	P-value
I	31 (42.5)	23 (46.9)	8 (33.3)	0.399
II	6 (8.2)	6 (12.2)	0 (0.0)	0.169
IIIa	0 (0.0)	0 (0.0)	0 (0.0)
IIIb	14 (19.2)	9 (18.4)	5 (20.8)	1
IVa	11 (15.1)	6 (12.2)	5 (20.8)	0.489
IVb	0 (0.0)	0 (0.0)	0 (0.0)
V	0 (0.0)	0 (0.0)	0 (0.0)

Table 10 Associations with the occurrence of severe enterostomy-related complications

	CDC < III	CDC ≥ III	P-value
n (%)	48 (65.8)	25 (34.2)
Gestational age (wk)	27 (23-38)	26 (22-41)	0.931
Birth weight (g)	867.5 (430-3370)	812 (460-3400)	0.591
Preterm infants	43 (89.6)	21 (84.0)	0.481
Age at enterostomy formation	9 (1-75)	16 (1-101)	0.159
Weight at enterostomy formation	1005 (480-3780)	1600 (450-3360)	0.699
Days until initiation of enteral nutrition after formation	4 (1-13)	4 (1-9)	0.29
Patients requiring PN until reversal	7 (14.6)	8 (32.0)	0.135
Days until full enteral nutrition after formation	24.5 (6-87)	25 (10-209)	0.634
Days until stool via enterostomy (wk)	4 (2-12)	5 (2-27)	0.487
Duration of enterostomy (wk)	13 (0-90)	12 (0-58)	0.682
Early reversal necessary	12 (25.0)	16 (64.0)	0.003
Days until initiation of enteral nutrition after reversal	2 (1-8)	2 (1-18)	0.389
Days until full enteral nutrition after reversal	7 (3-87)	12 (5-93)	0.006
Days to rectal stool	3 (1-12)	4 (1-13)	0.645

PN: Parenteral nutrition; CDC: Clavien-Dindo-Classification.

Table 11 Effect of complications on clinical course

	Reoperation	CDC ≥ III	Early reversal
Formation
Skin excoriation	0.736	1	0.882
Blister	0.12	0.342	1
Wound discharge	1	1	1
Wound bleeding	1	0.759	0.498
Prolapse	1	0.774	1
Wound dehiscence	1	1	1
Insufficient circulation of enterostomy	0.205	0.99	0.577
Necrosis of enterostomy	0.068	0.269	0.052
Mechanical ileus	< 0.001	0.001	1
Parastomal hernia	0.12	0.342	0.384
Obstruction/stenosis	0.094	0.026	0.492
Perforation	0.12	1	1
Abdominal compartment syndrome	0.12	0.342	0.384
Failure to thrive under enterostomy	0.676	0.99	< 0.001
Reversal
Mechanical ileus	< 0.001	< 0.001
Subcutaneous hematoma	1	1
Wound dehiscence with intestinal prolapse	0.137	0.342
Wound infection	0.362	0.269
Postoperative infection	1	1
Seroma of laparotomy wound	1	1
Anastomotic leakage	0.014	0.108

CDC: Clavien-Dindo-Classification.