title: The timing of ostomy closure in infants with necrotizing enterocolitis: a systematic review.
abstract: OBJECTIVE
  The optimal timing of ostomy closure is a matter of debate. We performed a systematic review of outcomes of early ostomy closure (EC, within 8 weeks) and late ostomy closure (LC, after 8 weeks) in infants with necrotizing enterocolitis.
  
  
  METHODS
  PubMed, EMbase, Web-of-Science, and Cinahl were searched for studies that detailed time to ostomy closure, and time to full enteral nutrition (FEN) or complications after ostomy closure. Patients with Hirschsprung's disease or anorectal malformations were excluded. Analysis was performed using SPSS 17 and RevMan 5.
  
  
  RESULTS
  Of 778 retrieved articles, 5 met the inclusion criteria. The median score for study quality was 9 [range 8-14 on a scale of 0 to 32 points (Downs and Black, J Epidemiol Community Health 52:377-384, 1998)]. One study described mean time to FEN: 19.1 days after EC (n = 13) versus 7.2 days after LC (n = 24; P = 0.027). Four studies reported complication rates after ostomy closure, complications occurred in 27% of the EC group versus 23% of the LC group. The combined odds ratio (LC vs. EC) was 1.1 [95% CI 0.5, 2.5].
  
  
  CONCLUSIONS
  Evidence that supports early or late closure is scarce and the published articles are of poor quality. There is no significant difference between EC versus LC in the complication rate. This systematic review supports neither early nor late ostomy closure.
authors.affiliation: Department of Pediatric Surgery, Erasmus MC-Sophia, Rotterdam, The Netherlands.
authors.forename: Marie-Chantal
authors.initials: MC
authors.lastname: Struijs
authors.forename: Cornelius E J
authors.initials: CE
authors.lastname: Sloots
authors.forename: Wim C J
authors.initials: WC
authors.lastname: Hop
authors.forename: Dick
authors.initials: D
authors.lastname: Tibboel
authors.forename: Rene M H
authors.initials: RM
authors.lastname: Wijnen
mesh_terms: D020345:Enterocolitis, Necrotizing / Q000601:surgery*; D006801:Humans; D007223:Infant; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000601:surgery; D010030:Ostomy / Q000379:methods / Q000706:statistics & numerical data*; D011183:Postoperative Complications; D013997:Time Factors