Ileostomy in extremely low birth weight and premature neonates.
OBJECTIVE
The establishment of an ileostomy is a surgical option in the treatment of neonatal intestinal diseases, such as necrotizing enterocolitis (NEC) and meconial disease, in premature or extremely-low-birth-weight (ELBW) infants.


METHODS
A prospective study was performed between July 2000-April 2011, with in exam all cases of acute abdomen in newborn premature babies. We perfomed a temporary ileostomy with a skin bridge and resection of the necrotic intestine. The temporary ileostomy was followed by anastomosis and the effect of possible confounding factors were assessed on the intestinal canalization. Data analysis and multiple monovariate were conducted.


RESULTS
Thirty-three neonates, 14 males and 19 females, operated for intestinal perforation were identified. They were ELBW or premature neonates. There were 24 neonates with NEC, 4 with meconium peritonitis and 5 with complicated meconium ileus. In 4 cases of meconium ileus we found ileale atresia. Eight patients were excluded from the study because 3 died; 2 had cystic fibrosis and 3 with hydrocephalus. Thirteen patients developed complications: 7 related to ileostomy, 2 cholestasis and 4 recurrent NEC. Patients with meconium ileus gain rcovery of bowel function 4 days or more the others (OR=8.0; P=0.0455).


CONCLUSIONS
In our experience, the establishment of ileostomy for the treatment of acute abdomen in child newborn premature or low birth weight allows optimal management of the child, excluding bowel sick and faster healing with a low rate of morbidity and mortality.
Pediatric Surgery Unit, Departiment of Medical, Surgical and Neurological SciencesUniversity of Siena, Siena, Italy - fferraradoc@gmail.com.
F
F
Ferrara
R
R
Angotti
A
A
Burgio
G
G
Di Maggio
F
F
Molinaro
M
M
Messina
D005260:Female; D006801:Humans; D007081:Ileostomy; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000601:surgery*; D007416:Intestinal Perforation / Q000601:surgery*; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors