ILEOSTOMY IN NEWBORNS: A COMPREHENSIVE 15-YEAR STUDY INVESTIGATING CAUSES, TIMING, AND NEUROLOGICAL OUTCOMES FOLLOWING BOWEL OBSTRUCTION
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Abstract
Background: Advancements in perinatal care have increased the survival rates of low birth weight (LBW) infants, leading to a rise in abdominal operations, notably for conditions like necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP). Ileostomies are common in newborns with surgical abdominal emergencies, yet a research gap exists in understanding causes, timing, and outcomes, especially neurological, following bowel obstruction in this population. Methods: A 15-year observational study at a tertiary care multispecialty hospital investigated 65 infants undergoing ileostomy. Variables included indications, gestational age, age at ileostomy, weight, closure timing, and outcomes. Exclusions comprised newborns with birth asphyxia, congenital malformations, and identified neurological deficit causes. Ethics clearance was obtained, and statistical analysis involved SPSS version 16.
Results: Total 65 babies underwent ileostomy from July 2006 to July 2021.Males were 48(73.8%) and females were 17(26.2). The most common indication for ileostomy was NEC (55.4%). Mean gestational age was 33weeks(±4 weeks SD), and mean age at ileostomy was 16 days.Mean weight at Ileostomy was 2.04 Kg(±0.96Kg). Outcomes showed 69.2% recovery, 20% mortality, 7.7% left against advice, and 6.1% transferred. Of those recovered, 33.8% experienced post-ileostomy complications which included conjugated hyperbiliribinemia, failure to thrive, prolapse, adhesions, wound dehiscence,etc. One-year neurological follow-up in 38 patients revealed 35 with normal development.
Conclusion:This comprehensive study sheds light on the complex landscape of neonates undergoing ileostomy, emphasizing the prominence of NEC and the impact of gestational age on outcomes. The positive neurological outcomes at one year underscore the need for continued monitoring in this vulnerable population. While promising, the study advocates for extended follow-ups and further exploration of long-term outcomes to refine perinatal management strategies
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Dr. Murchana Khound
Assistant Professor in Department of Pediatrics, AIIMS Guwahati
Dr. Sujit Chowdhary
Senior Consultant Paediatric Surgery and Paediatric urology in Indraprastha Apollo Hospital Delhi.
Dr. Saroja Balan
Senior Consultant and Neonatologist, Indraprastha Apollo Hospital Delhi