A. E. Vaughn1,2, W. T. Tran2, K. W. Liechty1,2, J. Gien3 1Children’s Hospital Colorado, Pediatric Surgery, Aurora, CO, USA 2University Of Colorado Denver, Surgery, Aurora, CO, USA 3Children’s Hospital Colorado, Neonatology, Aurora, CO, USA
Introduction: Necrotizing enterocolitis (NEC) occurs in ~10% of extremely premature infants and is one of the most significant causes of morbidity and mortality. In approximately 50% of cases, surgical intervention is necessary and results in resection of necrotic bowel and creation of ostomies, which ultimately require reversal. In addition to NEC, many premature neonates suffer from bronchopulmonary dysplasia (BPD) requiring respiratory support and feeding failure requiring gastrostomy tube (G-tube) placement. In the setting of BPD, surgical intervention is associated with additional risk and prolonged recovery time. In infants with ostomies secondary to NEC, we sought to determine the incidence of G-tube placement after ostomy reversal to define a potential subset of patients that would benefit from concurrent ostomy reversal and G-tube placement.
Methods: A single-center retrospective study of infants with surgical NEC between January 2007 and July 2021 was performed. Incidence of patients requiring G-tube placement and timing of this operation relative to ostomy reversal as well as respiratory status surrounding G-tube placement (if performed) was determined. Mann Whitney U and unpaired t-tests (p<0.05 significant) were used for analysis.
Results: 109 patients were diagnosed with surgical NEC, 9/109 (8.3%) did not have an ostomy created during their index operation and 17/109 (15.6%) did not survive to ostomy reversal. Of the remaining 83 patients, median gestational age (GA) was 27 weeks (IQR 25-32 weeks) and birth weight (BW) was 879 grams (IQR 718g-1670g). G-tube placement was required in 47/83 (56.6%) patients, of which 4/83 (8.5%) were placed prior to ostomy reversal, 20/83 (42.6%) concurrently with ostomy reversal, and 23/83 (48.9%) after ostomy reversal (median 79 days, IQR 61.5-105.5 days). When compared to infants that did not require G-tube placement, there were no significant differences in GA (27 vs 27 weeks, p=0.90) or BW (830g vs 1030g, p=0.47). Hospital length of stay (LOS) was significantly longer in the G-tube group (126.8 vs 69.5 days, p<0.0001), however within the G-tube group there was no significant difference in LOS whether placed concurrently with or after ostomy reversal (107.5 vs 138 days, p=0.36). While only 8/47 (33.3%) patients required mechanical ventilation prior to G-tube placement, 24/47 (54.5%) patients returned from the OR intubated and remained intubated for a median of 3 days (IQR 1.25-7 days). Logistic regression did not show an association between GA or BW and G-tube placement.
Conclusion: Approximately 50% of patients with surgical NEC required G-tube placement and had a longer hospital LOS. There were no significant differences between patients who had a G-tube placed concurrently with versus after the time of ostomy reversal. Therefore, we did not find evidence to support performing G-tube placement concurrently with ostomy reversal.