UK neonatal stoma practice: a population study
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Author(s)
Type
Journal Article
Abstract
Objective The optimal time for neonatal stoma closure is unclear and there have been calls for a trial to compare early and late surgery. The feasibility of such a trial will depend on the population of eligible infants and acceptability to families and health professionals. In this study, we aimed to determine current UK practice and characteristics of those undergoing stoma surgery.
Design A retrospective cohort study of neonates who had undergone stoma surgery (excluding anorectal malformations and Hirschsprung’s disease) using three national databases: the National Neonatal Research Database (NNRD, 2012–2019), British Association of Paediatric Surgeons Congenital Anomalies Surveillance System (BAPS-CASS, 2013–2014) and Hospital Episode Statistics–Admitted Patient Care (HES-APC, 2011–2018).
Results 1830 eligible neonates were identified from NNRD, 163 from BAPS-CASS, 2477 from HES-APC. Median (IQR) duration of stoma in days was 57 (36–80) in NNRD, 63 (41–130) in BAPS-CASS and 78 (55–122) for neonates identified from HES-APC. At the time of closure, there were low rates of invasive ventilation (13%), inotrope use (5%) and recent steroids use (4%). Infants who underwent earlier closure (<9 weeks) were less preterm (median 28 weeks vs 25 weeks), have higher birth weight (median 986 g vs 764 g) and more likely to have stoma complications (29% vs 5%).
Conclusion There are sufficient UK neonates undergoing stoma formation for a trial. Stoma closure is performed at around 2 months, with clinical stability, gestation, weight and stoma complications appearing to influence timing. The variation in practice we document indicates there is opportunity to optimise practice through a trial.
Design A retrospective cohort study of neonates who had undergone stoma surgery (excluding anorectal malformations and Hirschsprung’s disease) using three national databases: the National Neonatal Research Database (NNRD, 2012–2019), British Association of Paediatric Surgeons Congenital Anomalies Surveillance System (BAPS-CASS, 2013–2014) and Hospital Episode Statistics–Admitted Patient Care (HES-APC, 2011–2018).
Results 1830 eligible neonates were identified from NNRD, 163 from BAPS-CASS, 2477 from HES-APC. Median (IQR) duration of stoma in days was 57 (36–80) in NNRD, 63 (41–130) in BAPS-CASS and 78 (55–122) for neonates identified from HES-APC. At the time of closure, there were low rates of invasive ventilation (13%), inotrope use (5%) and recent steroids use (4%). Infants who underwent earlier closure (<9 weeks) were less preterm (median 28 weeks vs 25 weeks), have higher birth weight (median 986 g vs 764 g) and more likely to have stoma complications (29% vs 5%).
Conclusion There are sufficient UK neonates undergoing stoma formation for a trial. Stoma closure is performed at around 2 months, with clinical stability, gestation, weight and stoma complications appearing to influence timing. The variation in practice we document indicates there is opportunity to optimise practice through a trial.
Date Issued
2024-01
Date Acceptance
2024-06-06
Citation
Archives of Disease in Childhood: Fetal and Neonatal Edition, 2024, 110 (1), pp.F79-F84
ISSN
1359-2998
Publisher
BMJ Publishing Group
Start Page
F79
End Page
F84
Journal / Book Title
Archives of Disease in Childhood: Fetal and Neonatal Edition
Volume
110
Issue
1
Copyright Statement
© Author(s) (or their
employer(s)) 2025. Re-use
permitted under CC BY.
Published by BMJ Group
employer(s)) 2025. Re-use
permitted under CC BY.
Published by BMJ Group
License URL
Identifier
https://fn.bmj.com/content/early/2024/06/19/archdischild-2024-327020
Publication Status
Published
Date Publish Online
2024-06-19