Division of Pediatric Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Am Surg. 2024 Oct;90(10):2534-2542. doi: 10.1177/00031348241248788. Epub 2024 Apr 22.
The minimum weight for enterostomy closure (EC) in infants remains debated with the current acceptable cut-off of >2 kg. As enterostomy-related complications or high enterostomy output (>30cc/kg/d) may prohibit a premature infant from reaching 2 kg, additional data is needed to evaluate the safety of EC in infants <2 kg. The objective of this study was to evaluate postoperative outcomes in low body weight (<2 kg) infants undergoing EC compared to larger infants.
We performed a multi-center retrospective analysis from 1/1/2012-12/31/2022 of all infants (age <1 year) who were <4 kg at time of EC. Primary outcomes included postoperative complications and 30-day mortality. Non-parametric analysis was performed using the Kruskal-Wallis one-way analysis of variance and chi-square tests. Univariable logistic regression was performed to identify factors associated with postoperative complications.
Of 92 infants, 15 infants (16.3%) underwent EC at <2 kg, 16 (17.4%) at 2-2.49 kg, 31 (33.7%) at 2.5-2.99 kg, and 30 (32.6%) at ≥3 kg. Infants <2 kg at time of EC exhibited higher rates of hyperbilirubinemia ( = .030), neurologic comorbidities ( = .030), and high enterostomy output ( = .041). There was no difference in postoperative complications ( = .460) or 30-day mortality ( = .460) between the <2 kg group and larger weight groups. Low body weight was not associated with an increased risk for developing a postoperative complication (OR: 1.001, 95% CI: 1.001-1.001; = .032).
Our findings suggest that EC in infants <2 kg may be safe with comparable postoperative outcomes to larger weight infants. Thus, the timing of EC should be based on the infant's physiologic status, in contrast to a predetermined minimum weight cut-off.
婴儿肠造口关闭（EC）的最小体重仍存在争议，目前可接受的截止值为>2kg。由于肠造口相关并发症或高肠造口输出量（>30cc/kg/d）可能会阻止早产儿达到 2kg，因此需要额外的数据来评估体重<2kg 的婴儿进行 EC 的安全性。本研究的目的是评估体重<2kg 的低体重（<2kg）婴儿与较大婴儿相比行 EC 的术后结果。
我们对 2012 年 1 月 1 日至 2022 年 12 月 31 日期间所有（<1 岁）在 EC 时体重<4kg 的婴儿进行了一项多中心回顾性分析。主要结局包括术后并发症和 30 天死亡率。采用 Kruskal-Wallis 单向方差分析和卡方检验进行非参数分析。采用单变量逻辑回归分析确定与术后并发症相关的因素。
92 例婴儿中，15 例（16.3%）在<2kg 时行 EC，16 例（17.4%）在 2-2.49kg 时行 EC，31 例（33.7%）在 2.5-2.99kg 时行 EC，30 例（32.6%）在≥3kg 时行 EC。EC 时体重<2kg 的婴儿胆红素血症发生率较高（=0.030），神经系统合并症发生率较高（=0.030），肠造口输出量较高（=0.041）。<2kg 组与较大体重组之间术后并发症（=0.460）或 30 天死亡率（=0.460）无差异。低体重与术后并发症风险增加无关（OR：1.001，95%CI：1.001-1.001；=0.032）。
我们的研究结果表明，体重<2kg 的婴儿行 EC 可能是安全的，与较大体重婴儿的术后结果相当。因此，EC 的时机应基于婴儿的生理状态，而不是预先设定的最小体重截止值。
