Exploring Growth Failure in Neonates With Enterostomy

Joseph R Davidson; Kareem Omran; Clara K L Chong; Simon Eaton; A David Edwards; Iain E Yardley

doi:10.1016/j.jpedsurg.2023.10.010

Exploring Growth Failure in Neonates With Enterostomy

J Pediatr Surg. 2024 Feb;59(2):211-215. doi: 10.1016/j.jpedsurg.2023.10.010. Epub 2023 Oct 18.

Authors

Joseph R Davidson¹, Kareem Omran², Clara K L Chong³, Simon Eaton⁴, A David Edwards⁵, Iain E Yardley⁶

Affiliations

¹ Department of Paediatric Surgery, Evelina London Children's Hospital, London, UK; Stem Cells and Regenerative Medicine Section, GOS-UCL Institute of Child Health, London, UK; Prenatal Cell and Gene Therapy, Elizabeth Garrett Anderson UCL Institute for Women's Health, London, UK.
² Department of Neonatology, Evelina London Children's Hospital, London, UK.
³ Department of Paediatric Surgery, Evelina London Children's Hospital, London, UK.
⁴ Stem Cells and Regenerative Medicine Section, GOS-UCL Institute of Child Health, London, UK.
⁵ Department of Neonatology, Evelina London Children's Hospital, London, UK; Centre for the Developing Brain, King's College London, London, UK.
⁶ Department of Paediatric Surgery, Evelina London Children's Hospital, London, UK; Department of Neonatology, Evelina London Children's Hospital, London, UK. Electronic address: iain.yardley@gstt.nhs.uk.

PMID: 37940463
DOI: 10.1016/j.jpedsurg.2023.10.010

Abstract

Aim of the study: Neonatal enterostomy is a known risk for growth failure. We hypothesized that episodes of inflammation may drive a catabolic state, exploring this by assessing serum biochemistry alongside growth trajectory in enterostomy patients.

Methods: A retrospective analysis of infants with histologically confirmed NEC from 01/2012-07/2021 in a tertiary neonatal surgical centre was performed. Change in weight-for-age Z-score (ΔZ) between stoma formation and closure was calculated. Serum CRP (C-reactive protein), urea, and creatinine levels were recorded and duration of elevated levels calculated as Area Under Curve (AUC). We examined for trends of serum levels rising together using intersecting moving averages. Spearman's correlation analysis was performed, while multivariable linear regression examined factors associated with ΔZ.

Results: 79 neonates were included. At stoma formation, median Z-score was -1.42 [range -4.73, +1.3]. Sixty-two patients (78 %) had a fall in Z-score during their time with a stoma, 16 (20 %) had a ΔZ less than -2. Urea AUC was significantly univariably correlated with ΔZ and remained statistically significant in a multivariable model (Exp(B) x 100 = -0.57[-1, -0.09]; p = 0.022). The number of biomarker peaks correlated significantly with ΔZ for urea (r = -0.25; p = 0.025) and CRP (r = -0.35; p = 0.0017) but not Creatinine (r = -0.21; p = 0.066). Analysing the number of peaks of any combination of variables coinciding was consistently significantly correlated negatively with ΔZ (r = -0.29 to -0.27; p ≤ 0.016 for all).

Conclusion: Our data shows that infants who were more severely affected by growth failure had more frequent and severe uremia while they had a stoma (suggesting a catabolic state). Disturbances in urea were commonly associated with CRP, suggesting that inflammation is a significant factor in growth failure in these infants. These findings promote aggressive management of sepsis in these infants, as well as suggesting an earlier closure of stoma to minimise their "at-risk"' period.

Keywords: Growth failure; Necrotizing enterocolitis; Stoma.

MeSH terms

Enterocolitis, Necrotizing* / surgery
Enterostomy*
Failure to Thrive / etiology
Humans
Infant
Infant, Newborn
Inflammation
Retrospective Studies
Surgical Stomas*
Urea

Substances

Urea

Grants and funding

MR/V006797/1/MRC_/Medical Research Council/United Kingdom