241 Impact of presence, level and closure of a stoma on growth in young children Chapter 11 Introduction In young children (age ≤3 years), a small bowel stoma or colostomy might be necessary in the treatment of congenital intestinal diseases or abdominal sepsis.(1, 2) Stomas come with a substantial risk of morbidity. Taking into account both stoma creation and closure, major stoma related morbidity (Clavien-Dindo grade ≥III) occurs in 39% of the children. (3) Moreover, a stoma increases the loss of fluids and nutrients, which might result in impaired growth.(4) This growth impairment at a young age can negatively impact longterm development and cognitive ability, in particular when it occurs in the first nine months of life.(5, 6) Moreover, this impairment of growth in itself is associated with an increased risk of stoma related complications and the need for reoperations.(7) For these reasons some surgeons recommend early stoma closure, within six weeks following formation. (3, 4, 8-10) Children treated by a small bowel stoma are thought to be more prone to growth impairment than children treated by colostomy. The higher risks of a high-output stoma and loss of absorbent function of the small bowel and colon distal of the stoma are suggested to cause this difference between both levels of stoma. (11, 12) To what extent this different levels of stoma limit growth in young children is not well known. Next type of intestine used to create the stoma, other patient specific factors, such as proximal small bowel stomas (within 50 centimeters of Treitz) and undergoing major small bowel resection (≥30 centimeters), might decrease functional bowel length even more, which could further impair growth. Moreover, experimental studies are linking inadequate sodium supply with impaired growth in case of urine sodium levels ≤30 mmol/L.(13, 14) Sodium supplementation might restore the cellular sodium environment and stimulate growth, for which reason this became common practice at many institutions over the last 20 years. However, there are no guidelines on the optimal management of sodium supplementation in the presence of a stoma.(15) Therefore, the aim of this study was to evaluate 1) the effect of constructing either a small or large bowel stoma on growth in young children and 2) the effect of certain patient specific factors (early stoma closure, having a proximal stoma, undergoing major small bowel resection (≥30 centimeters) or adequate sodium supplementation) on growth status at stoma closure and within a year following closure expressed by weight-for-age Z scores. Methods Patients and management All consecutive young children (≤3 years of age) with a small bowel stoma (jejunostomy or ileostomy) or large bowel stoma (colostomy), created between 1998 and 2018 at our tertiary university medical center, were identified from a surgical administrative
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