242 Chapter 11 database. Patients were included in this analysis if 1) they underwent stoma closure and 2) if birthweight, weight at stoma creation and closure, and at least one weight measurement after closure were available. The medical ethical committee of the Academic Medical Center in Amsterdam reviewed and approved the observational study (reference: W18_233#18.278) design. Patients and parents received an opt-out letter for consent. Following consent, patient records were checked for eligibility. Data was retrieved and stored in an electronic database (Castor EDC). Data extraction We (LES, IV) extracted information concerning: gender, prematurity (defined as gestational age < 37 weeks), duration of pregnancy, underlying disease, time to stoma closure (early closure was defined as closure within 6 weeks following creation), need for readmission for stoma closure, need for total parenteral nutrition (TPN) following stoma creation, number of centimeters of small bowel resected (major resection was defined as ≥ 30 centimeters, independent of age), proximal location of a small bowel stoma (defined as within 50 centimeters of the ligament of Treitz), weight before stoma creation (weight closest to creation with a maximum of three days before creation), weight at stoma closure (weight closest to closure with a maximum of three days before or after closure), weight after stoma closure (first measure which was reported in a minimum of three months and a maximum of one year after closure) and if sodium supplementation was given after stoma creation. Growth was measured with weight-for-age Z-scores, and was calculated with the growth calculator of the Youth Health Department (JGZ).(16) The weight-for-age Z-score (or standard deviation (SD) score) is a measure of the SD for weight from the median value of a reference population matched for duration of pregnancy, age and sex.(16) The Z-score can be used to discriminate between a child that is gaining weight at a slower (or faster) rate than the reference population and is well suited for a cohort with prematures.(17) Malnourishment was defined according to the WHO definition; a weight-for-age Z-score between -3 and -2 was classified as mildly malnourished, and a score weight-for-age Z-score < -3 as severely malnourished.(18) The difference between Z-score at stoma creation and closure was calculated to express growth curve in the presence of a stoma, with a negative growth curve indicating growth impairment. The difference between Z-score at stoma closure and Z-score within the year after closure was used to express the growth curve after stoma closure.
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