244 Chapter 11 Results Patient characteristics A total of 172 young children were included in our analysis. 61% (105/172) Of all infants were male and the median gestational age was 36 weeks (IQR: 32 - 38) of which 54% (93/172) were born prematurely. In total 58% (99/172) of the patients received a small bowel stoma. Of the patients with a small bowel stoma, 10% (10/99) received a jejunostomy and 90% (89/99) an ileostomy. Of all these small bowel stomas, 20% (20/99) were proximal small bowel stomas. The median length of resected small bowel in those treated by ileostomy was 7 centimeters (IQR: 2 – 13), 11% (10/89) received a resection of more than 30 centimeters. In six (6%) patients treated by a small bowel stoma, data was missing on length of resection . A colostomy was created in 42% (73/172) of the patients. Out of all small bowel stomas, 43% (43/99) were created for treatment of necrotizing enterocolitis. Treatment for an anorectal malformation was the most common (50/73, 63%) reason for a colostomy. Median time to stoma closure was 15 weeks (IQR: 8-30) with a median follow-up of 5 years (IQR: 2-9) after stoma closure. Early closure was performed in 21% (21/99) of the small bowel stomas and 1% (1/73) of the colostomies. A comparison of the patient characteristics of children treated with either small bowel stomas or colostomies is presented in Table 1. Changes in Z-scores from birth up until a year after stoma closure The individual Z-scores for birthweight, weight at the time of stoma creation and closure, and weight measurement within the first year after closure are presented in Figure 1 and the information on nutritional status and growth are presented in Table 2. In the presence of a stoma, 61% (105/172) of the young children were declining on the growth chart with a median Z-score for weight-for-age of -3.1 (IQR: -5.6 – -1.23) in the small bowel stoma group and -1.45 (IQR: -2.3 – -0.62) in the colostomy group at the time of stoma closure. This resulted in severe malnourishment during the stoma closure in 51% (50/99) of the patients with a small bowel stoma, and 16% (12/73) of those with a colostomy. Median time to stoma closure was 9 weeks (IQR: 6.3-15) in patients treated by a small bowel stoma and 28 weeks (IQR: 18 - 42) in the case of a colostomy. After stoma closure most young children were thriving with a positive tract on the growth chart, 74% (73/99) vs 58% (42/73) in the small bowel stoma and colostomy group respectively. The change in Z-score from the time point of stoma formation to stoma closure and to the time point within three months to a year after closure (mean: 9.2 months, std: 5 months) was significant in both patient groups treated by small bowel stoma (p<0.00) as well as colostomies (p = 0.04). Post-hoc test showed that within small bowel stomas this difference in Z-score was most profound between stoma formation and stoma closure
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