245 Impact of presence, level and closure of a stoma on growth in young children Chapter 11 (p<0.00) showing a decline in Z-score as well as the moment of stoma closure and within a year following closure (p<0.00) showing an incline. Z-scores did not differ significantly between moment of stoma formation and within a year following closure (p = 0.44). In colostomies the post-hoc test showed a borderline non-significant (p = 0.07) difference in Z-scores between the moment of stoma closure and within a year following closure. The differences in Z-scores between formation and closure (p = 0.10) and formation and within a year following closure (p = 0.24) were similar. Factors influencing growth in patients treated with a stoma There was no significant difference in Z-score at the moment of closure (p = 0.19) for as well as the Z-score within the year after closure (p = 0.20) when comparing patients that had early closure and those that had not. The age at closure differed significantly (p < 0.00) between those who had an early closure (median 11 months; IQR 9 – 14) and those who had not (median: 16 months; IQR 11 – 21). Those treated with a proximal small bowel stoma had significantly lower Z-scores (p = 0.01) at stoma closure compared to those with a non-proximal small bowel stoma, but weight within a year after closure did not differ between both groups (p = 0.07). Moreover, those who received a major small bowel resection had a lower Z-score at stoma closure (p = 0.04) than those with less than 30 centimeters of resected small bowel. This significant difference disappeared within a year after closure at which moment the Z-scores did not differ between groups (p = 0.27). From the 172 young children, 49% (84/172) had data regarding urinary sodium measurements. After the creation of a small bowel stoma, 92% (55/60) of the young children had a mild or severe sodium deficiency, following a colostomy this was 83% (20/24), Table 3. Of the young children with a small bowel stoma, 92% (55/60) received sodium supplementation. In 68% (41/60) of patients, there were more than two urine sodium levels below 30 mmol/L after the start of supplementation, indicating inadequate sodium supplementation. In the patients with a colostomy, 54% (13/24) received sodium supplementation which was inadequate in 29% (7/24). The median Z-score at stoma closure of adequately supplemented children was -2.4 (IQR: -4.3 – -1.3) which is lower than the median in non-adequately supplemented children which was -1.7 (IQR: -3.4 – -0.5). This difference was borderline non-significant (p=0.06). A year after closure, this difference remained non-significant (p=0.42). Also, there was no correlation (p=0.50) between adequate sodium supplementation and a positive growth curve in the presence of a stoma.
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