PC1107: Determinants of Outcome in Infants with Intestinal Failure and Ostomy Following Restoration of Intestinal Continuity

Background: Infants with intestinal failure (IF) and ostomy form a major population of a neonatal intensive care unit. They are at risk for mortality, long hospital stays, prolonged dependence on parenteral nutrition, blood stream infections, cholestasis, and growth failure. The factors that result in better postoperative outcomes in infants with IF who undergo restoration of intestinal continuity (reanastomosis; RA) are currently not well understood.

Methods: We conducted a single center, retrospective cohort review of infants admitted to Texas Children's Hospital between November 2017 and December 2020 with IF requiring stoma creation and subsequent RA. Data abstracted included demographics, medical and surgical characteristics, and nutrition information. Measured outcomes included mortality, liver transplant, duration of hospital stay, cholestasis and ability to achieve enteral autonomy. Logistic regression was used to investigate associations with binary outcomes and linear regression was used for continuous outcomes.

Results: Fifty-five infants with a median gestational age of 27 weeks and the birth weight of 910 g were included (Table 1). Enteral feeds were achieved in 87% of infants, 3 infants died, and no transplants were noted. Variables associated with significant outcomes are shown in Table 2. Among gastrointestinal diagnoses, necrotizing enterocolitis was associated with prolonged hospital stay. Longer duration between ostomy and RA was associated with decreased likelihood of achieving enteral autonomy, prolonged hospital stay, and death. Mature gestational age at birth, presence of ileocecal valve (ICV), ileostomy, lower level of conjugated bilirubin, amount of enteral nutrition prior to RA, and better weight z-score at both ostomy creation and RA were associated with better post-operative outcomes.

Conclusion: In this retrospective study of infants with IF and stoma, gestational age, level of ostomy, ICV presence, duration of discontinuity, nutritional status and presence of cholestasis prior to restoration of intestinal continuity appear to affect postoperative outcomes. We speculate that infants’ nutritional status prior to reanastomosis is a modifiable variable that could positively impact outcomes.