High-output stoma after enterostomy for neonatal necrotizing enterocolitis: a retrospective cohort study.
- 1Department of Neonatology, Children's Hospital of Nanjing Medical University, Nanjing, China.
Abstract
High-output stoma (HOS) is a challenging complication after enterostomy for necrotizing enterocolitis (NEC), leading to massive fluid and nutrient losses, growth failure, and prolonged hospitalization; however, its risk factors and optimal management remain incompletely defined. This study aims to identify independent risk factors for HOS following NEC enterostomy and to evaluate its impact on clinical outcomes in neonates. This retrospective cohort study enrolled 236 infants who underwent small bowel enterostomy for NEC at a single centre. HOS was defined as stoma output >40 mL/kg/day or >50% of enteral intake lasting >48 hours. Univariate and multivariate logistic regression, receiver operating characteristic (ROC) analysis, and subgroup comparisons were performed. HOS occurred in 58 infants (24.6%). Independent risk factors included residual proximal small bowel length ≤105 cm [odds ratio (OR) 8.65, 95% confidence interval (CI): 3.76-19.93], birth weight <1,250 g (OR 4.42), gestational age <30 weeks (OR 3.33), extensive NEC (OR 2.44), and NEC stage III (OR 2.04). The combined predictive model demonstrated excellent discrimination [area under the curve (AUC) 0.906, sensitivity 84.5%, specificity 87.6%]. Infants with residual length ≤105 cm had significantly higher HOS incidence (62.0% vs. 5.7%), longer time to full enteral nutrition, extended hospital stay, and lower weight gain velocity (all P<0.001). The model's calibration was acceptable (Hosmer-Lemeshow P=0.62), and bootstrap internal validation yielded an optimism-corrected AUC of 0.88 (95% CI: 0.83-0.93). Residual proximal small bowel length ≤105 cm is the strongest predictor of HOS after NEC enterostomy. The five-variable model facilitates early risk stratification and guides targeted nutritional and surgical interventions. Multicentre prospective studies are warranted to validate these findings.
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BibTeX
@article{liu2026highoutput,
title = {{High-output stoma after enterostomy for neonatal necrotizing enterocolitis: a retrospective cohort study.}},
author = {Yuyao Liu and Yueyue Chen and Xingzhou Zhou and Yanbo Wang},
journal = {Translational pediatrics},
year = {2026},
month = oct,
doi = {10.21037/tp-2026-0630},
url = {https://europepmc.org/article/MED/42996400},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - High-output stoma after enterostomy for neonatal necrotizing enterocolitis: a retrospective cohort study.
AU - Yuyao Liu
AU - Yueyue Chen
AU - Xingzhou Zhou
AU - Yanbo Wang
PY - 2026
DA - 2026/10/26
JO - Translational pediatrics
DO - 10.21037/tp-2026-0630
UR - https://europepmc.org/article/MED/42996400
AB - High-output stoma (HOS) is a challenging complication after enterostomy for necrotizing enterocolitis (NEC), leading to massive fluid and nutrient losses, growth failure, and prolonged hospitalization; however, its risk factors and optimal management remain incompletely defined. This study aims to identify independent risk factors for HOS following NEC enterostomy and to evaluate its impact on clinical outcomes in neonates. This retrospective cohort study enrolled 236 infants who underwent small bowel enterostomy for NEC at a single centre. HOS was defined as stoma output >40 mL/kg/day or >50% of enteral intake lasting >48 hours. Univariate and multivariate logistic regression, receiver operating characteristic (ROC) analysis, and subgroup comparisons were performed. HOS occurred in 58 infants (24.6%). Independent risk factors included residual proximal small bowel length ≤105 cm [odds ratio (OR) 8.65, 95% confidence interval (CI): 3.76-19.93], birth weight <1,250 g (OR 4.42), gestational age <30 weeks (OR 3.33), extensive NEC (OR 2.44), and NEC stage III (OR 2.04). The combined predictive model demonstrated excellent discrimination [area under the curve (AUC) 0.906, sensitivity 84.5%, specificity 87.6%]. Infants with residual length ≤105 cm had significantly higher HOS incidence (62.0% vs. 5.7%), longer time to full enteral nutrition, extended hospital stay, and lower weight gain velocity (all P<0.001). The model's calibration was acceptable (Hosmer-Lemeshow P=0.62), and bootstrap internal validation yielded an optimism-corrected AUC of 0.88 (95% CI: 0.83-0.93). Residual proximal small bowel length ≤105 cm is the strongest predictor of HOS after NEC enterostomy. The five-variable model facilitates early risk stratification and guides targeted nutritional and surgical interventions. Multicentre prospective studies are warranted to validate these findings.
SN - 2224-4336
SN - 2224-4344
ER -