CC BY 4.0 · Eur J Pediatr Surg
DOI: 10.1055/a-2067-4847
Original Article

Impact of Presence, Level, and Closure of a Stoma on Growth in Young Children: A Retrospective Cohort Study

1   Department of Pediatric Surgery, Amsterdam UMC Locatie AMC, Amsterdam, the Netherlands
Irene Vogel
2   Department of Surgery, Amsterdam UMC Locatie AMC, Amsterdam, the Netherlands
Justin R. de Jong
3   Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
Pieter J. Tanis
4   Department of Surgery, Erasmus MC, Rotterdam, Zuid-Holland, the Netherlands
Ramon Gorter
5   Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam UMC, Amsterdam, the Netherlands
Merit Tabbers
6   Department of Pediatric Gastroenterology, Hepatology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
L. W. Ernest van Heurn
3   Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
Gijsbert Musters
1   Department of Pediatric Surgery, Amsterdam UMC Locatie AMC, Amsterdam, the Netherlands
Joep P. M. Derikx
3   Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
› Author Affiliations


Introduction A stoma will cause nutrients loss which could result in impaired growth. Impaired growth can negatively impact long-term development. This study aims to evaluate: (1) the effect of stomas on growth comparing small bowel stoma versus colostomy and (2) if early closure (within 6 weeks), proximal small bowel stoma (within 50 cm of Treitz), major small bowel resection (≥ 30 cm), or adequate sodium supplementation (urinary level ≤ 30 mmol/L) influences growth.

Methods Young children (≤ 3 years) treated with stomas between 1998 and 2018 were retrospectively identified. Growth was measured with weight-for-age Z-scores. Malnourishment was defined using the World Health Organization's definition. Comparison between changes in Z-scores at creation, closure, and a year following closure was done by Friedman's test with post hoc Wilcoxon's signed rank test or Wilcoxon's rank-sum test when necessary.

Results In the presence of a stoma in 172 children, 61% showed growth decline. Severe malnourishment was seen at the time of stoma closure in 51% of the patients treated by small bowel stoma and 16% of those treated by colostomy. Within a year following stoma closure, 67% showed a positive growth trend. Having a proximal small bowel stoma and undergoing major small bowel resection led to significantly lower Z-scores at closure. Adequate sodium supplementation and early closure did not lead to significant changes in Z-scores.

Conclusion Stomas have a negative impact on growth in the majority of children. This impact might be decreased by preventing small bowel stomas when possible, specifically proximal stomas, and limiting small bowel resection. Since stoma closure is essential in reversing the negative effect on growth, we opt that early closure might result in an early shift to catch-up growth.

Publication History

Received: 20 December 2022

Accepted: 28 March 2023

Accepted Manuscript online:
01 April 2023

Article published online:
16 May 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

  • References

  • 1 Steinau G, Ruhl KM, Hörnchen H, Schumpelick V. Enterostomy complications in infancy and childhood. Langenbecks Arch Surg 2001; 386 (05) 346-349
  • 2 Hunter CJ, Chokshi N, Ford HR. Evidence vs experience in the surgical management of necrotizing enterocolitis and focal intestinal perforation. J Perinatol 2008; 28 (Suppl. 01) S14-S17
  • 3 Vogel I, Schattenkerk LDE, Venema E. et al. Major stoma related morbidity in young children following stoma formation and closure: a retrospective cohort study. J Pediatr Surg 2022; 57 (10) 402-406
  • 4 Bethell G, Kenny S, Corbett H. Enterostomy-related complications and growth following reversal in infants. Arch Dis Child Fetal Neonatal Ed 2017; 102 (03) F230-F234
  • 5 Homan GJ. Failure to thrive: a practical guide. Am Fam Physician 2016; 94 (04) 295-299
  • 6 Corbett SS, Drewett RF. To what extent is failure to thrive in infancy associated with poorer cognitive development? A review and meta-analysis. J Child Psychol Psychiatry 2004; 45 (03) 641-654
  • 7 Wolf L, Gfroerer S, Fiegel H, Rolle U. Complications of newborn enterostomies. World J Clin Cases 2018; 6 (16) 1101-1110
  • 8 Chong C, van Druten J, Briars G. et al. Neonates living with enterostomy following necrotising enterocolitis are at high risk of becoming severely underweight. Eur J Pediatr 2019; 178 (12) 1875-1881
  • 9 Crealey M, Walsh M, Awadalla S, Murphy JF. Managing newborn ileostomies. Ir Med J 2014; 107 (05) 146-148
  • 10 Honoré KD, Johansen MN, Rasmussen L, Zachariassen G. Stoma closure improves head circumference growth in very preterm infants after necrotizing enterocolitis. Eur J Pediatr Surg 2021; 31 (06) 504-508
  • 11 Baker ML, Williams RN, Nightingale JM. Causes and management of a high-output stoma. Colorectal Dis 2011; 13 (02) 191-197
  • 12 Eeftinck Schattenkerk LD, Backes M, de Jonge WJ, van Heurn ELW, Derikx JPM. Treatment of jejunoileal atresia by primary anastomosis or enterostomy: double the operations, double the risk of complications. J Pediatr Surg 2022; 57 (09) 49-54
  • 13 Bower TR, Pringle KC, Soper RT. Sodium deficit causing decreased weight gain and metabolic acidosis in infants with ileostomy. J Pediatr Surg 1988; 23 (06) 567-572
  • 14 Mansour F, Petersen D, De Coppi P, Eaton S. Effect of sodium deficiency on growth of surgical infants: a retrospective observational study. Pediatr Surg Int 2014; 30 (12) 1279-1284
  • 15 Bischoff AR, Tomlinson C, Belik J. Sodium intake requirements for preterm neonates: review and recommendations. J Pediatr Gastroenterol Nutr 2016; 63 (06) e123-e129
  • 16 World Health Organization. WHO definitions of congenital anomalies. Accessed on April 22, 2023, at:
  • 17 Simon L, Hanf M, Frondas-Chauty A. et al. Neonatal growth velocity of preterm infants: the weight Z-score change versus Patel exponential model. PLoS One 2019; 14 (06) e0218746
  • 18 Veenstra M, Nagappala K, Danielson L, Klein M. Timing of ostomy reversal in neonates with necrotizing enterocolitis. Eur J Pediatr Surg 2015; 25 (03) 231-235
  • 19 Butterworth SA, Lalari V, Dheensaw K. Evaluation of sodium deficit in infants undergoing intestinal surgery. J Pediatr Surg 2014; 49 (05) 736-740
  • 20 Burch J. Nutrition and the ostomate: input, output and absorption. Br J Community Nurs 2006; 11 (08) 349-351
  • 21 DeBoer MD, Scharf RJ, Leite AM. et al. Systemic inflammation, growth factors, and linear growth in the setting of infection and malnutrition. Nutrition 2017; 33: 248-253
  • 22 Lee J, Kang MJ, Kim HS. et al. Enterostomy closure timing for minimizing postoperative complications in premature infants. Pediatr Neonatol 2014; 55 (05) 363-368
  • 23 Zani A, Lauriti G, Li Q, Pierro A. The timing of stoma closure in infants with necrotizing enterocolitis: a systematic review and meta-analysis. Eur J Pediatr Surg 2017; 27 (01) 7-11
  • 24 Struijs MC, Poley MJ, Meeussen CJ, Madern GC, Tibboel D, Keijzer R. Late vs early ostomy closure for necrotizing enterocolitis: analysis of adhesion formation, resource consumption, and costs. J Pediatr Surg 2012; 47 (04) 658-664
  • 25 Eeftinck Schattenkerk LD, Musters GD, Coultre SEL, de Jonge WJ, van Heurn LE, Derikx JP. Incisional hernia after abdominal surgery in infants: a retrospective analysis of incidence and risk factors. J Pediatr Surg 2021; 56 (11) 2107-2112
  • 26 Hall NJ, Curry J, Drake DP, Spitz L, Kiely EM, Pierro A. Resection and primary anastomosis is a valid surgical option for infants with necrotizing enterocolitis who weigh less than 1000 g. Arch Surg 2005; 140 (12) 1149-1151
  • 27 Stollman TH, de Blaauw I, Wijnen MH. et al. Decreased mortality but increased morbidity in neonates with jejunoileal atresia; a study of 114 cases over a 34-year period. J Pediatr Surg 2009; 44 (01) 217-221
  • 28 Trautmann T, Bang C, Franke A, Vincent D, Reinshagen K, Boettcher M. The impact of oral sodium chloride supplementation on thrive and the intestinal microbiome in neonates with small bowel ostomies: a prospective cohort study. Front Immunol 2020; 11 (1421): 1421
  • 29 Al-Dahhan J, Haycock GB, Chantler C, Stimmler L. Sodium homeostasis in term and preterm neonates. I. Renal aspects. Arch Dis Child 1983; 58 (05) 335-342
  • 30 Widness JA. Pathophysiology of anemia during the neonatal period, including anemia of prematurity. Neoreviews 2008; 9 (11) e520
  • 31 Koike Y, Uchida K, Nagano Y. et al. Enteral refeeding is useful for promoting growth in neonates with enterostomy before stoma closure. J Pediatr Surg 2016; 51 (03) 390-394