Management of pneumatosis intestinalis after stoma takedown in preterm infants

We aimed to compare pre-term infants with and without post stoma takedown pneumatosis intestinalis (PSTPI), describe outcomes of PSTPI, and discuss current management strategies. We reviewed infants born at less than 34 weeks who underwent laparotomy with stoma formation and subsequent stoma takedown between 2010-2019 at two level IV NICUs. Comparisons were made between infants with PSTPI defined by the presence of PI on plain radiograph after stoma takedown (n=13), and those without PSTPI (n=102) with either Fisher's exact or Mann Whitney U test. No infants required urgent operation for PSTPI. All infants were treated with a period of NPO (median 8 days; range: 2-39) and antibiotic therapy (median 7 days; range:3-10). TPN at discharge was more common among the PSTPI group (31% vs 10%; p=0.05). Among this limited cohort, PSTPI among premature infants seems to follow a benign course and is often adequately treated with antibiotics and bowel rest.