Optimal stoma closure weight after intestinal perforation in extremely low birth weight infants based on the national clinical database in Japan

In extremely low-birthweight infants with stomas following neonatal intestinal perforation, early stoma closure is desirable to avoid complications associated with prolonged stoma management. However, from a surgical standpoint, closure after sufficient weight gain is considered safer due to improved tolerance of general anesthesia and intestinal anastomosis. To assess the optimal body weight for stoma closure, we used the National Clinical Database in Japan. This nationwide retrospective study included 420 neonates with intestinal perforations who weighed <1000 g at the time of enterostomy and subsequently underwent stoma closure between 2017 and 2022. A multivariate analysis was conducted using the preoperative items of stoma closure as variables and the postoperative 90-day status, rate of unexpected reoperation within 30 days postoperatively, and rate of postoperative complications as outcomes. The median body weight at stoma closure in all eligible patients was 1950 g [1500–2350]. Data indicated that patients with liver failure (p = 0.002) and growth failure (p = 0.016) were more likely to undergo stoma closure at lower body weights. Multivariate analysis revealed that cardiovascular disease (OR = 3.41 (1.06–10.81, p = 0.040)) and stoma closure weight <1000 g (OR = 10.65 (2.27–54.98, p = 0.003)) were independently associated with postoperative mortality within 90 days, and preoperative liver failure was a significant predictor of postoperative complications (OR = 2.17 (1.19–3.87, p = 0.010)). Stoma closure in infants weighing <1000 g may be associated with an increased risk of mortality. To mitigate this risk, efforts should focus on preventing the progression of liver failure and promoting weight gain through appropriate nutritional interventions, such as recycling stoma effluent or administering intravenous omega-3 fatty acid emulsions.