Common Conditions Requiring Stomas in Premature Infants

doi:10.1067/mjw.2003. 27 A neonatologists, neonatal intensive care unit (NICU) personnel, and pediatric surgeons have become increasingly successful in improving survival rates of premature neonates (preemies), the surgical creation of fecal stomas to manage diseases in this population has become more commonplace. Diversion of the fecal stream allows recovery of diseased organs and surgical anastamoses distal to the enterostomy, with improved outcomes. The stoma is usually temporary and created as a stage in the surgical management of congenital or acquired disease. Caring for these low, very low, or extremely low birth weight infants with their tiny stomas and special needs can be challenging and frustrating. Never before have more ostomy products been available for managing a wide variety of stomas and stomal complications. Many of these products are being used on premature infants with an ostomy. In general, however, caregivers lack knowledge regarding the management of preemie ostomies and are unfamiliar with ostomy equipment suitable for this population. The result is stoma care that is inappropriate for low gestational age infants, inconsistent among caregivers from shift to shift, and ineffective in containing effluent from the stoma or preventing stomal complications. WOC nurses provide expertise in managing ostomies in a wide variety of patients. They possess specialized knowledge of skin and wound care and familiarity with ostomy products, and can be an invaluable resource for nurses, physicians, and parents involved in the care of a premature infant with a stoma. Nevertheless, care of the low gestational age infant is so specialized that WOC nurses accustomed to caring for adults will benefit from an overview of the premature ostomy patient as a unique individual with needs quite different from those of adult ostomates. This article reviews disease conditions in the premature infant most commonly resulting in construction of fecal diversions and the types of stomas created during these surgeries. Unique aspects of preterm infant physiology that influence pouching and stomal management, such as immature epidermal barrier function and increased percutaneous absorption, are examined. Finally, ostomy equipment and pouching techniques appropriate for the preemie are discussed in detail to provide research-based guidelines and practical strategies for caring for premature ostomates.