Neonates with a small bowel ostomy suffer from fluid and electrolyte loss, long term total parenteral nutrition (TPN) with central venous line- or gut-born infections and cholestatic liver disease. Re-infusion in the distal ileostomy of proximal ostomy output might reduce the loss of valuable small bowel contents as well as stimulate the structural and functional integrity of the remaining bowel. Aim: The present study evaluates our experience in 15 cases where we either re-infused the stomal contents (group I, n=9) or where for various reasons no re-infusion was performed (group II, n=6). Methods: Diagnosis of small bowel atresia, necrotizing enterocolitis or meconium ileus were equally distributed between group I and II. Mean birth weight and gestational age were 2388 gram (570-3580) and 36 weeks (27-40) and 1858 gram (730-3345) and 31 weeks (25-38) in group I and II respectively. The evaluation period considered the time from birth until closure of the ostomies. Parameters studied are mean weight gain per week, blood culture proven central venous line infections, total number of infections, increased direct bilirubin value and complications related to bowel disuse after closure of the ostomies. The retrospective character of the study and the small numbers did not allow an adequate statistical analysis.Results: No mortality was found in either group during the observation period. The mean weight gain per week in group I and II was 99.1 gram (54-144) and 104.8 gram (58-128) respectively. Bacteriologically proven line sepsis was encountered 3 times in group I versus 5 times in group II. The total number of infections was respectively 14 and 51 in group I and II. In group I direct bilirubin was increased 3 times, in group II this occurred in 5 patients. Finally, in group I no complications were seen after ostomy closure whereas in group II, 2 patients developed post-operative ileus after ostostomy closure requiring re-operation. One patient in group II developed gall stones requiring cholecystectomy at the age of one year.

Conclusion: These data show that distal ileostomy re-infusion of proximal ostomy output in neonates is feasible and might have beneficial effects on the frequency of bacteriologically proven line sepsis, the total number of infections, and cholestatic liver disease. Finally, the post-operative course after stomal closure seems to benefit from the early use of the distal bowel.