As newborns have undeveloped systems and low immunity, any mildly improper nursing may probably cause peristomal skin complications and therefore, admirable stoma nursing techniques are critical for reducing incidence of complications [13-15]. Neonatal enterostomy is temporary ostomy and patients will usually undergo the secondary intestinal anastomosis operation three to six months later depending on their recovery status. In general, the patients will be discharged after they recover intestinal functions and their milk volume meets physiological requirements and therefore, family is the main venue of nursing after neonatal enterostomy and parents are the major caregivers after the patients are discharged from hospital. However, currently in China, medical services are concentrated in hospitals. As patients leave hospital, the medical service relationship between hospitals and patients ends accordingly . The majority of Chinese households are in the countryside, where medical level is low and most grass-roots medical centers are unable to provide professional stoma nursing service [17, 18]. Besides, most families that have limited educational background cannot fully master knowledge and skills in stoma nursing during the short inpatient stay and will go to local township or community hospitals for consultation when encountering nursing problems after discharge, only to find no professional nursing support or no answer to their questions. Consequently, the patients tend to visit the hospital only in the case of severe complications, which seriously undermines their health and quality of the secondary closure of ostomy. As found in this study, three months after discharge, most patients in the traditional nursing group have unhealthy peristomal skin and only 33 patients (23.1%) are in healthy status. Therefore, continuous follow-up and nursing guidance after discharge from hospital for patients after neonatal enterostomy are critical.
Continuous nursing extends the high-level and high-quality nursing service and psychological support at hospital to patients’ families to ensure that high-quality treatment and nursing proceed at home without being interrupted, which can effectively address the issue of insufficient support for patients’ families after discharge and improve the quality of home nursing [19, 20]. Previously, continuous nursing mainly takes the form of telephone follow-up, outpatient follow-up and family visit, but each one of the forms has its limitations . Telephone follow-up, though easy to conduct, is limited to verbal communications and cannot specifically identify perception of the families easily, be conducted anytime or whenever it’s needed or offer guidance under direct visual image, thus making it difficult to transmit information accurately. Outpatient follow-up and family visit, though supporting direct face-to-face guidance, are hard to conduct due to time cost, economic cost and labor cost. Therefore, to explore a more reasonable and efficient mode of continuous nursing management after neonatal enterostomy is an important issue clinically. WeChat, as the currently most popular instant messaging platform in China, is featured by low cost, convenience and support for face-to-face communication. Health education depending on the WeChat platform offers new approaches for continuous nursing  and it enjoys the following advantages. 1. With continuous nursing based on the WeChat platform, medical personnel can answer questions of the patients’ families in a timely manner, which improves timeliness and effectiveness of neonatal enterostomy nursing after discharge and saves tremendous time and economic cost for the families. 2. WeChat transmits information in various forms such as texts, voice, animations and videos, which is helpful for vivid information communication in both ways, ensures accurate and professional nursing intervention and makes it easier for the families to understand and accept knowledge on nursing and feeding. 3. With the WeChat group, the patients’ families can communicate and share their feelings, experience and achievements in nursing and feeding, with a team atmosphere of mutual support being shaped. Besides, when the medical personnel do not reply in time, the families with similar experience can offer help and share their own experience. 4. With WeChat, we can clearly see the photos and videos uploaded by the parents, be updated on the patients’ stoma conditions and their parents’ nursing status, correct nursing errors in time and offer real-time guidance, which can effectively improve the families’ nursing techniques and better nursing quality. 5. Communications via WeChat make the nursing work more relevant to reality, easier and compact and application of the WeChat platform in continuous nursing can effectively decrease missing rate and refusal rate of patients. In implementing continuous nursing based on the WeChat platform among patients after neonatal enterostomy, we have achieved admirable clinical effect. The study shows that in terms of peristomal skin DET score, the continuous nursing group dramatically outperforms the traditional nursing group in health status of peristomal skin. After discharge, the continuous nursing group replaces ostomy bags much less frequently than the traditional nursing group (P<0.05), saving the household expenses. This indicates that with continuous nursing and guidance based on the WeChat platform, medical personnel can help the patients’ families tackle nursing problems at home in time, the families can better understand knowledge on nursing and feeding, and the patients get access to better enterostomy nursing.
During the inpatient stay of patients after neonatal enterostomy, most mothers of the newborns are not in company at hospital because they are sitting the month after childbirth, but mothers are generally the main caregiver for home nursing. Therefore, the majority of the patients’ mothers know less about enterostomy nursing. For most families, especially mothers, this will incur a heavy psychological burden, and some may even lose confidence and have strong negative feelings . Also given that the grassroots medical level in China is low and most grassroots medical centers are unable to provide professional stoma nursing or address problems in time, the families are even further inclined to anxiety and negative feelings. Taking this into consideration, after the patients are discharged from the hospital, we will guide their mothers via WeChat to help them master nursing knowledge and skills as soon as possible. Also because WeChat supports timely and visual communication, in the case of emergencies with home nursing, we can offer guidance immediately. With the WeChat platform, our medical personnel regularly push information on health education and child nurturing to enable the families to study by making full use of home time, which boosts their confidence in nursing, improves their understanding and skills in enterostomy nursing and elevates their nursing abilities. Thanks to photo and video communications, we are rapidly updated on the patients’ rehabilitation effect after discharge and can correct mistakes in home nursing. In the meantime, we encourage the families in the WeChat group to communicate and share successful cases and experience, with the purpose of enabling the families to feel the strength of group efforts and enhancing their confidence and the sense of hope. By chatting via WeChat, we can also understand the patients’ psychological status in time, listen to them, offer care, guidance and support and ease their negative feelings and anxiety. As revealed by the study, compared with the first day after operation, the continuous nursing group has a much lower SAS score and SDS score three months after discharge (P<0.05), while the traditional nursing group has a difference that is not statistically significant, but rising. For SAS score and SDS score three months after discharge, the continuous nursing group considerably outperforms the traditional nursing group (P<0.05). This signals that continuous nursing from the patients’ families can noticeably alleviate the patients’ depression and anxiety.
The paper still has its limitations. Patients that are incapable of independently reading, have no communication device and are blocked in information communication are excluded from the study, which incurs selection bias.