Ethics approval was obtained from the Research Ethics Board of the Children’s Hospital of Fudan University. All participants were informed and consented to be involved in the study.
Study tool
“very early-onset inflammatory bowel disease, “VEO-IBD”, “ Jejunostomy,” “ Ileostomy”, “Colostomy,“ “Ascending colostomy,” “Transversostomy”, “Descending colostomy,” “Sigmoid colostomy,” “Enterotomy,” “ Complication”, “Ostomy edema,” “Ostomy hemorrhage,“ “Ostomy necrosis,” “Mucocutaneous separation”, “Irritant dermatitis,” “Fistula” and “Risk factor” were used to search the database including China National Knowledge Network, Wanfang Data, Chinese biomedical literature database, PubMed, MEDLINE, Web of Science, EMBASE to screen risk factors for postoperative complications of VEO-IBD enterostomy and to consult IBD specialists in pediatrics to design research tools.
The demographic characteristics include gender, age of diagnosis, age of operation, length of hospitalization, total hospital expenses, clinical manifestation, medication use, diagnosis, and clinical outcome.
The enterostomy-related characteristics comprise preoperative X-ray results, the type of emergency and selective operations, incision complications, the second surgery's incidence, and the second surgery's cause.
Stoma-related characteristics include the intestinal location of the stoma, the type of stoma (single-barreled stoma, loop stoma, double-barreled stoma), the type of complication(stomal complication, peristomal stoma), the number of cases of stoma closure, the time from enterostomy performed to the stoma closure, the time from enterostomy performed to the stomal-related complication occurred(hour), the time from enterostomy performed to the peristomal-related complication occurred(hour), type of stomal complications, type of peri-stomal complications, and the type of stoma bag (one-piece, two-piece, one-piece convex, two-pieces convex), DET score (including the first DET score, DET score at one week, and DET score at discharge).
The Ostomy Skin Tool (OST) is widely used and internationally accepted to assess the extent and severity of peristomal skin change.22–23, which has three domains: discoloration (D), erosion (E), and tissue overgrowth (T) (DET). Within each domain, the area of peristomal skin affected and the severity of the skin changes are considered. For example, the DET score ranges from 0–15; 0 represents normal skin, and 15 represents the worst combination of severity and extent. The levels of severity of DET are defined as “mild” (DET < 4), “moderate” (DET ≥ 4 < 7), and “severe” (DET ≥ 7).
The IBD-related indexes include Esr, WBC, CRP, and wPCDAI, which were measured at four-time points: at admission, three days before surgery, one week after surgery, and at discharge. wPCDAI was developed specifically for children with Crohn's disease. It assesses abdominal pain, general status, number of stools (daily), ESR, weight change, perianal lesions, and intestinal manifestations with an overall score ranging from 0 to 125. In addition, the severity of disease activity was differentiated according to the score: remission < 12.5, mild 12.5–40, moderate 40-57.5, and severe > 57.5.
Nutrition-related characteristics include the physical indexes (height, weight, WAZ and HAZ), level of malnutrition (mild malnutrition, moderate malnutrition, severe malnutrition), the type of preoperative nutritional support (EN, PN, EN combined PN), postoperative nutritional support starting time, the time from the enterostomy completed to the administration of postoperative healthy (hour), the type of postoperative nutrition support (EN, PN, EN combined PN).
The registered incision, ostomy, and continence (WOC) nurse assessed all the stomas and incisions of the children.