Stoma recycling in a surgical neonatal unit: Prevalence, challenges, and review of nursing attitudes

Aim: Recycling has been shown to improve growth, nutrition and facilitate early stoma closure. We aim to review current practice and nursing experience at a tertiary paediatric surgical unit and to evaluate possible areas for improvement.

Method: Retrospective study of all neonates who underwent a stoma closure between January 2018 and October 2020, alongside a nursing staff survey on experience and barriers to effective recycling. Data presented as median (range) and number (percentage). P value <0.05 was regarded as significant.

Results: A total of 71 neonates were included; median birthweight 869.5 (500-3600)g and gestation 26 (23-40) for a median of 15.5 (1-51) days. Rates of early stoma closure were similar in both the recycling (RG) and non recycling groups (NRG); 15/29 vs. 21/42, p > 0.999. Thirty-nine neonatal nurses responded to the survey with 36/39 (92%) having prior experience of recycling. Time constraints were the main reason nurses felt it was difficult to achieve effective recycling, with some also being worried about causing damage. Increased training and parental involvement were two potential solutions suggested by nurses to overcome these issues.

Conclusion: Despite the known benefits, less than half of our cohort had successful recycling prior to stoma closure. Increased training, development of a uniform policy and involvement of the parents may help to improve the rates of stoma recycling.

Level of evidence: Level III (Retrospective Comparative Study).