292

Linda C. D’Angelo

Dorothy Goodman

Neonatal Ostomy and

Gastrostomy Care

42

An ostomy is the construction of a permanent or temporary

opening in the intestine (enterostomy) or urinary tract (urostomy) through the abdominal wall to provide fecal or urinary diversion, decompression, or evacuation (1).

Gastrostomies (G tubes) are stomas that allow direct access

into the stomach and are used for feeding, medication

administration, and decompression. This chapter discusses

care of simple and complex ileostomies, colostomies, urostomies, and gastrostomies (see also Chapter 41). Tracheostomy

care is discussed in Chapter 37.

Enterostomies and Urostomies

A. Indications

Ostomies may be indicated in the neonate for a variety of

congenital or acquired conditions (Table 40.1). The stoma

is usually temporary, and reanastomosis of the bowel or urinary tract with closure of the stoma is performed during

infancy or early childhood (2, 3).

B. Types of Ostomies

1. There are several types of intestinal stoma. The patient’s

condition, the segment of bowel affected, and the size

of the patient’s abdomen often determine the type of

stoma and its external location. Figure 42.1 depicts the

most common types of neonatal stoma (1).

2. Urostomies are urinary diversions constructed to bypass

a dysfunctional portion of the urinary tract. Ileal conduits and ureterostomies are rarely performed in the

neonatal period.

3. A vesicostomy is an opening directly from the bladder

through the abdominal wall and is a more common urinary diversion in the neonate. Urine flows freely

through the stoma from the bladder.

C. Ostomy Assessment

The neonate with a stoma needs careful observation and

assessment for a variety of potential complications (4).

Monitoring the infant for function of the ostomy is vital in

the initial postoperative period. Possible surgical complications are paralytic ileus, intestinal obstruction, anastomotic

leak, and stomal necrosis. The factors to be considered during evaluation of the stoma are listed below.

1. Type of stoma: The segment of bowel from which the

stoma is made.

2. Viability: A healthy stoma should be bright pink to

beefy red and moist, indicating adequate perfusion and

hydration (Fig. 42.2). The stoma is formed from the

intestine, which is very vascular and therefore may

bleed slightly when touched or manipulated, but the

bleeding usually resolves quickly. The stoma is not sensitive to touch because it does not have somatic afferent

nerve endings (4).