a. A purple or dark brown to black stoma with loss of
tissue turgor and dryness of the mucous membrane
may indicate ischemia and possible stomal necrosis.
b. A pale pink stoma is indicative of anemia.
3. Size: The stoma shape (round, oval, mushroom, or
irregular) and diameter (length and width) in inches or
millimeters is noted. In the early postoperative period,
the stoma will be edematous. After the first 48 to
72 hours, the edema should resolve and result in a
reduction in size of the stoma, which should, however,
postoperatively. It is not uncommon for the stoma to
become edematous when exposed to air while changing the pouch; this edema generally resolves quickly
4. Stomal height: The degree of protrusion of stoma from
the skin. Ideally, the surgeon will evert the stoma prior
to suturing it to the skin to produce an elevation, which
will promote a better seal with the ostomy wafer. With
the stoma elevated above the surface of the skin, the
effluent will be more likely to go into the pouch instead
of staying in contact with the skin (2). Eversion of the
stoma, referred to as maturing the stoma, is not always
possible in neonates, in whom blood supply may be
Chapter 42 ■ Neonatal Ostomy and Gastrostomy Care 293
tenuous, and in situations in which the bowel is markedly edematous (1,5).
5. Stomal construction: The ostomy may be an end, loop,
or double barrel (Figs. 42.1 and 42.3).
7. Peristomal skin: Ideally the peristomal skin should be
intact, nonerythematous, and free from rashes.
However, frequently the stoma(s) is not separate from
the surgical incision (Fig. 42.4). There is often not
enough space on the baby’s abdomen for the surgeon to
create separate incisions. In addition, stomas are often
in close proximity to the umbilicus, ribs, or groin,
which may interfere with pouch selection and adherence (6).
(1) Hemorrhage during the immediate postoperative period is caused by inadequate hemostasis
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