AIM:To investigate the complications of intestinal stoma in children and to develop measures for decrease of their incidence.MATERIAL AND METHODS:The study included 152 children with congenital and acquired gastrointestinal pathology requiring surgical treatment with the imposition of intestinal stoma. Atresia of intestinal tube was observed in 28 (18.4%) children, meconium ileus - in 10 (6.6%) cases, Hirschsprung's disease - in 11 (7.2%)cases, anorectal malformations - in 39 (25.7%) cases, multiple malformations - in 11 (7.2%) patients, necrotic enterocolitis - in 56 (36.8%) patients, other reasons - in 7 (4.6%) cases. The average age of patients was 12,3±7,2 days. There were 93 (61.2%) boys and 59 (38.8%) girls. Ileostomy, ileocolostomy and colostomy were made in 37 (24.3%), 46 (30.3%) and 69 (45.4%) cases respectively. Time of intestinal stoma function was 18-217 days.RESULTS:Early complications were dehiscence in the area of stoma in 4 (2.6%) children, evagination in 7 (4.6%) patients, marginal necrosis of stoma in 2 (1.3%) cases, retraction of stomy into abdominal cavity in 1 (0.6%) child and abdominal skin maceration in 8 (5.2%) patients. Remote complications included dermatitis around stomy in 35 (23.1%) children, stenosis of stoma in 9 (5.9%) cases, evagination of stoma in 12 (7.9%) patients. Also, 5 patients were unable to use the colostomy bag due to vicious overlaying of intestinal stoma. Using the colostomy bags «Coloplast» and skin care products around the stoma significantly reduced (p<0.01) the number of complications at inpatient stage of treatment.CONCLUSION:Successful function of stoma depends on not only technical aspects but also obligatory care performance with timely correction of complications.

Background. Newborns often develop purulent septic complications soon after surgical treatment of inherent gastrointestinal pathology. The aim: to define the prognosis significance of catelicidine (LL-37) as the marker of inflammatory complications during the post-operation period in neonates with gastrointestinal pathologies. Patients and methods. 21 newborns with inherent intestinal obstruction were included into the study. Each child received surgical correction of the defect. The children were divided into 2 groups: group 1 (n = 10) — newborns with purulent inflammatory complications after the operation (anastomosis failure — 2, peritonitis with ileus — 3, sepsis and pneumonia — 5); group 2 (n = 11) — children with no post-surgery complications. Healthy newborns formed the reference group (n = 20). The level of catelicidine LL-37 in the blood plasma was determined in all the children at delivery (BCM Diagnostics). Patients in groups 1 and 2 had their catelicidine LL-37 concentration measured on the 1,3,7 and 14th day after surgery.Results. A statistically significant (p < 0,05) difference in catelicidine was revealed only on the first day. While investigating the difference in LL-37 levels in the blood serum between children from the reference group and children from groups 1 and 2, statistically significant differences were found on all days. Conclusion. Determining the catelicidine level is an effective way of predicting post-surgery complications in the correction of developmental gastrointestinal defects.

The influence of several factors, impacting on the development of purulent-septic complications in newborns with congenital gastrointestinal tract malformations was studied. As independent variables they were chosen both binary and numeral ones. Furthermore, the authors investigated the combined effect of different factors of pre-admission (primary and secondary) medical care, which had shown a high possibility of influence on the complications development during the preliminary analysis. The total amount of various analyzed predicting factors of purulent-septic complications after surgical procedures was 42. Three main groups of risk factors were established. These groups were associated with: 1) type of the performed post-operative analgesia and child sex; 2) disturbances of the intestinal wall permeability; 3) disturbances of the intestinal wall perfusion. In order to develop an appropriate model the method of logistic regression with variables normalization quazi-Newton approach was used. This model has high enough possibilities to predict both positive (risk of purulent-septic complications) and negative (absence of such risk) results. The rate of correctly predicted cases ofcomplications is 76%, the rate of their absence — 84%.