Belted solutions for neonatal pouching challenges

Introduction: Intestinal diversions are created in infants and neonates due to issues such as Hirschsprung’s disease, intestinal atresia, necrotizing enterocolitis (NEC) and imperforate anus. At a large academic medical center in the Southeastern United States with a level III neonatal intensive care unit, management of these ostomies is often problematic because of stoma construction or location, multiple stomas, peristomal hernias, peristomal tubes and/or incisions, and is further compounded by the small size of the abdomen.

Approach: Bearing in mind the less mature, more permeable epidermis, an unusual but successful pouching technique with modified adult two-piece extended wear pouching systems was used. To reduce the adhesive footprint and make the barrier comparable in size to pediatric barriers, the tape border was cut off of the barrier. The barrier opening was cut to accommodate the patient’s presentation and the pouching system was belted in place to provide stabilization. Due to the diminutive size of the patients, the ostomy belts were re-sewn to a more appropriate size. Wear time ranged from 2-6 days with this approach. Parents & caregivers were instructed with pictorial instructions left at bedside.

Conclusion: It is essential to minimize chemicals and adhesion with neonatal/infant ostomates but it is of paramount importance to maintain a good pouch seal in order to avoid painful skin loss which worsens pouching issues and the angst the parents and staff are already experiencing. If this approach is used, it is imperative to teach the parents and nursing staff in addition to leaving instructions at the bedside to help insure continuity of approach and positive outcomes. No adverse outcomes were noted with the approach described.