Ostomy complications and clinical profile of children attending in a reference hospital

Objective: The aim was to study the incidence of ostomy complications in children, as well as characterize the sociodemographic and clinical profile of the children seen in the outpatient clinic. Methods: This is a quantitative, descriptive, prospective character study performed with 37 children between February and August 2016 at an outpatient clinic of a public hospital in Brasília, Federal District. For the statistical analysis, the categorical variables were described by absolute and relative frequencies and the quantitative variables were described by means of average and standard deviation. The chi-square test was used to verify associations between qualitative variables. Results: From the studied children, 56,7% had ostomy complications. The most frequent complication was contact dermatitis. Conclusion: Not that many studies are directed towards the children with ostomy. It is expected that the data obtained from this research can subsidize action planning on behalf of health professionals to reduce and/or avoid the complications incidence. DESCRIPTORS: Postoperative complications; Ostomy; Child; Enterostomal therapy. https://doi.org/10.30886/estima.v18.911_PT

Ostomy and stoma are words derived from the Greek stóma which means opening or mouth, indicating the surgical exteriorization of organs or hollow viscera 2 . Although the making of a stoma is considered a simple surgical procedure and is commonly performed, complications that are usually underestimated may occur, such as parastomal hernia, stenosis, retraction, dermatitis, among others 3 .
In Brazil, all individuals up to twelve years of age are considered children 4 . Therefore, the care provided to the child with stoma requires the involvement of family members and support from health professionals 5 , especially nurses, to assist them in the proper management of the stoma and its possible complications.
There are few studies that demonstrate the epidemiological data regarding children with stoma 2 , as well as the complications of stomata in children, revealing the need for further research in this area. Periestomal dermatitis, loop prolapse and retraction are some of the complications observed in this clientele 6,7 . However, most of the published studies still refer only to the adult population, and it is often not possible to adapt the results for the pediatric population.
This study is justified by the need to investigate the occurrence of complications related to the stoma and periestomal skin in childhood, as well as to know its clinical profile, being these factors important for the planning of care, the construction of prevention strategies and the organization of health services that attend this clientele.

OBJECTIVE
The study aimed to verify the occurrence of stoma complications in children.

METHODS
It is a quantitative, descriptive, prospective study, carried out with 37 children attended at the Outpatient Ostomy Clinic of a public hospital in Brasília, Federal District, being this hospital unit a reference in neonatal and pediatric surgical care, both outpatient and emergency.
The sample selection was made for convenience, i.e., not random, composed of children registered for outpatient care in the period from February to August 2016. The inclusion criteria established for this study were: having a stoma (respiratory, gastrointestinal and/or urinary), regardless of the time of surgery; being between zero and incomplete twelve years of age; and having made at least two outpatient appointments. Those individuals aged 12 or older and those whose legal representatives refused to sign the Free and RESUMEN Objetivo: Estudiar la ocurrencia de las complicaciones de ostomías en niños, así como caracterizar el perfil sociodemográfico y clínico de los niños atendidos en el ambulatorio. Métodos: Se trata de un estudio cuantitativo, descriptivo, de carácter prospectivo, realizado entre 37 niños en el periodo de febrero a agosto de 2016 en un ambulatorio de un hospital de la red pública de Brasilia, Distrito Federal. Para el análisis estadístico se describieron las variables categóricas por medio de frecuencia absoluta y relativa y las variables cuantitativas por medio del promedio y desvío estándar. El test chi cuadrado fue utilizado para comparar asociaciones entre variables cuantitativas. Resultados: De los niños estudiados, el 56,7% presentaron complicaciones relacionadas a las ostomías. La complicación más frecuente fue dermatitis de contacto. Conclusión: Pocos estudios están dirigidos solo a niños con estomías. Se espera que los datos obtenidos a partir de esta investigación puedan apoyar la planificación de las acciones de los profesionales de salud, a fin de evitar y/o disminuir la ocurrencia de las complicaciones. DESCRIPTORES: Complicaciones posoperatorias; Estomía; Niño; Estomaterapia.
Informed Consent Term (FICT) or withdrew their consent were excluded.
The data collection was carried out using an instrument prepared by researchers specifically for this purpose 8 . In the first month, a pilot study was conducted with 10 children to verify the adequacy of the data collection instrument and, as there was no need to adjust it, these children were included in the final sample.

RESULTADOS
The study identified that, of the 37 children who composed the sample, the majority were male (67.6%), from the Federal District (54%), aged between two and twelve months (67.6%) and fit the category without schooling (67.6%).
Regarding the cause that led to the making of stoma in children, 73% were made due to congenital anomalies (n = 27), 13.5% of the stomata were made by intestinal perforation (n = 5), 8.1% had intestinal obstructions as a causal factor (n = 3) and 5.4% were made due to probable motility disorder (n = 2).
All children who participated in this study had their stomata classified as temporary, and 73% of them had no forecast for reconstruction of intestinal transit and 13.5% had 2 months forecast for reconstruction. There was no information in the medical records about the prediction for reconstruction in the case of urinary stomata. The data regarding the time the children remained with their stomata are described in Table 1. In this study, 86.5% of the children had only one type of stoma, 5.4% had 2 types and 8.1% had one type of stoma accompanied by a mucosal fistula, as shown in Fig. 1. were accompanied by their father and mother.
Regarding the use of collecting equipment, 59.5% of children used collecting equipment frequently (n = 22) and 40.5% did not use it frequently (n = 15).
It was possible to observe that 21 children presented stoma complications, and in some of them more than one type of complication occurred. The cumulative incidence of stoma complications in this study was 56.7%.
Contact dermatitis was the most frequent among the complications observed (76% of the cases), as shown in Table 2. Regarding the factor that caused the complications, in 76% they occurred due to skin contact with effluents (n = 19), in 8% appeared by hypersensitivity to the adhesive base of the collecting equipment (n = 2), in 8% occurred by the surgical technique for stoma construction(n = 2) and in 8% occurred by the increase in intra-abdominal pressure (n = 2). Regarding the treatment used to solve the complication, in 100% of the cases products were used whose purpose was to provide a protective barrier for the periestomal skin and/or to treat dermatitis (synthetic skin protectors with powder or paste presentation). No specific products were used for the treatment of other complications presented by the children in this study.
The variables "sex" and "occurrence of complication", as well as "previous orientation on the making of the stoma" and "occurrence of complication" had their absolute frequencies compared and associated through chi-square test, showing that there was no significant statistical association. When the variables "use of the collecting equipment" and "occurrence of complication" were associated, a significant statistical association was observed, as shown in Table 3.

DISCUSSION
The predominance of male children without schooling was observed due to age, corroborating data from other studies 1,6 .
Congenital malformations such as congenital megacolon and imperforate anus were the most frequent medical diagnoses in this study, and these are the ones that usually lead children to be submitted to the making of stomata 1,6,7,10 .
The imperforate anus is one of the most common anorectal anomalies and can be associated with defects in other systems, such as the urogenital tract. Usually, a colostomy is performed in the newborn and, four to six months later, an anal fistula is made, for later surgical reapproach and reconstruction of its intestinal transit 11 .
The congenital megacolon is a multifactorial disease that results from the absence of migration of cells from the neural crest to the large intestine, generating an absence of nerve plexus in the colon and, consequently, absence of motility in the affected segment and intestinal obstruction 10,12 .
Other comorbidities such as necrotizing enterocolitis, inflammatory bowel diseases, as well as trauma caused by violence or domestic accidents also lead children to become individuals with stoma, either temporarily or definitely 11,12 .
In the children who composed the sample of this study, there was a predominance of colostomies related to other types of stomata, corroborating data from other studies 6,7,10 . Some children had more than one stoma, and this is a very common condition in this clientele. Thus, it is essential that the nurses seek training to serve this clientele and that the assistance includes the evaluation of the clinical conditions of the child, the demarcation of the place where the stoma will be made, the teaching of self-care or the care that will be provided by parents and/or guardians, as well as the identification of factors that may lead to the occurrence of complications and their proper management.
It is noticeable that few studies are directed only to the pediatric population and, therefore, it is suggested that future researches explore the issue of stoma complications in children, as well as their characteristics, factors associated with their appearance and the treatment employed in the management of these complications. It is expected that the data obtained from this research support the planning of health professionals' actions in order to reduce and/or avoid the occurrence of these complications.