The impact of early stoma closure on infants after surgery for necrotizing enterocolitis (NEC): real-world data analysis.

To evaluate the impact of early (< 8 weeks) versus late (≥ 8 weeks) stoma closure on postoperative recovery and complications in preterm infants following surgery for necrotizing enterocolitis (NEC). In this multicenter retrospective cohort study, we analyzed data from preterm infants who underwent stoma closure between 2011 and 2022. Propensity score matching (PSM) was applied in a 1:2 ratio to balance baseline characteristics between early and late closure groups. Outcomes assessed included stoma-related complications, operative characteristics, gastrointestinal recovery, and postoperative complications. Of 367 eligible infants, 80 in the early closure group and 186 in the late closure group were included after matching. Baseline characteristics were well-balanced. The early closure group had significantly lower median weight at closure (2674 g vs. 3374 g, p = 0.038) and shorter stoma duration (48 vs. 69 days, p = 0.0064). Time to first flatus/defecation was shorter in the early group (2.7 ± 1.8 days vs. 3.2 ± 1.9 days, p = 0.012). There were no significant differences in overall complication rates, reoperation, readmission, mortality, duration of parenteral nutrition, or hospital stay. A non-significant trend toward higher median weight at 6 months corrected age was observed in the early group (6548 g vs. 6287 g, p = 0.12). Early stoma closure (< 8 weeks) is associated with faster recovery of gastrointestinal function and does not increase the risk of postoperative complications. These findings support the feasibility and safety of early closure in selected NEC infants, though timing should be individualized based on clinical assessment.