Summary
Background and Aims:  
Premature and low-birthweight infants are at high risk of poor growth, micronutrient deficiencies and metabolic bone disease.  Presence of a stoma and prolonged parenteral nutrition (PN) are further risk factors for poor nutritional outcomes.  This systematic review examined empirical evidence regarding nutritional outcomes in infants with surgical stomas.  Due to the paucity of research in premature infants, outcomes for all infants undergoing stoma formation were evaluated.
Methods:
A systematic review of nutritional outcomes in infants with surgical stomas (English language, peer-reviewed journals, published 1996-2017) was performed according to the PRISMA protocol. Data included demographics, interventions and nutritional outcomes.  The heterogeneity of outcomes precluded meta-analysis.  
Results:
16 studies met inclusion criteria, mostly small retrospective reviews. A total of 462 premature and term infants were included. Studies were significantly limited by unavailable data and methodological shortcomings.  Common themes explored included weight gain, duration of PN, rates of PN-associated cholestasis, micronutrient levels and protein absorption. High rates of PN-associated cholestasis, sodium deficiency and duration of PN were clinically noteworthy, however study groups were subject to confounding.  Conclusions regarding appropriate weight gain were not possible due to the lack of control data.  
Conclusions:
The current literature exhibits a paucity of high-quality studies examining nutritional outcomes for infants with stomas.  Given the high risks of both undernutrition and overnutrition, further research is required to quantify normal growth compared with growth in infants with stomas.  Standardised nutritional parameters and measurable outcomes need to be established to enable meaningful analysis across datasets and to inform evidence-based nutrition recommendations.

NUTRITIONAL OUTCOMES IN PREMATURE INFANTS WITH SURGICAL STOMA FORMATION: A SYSTEMATIC REVIEW