Table 2

: Core themes identified from qualitative analysis of free text responses

ThemeSubtheme (number of respondents who mentioned this theme)Example free text responses (respondent role)
Factors supporting expediting stoma closureGrowth failure and PN dependence (including liver disease) (127) ‘If there are growth issues, PN [parenteral nutrition] requirement or stoma complications, I would aim for an early closure.’ (Respondent 146, Paediatric surgeon)
High-output (or proximal) stoma (112) ‘If a baby is failing to thrive, high output stoma losses and TPN [total parenteral nutrition] dependent then we would close sooner rather than later and certainly before discharge.’ (Respondent 150, Neonatologist)

‘Usually, with high-output stomas, early closure is required to avoid growth failure. However, a stably growing infant with successful pro-cycling of stoma outputs can have delayed closure.’ (Respondent 11, Neonatologist)
Peristomal issues (eg, skin breakdown, prolapse, granulation) (26)
Social issues (18) ‘…if the baby had difficult social situation and the risk of a stoma at home and picking up issues high [risk] then would advocate for early closure.’ (Respondent 154, Neonatal surgical specialist nurse)

‘Timing of stoma closure is multifactorial—depends on stoma care, stoma complications, level of stoma, success of recycling, distance family are from home, social circumstances, tolerance of feed, IV [intravenous] access, parent’s wishes, other pathology, and many other factors that is, it is individualised to each child and family.’ (Respondent 22, Paediatric surgeon)
Vascular access (7)
Factors supporting delaying planned stoma closureThriving with stoma and enterally autonomous (including successful recycling) (109) ‘I am not sure if the timing of stoma closure is my main concern as a neonatologist. My main concern is time to full feeds, and growth rate. Stoma closure is secondary, and I am happy to consider discharge home with a stoma. In fact, I would prefer to discharge this baby home with a stoma than prolong hospital stay to achieve closure before discharge home.’ (Respondent 165, Neonatologist)

‘Ideally if patient is well with good stoma management and recycling and gaining weight then I would wait until a few months of age.’ (Respondent 59, Paediatric surgeon)
Comorbidities (not optimised for surgery and/or anaesthetic) (56) ‘This baby is more likely to have co-morbidities which will influence surgical and anaesthetic risk, especially CLD [chronic lung disease]…Some of these babies get closed many months post-discharge if they are complicated.’ (Respondent 28, Neonatologist)
Underlying gut pathology/surgical technical concerns (35) ‘Ideally, I would wait for 6 weeks after NEC [necrotising enterocolitis], to allow for maturation and identification of post-NEC strictures, which may have bearing on success of closure …I would move to close sooner if MDT [multidisciplinary team] discussion agreed best for baby; again, other comorbidities have a bearing on timing of closure.’ (Respondent 34, Paediatric surgeon)
Difficulty accessing theatre lists (including COVID-19 limitations) (14) ‘One of our main confounding issues at the present time is timely access to theatre lists. Our capacity was diminished pre COVID and worse now. The 1 year wait for stoma closure was certainly not through choice but reflects this problem.’ (Respondent 144, Paediatric surgeon)