Difficult neonatal ileostomy/fistula

Hello,

I'm new here but I was hoping someone might be able to help. I am newly qualified and work on a NICU which mainly deals with surgical neonates eg. NEC, Gastroschisis, Exomphalos, Oesophageal Atresia etc.

The neonate in question is a 32 weeker who is now 3 months old. He contracted NEC which failed to respond to medical management and he went to theatre for a laparotomy. He now has an ileostomy and a mucus fistula. Both stomas have herniated so are 'mushroomed' at the bottom and the fistula is badly prolapsed. His umbilicus is also herniated. This infant is about 3.5kg but has a very small abdomen as you would expect. We are having major problems applying the stoma bags as he needs one on both the ileostomy and the fistula. Due to the bad prolapse it is almost impossible to get a bag over the fistula (and it gets worse as he screams) and when you do the outside sticky part is barely adhered to the skin as it is too small. Child's mum has been applying duoderm around the edges of both bags and up over the ridge in between the bags to try and stop leaks. The bags are needing changing twice a day at least and the skin is starting to break down. We've tried putting 'doughnuts' around the base of the stoma but the main problem is getting the bags on. Any wise words?

Sorry if its all very ineloquent, I'm very new to stoma care as didn't get much experience of it as a student, and just want to find a way to make things better for this baby. Our stoma nurse is also stumped and the surgeons don't want to know!

Charlotte x