Mucous fistula refeeding in neonates with enterostomies
Candace A Haddock1, Jennifer D Stanger1, Susan G Albersheim2
1Division of Pediatric Surgery, Department of Surgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada.
Insights
Refeeding mucous fistula (MF) output in neonates with intestinal failure showed significant complications and ongoing parenteral nutrition (PN) dependence. The benefits of MF refeeding must be carefully weighed against potential risks.
Area of Science:
- Neonatal surgery
- Gastroenterology
- Pediatric surgery
Background:
- Neonates with intestinal pathology often require staged surgery, including enterostomy and mucous fistula (MF) creation.
- Refeeding ostomy output (MFR) is proposed to minimize fluid/electrolyte losses and reduce parenteral nutrition (PN) dependence.
- Limited evidence currently supports the practice of MFR.
Purpose of the Study:
- To assess the outcomes of infants undergoing mucous fistula refeeding (MFR).
- To document complications associated with MFR in neonates.
Main Methods:
- Retrospective chart review of neonates undergoing MFR between January 2000 and December 2012.
- Descriptive statistical analysis of collected patient data.
Main Results:
- Twenty-three neonates underwent MFR for various intestinal pathologies.
- Seven patients successfully weaned from PN; however, four experienced complications, including MF perforation and bleeding.
- Four patients died, with one death linked to MFR.
Conclusions:
- Mucous fistula refeeding in this cohort was linked to significant complications and persistent PN dependence.
- The potential benefits of MFR must be evaluated against its associated risks, especially with advancements in intestinal rehabilitation and PN.
Background/Purpose:
Neonates with intestinal pathology may require staged surgery with creation of an enterostomy and mucous fistula (MF). Refeeding (MFR) of ostomy output may minimize fluid and electrolyte losses and reduce dependence on parenteral nutrition (PN), though a paucity of evidence exists to support this practice. The purpose of this study was to assess the outcomes of infants undergoing MFR and document associated complications.
Methods:
With REB approval, infants with intestinal failure undergoing MFR between January 2000 and December 2012 were identified. A chart review was conducted and relevant data were collected. Descriptive statistics were used.
Results:
Twenty-three neonates underwent MFR. Mean gestational age and birth weight were 35weeks and 2416grams. Pathologies included intestinal atresia (n=12), necrotizing enterocolitis (n=5), meconium ileus (n=4), and other (n=6). Seven patients were able to wean from PN. Four patients had complications: 3 had perforation of the MF, 1 had bleeding. Four patients died, with one death directly attributable to MFR.
Conclusions:
In this cohort MF refeeding was associated with significant complications and ongoing PN dependence. With advances in intestinal rehabilitation and PN, the benefit of MF refeeding must be weighed against the potential complications.
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