Mucous Fistula Refeeding Promotes Earlier Enteral Autonomy in Infants With Small Bowel Resection

Area of Science:

• Pediatric Surgery
• Neonatal Nutrition
• Gastroenterology

Background:

• Infants with necrotizing enterocolitis (NEC) or small bowel atresia (SBA) often require intestinal resection and enterostomy.
• Mucous fistula refeeding (MFR) is a technique to reintroduce enterostomy output into the distal bowel to improve nutrition and adaptation.
• Previous studies suggested MFR benefits, but lacked adjustment for confounding factors.

Purpose of the Study:

• To evaluate the impact of MFR on nutritional outcomes and bowel adaptation in infants with NEC or SBA.
• To compare outcomes between infants who received MFR and those who did not, using multivariable adjusted models.

Main Methods:

• Retrospective cohort analysis of infants with NEC or SBA undergoing intestinal resection and enterostomy.
• Comparison of demographic and outcome data between MFR and non-MFR groups.
• Multivariable analysis to adjust for potential confounding variables.

Main Results:

• MFR was utilized in 64% of the 101 infants studied.
• Infants with NEC receiving MFR achieved full enteral feeds 14 days sooner and required 22 fewer days of parenteral nutrition.
• MFR was associated with lower peak direct bilirubin, reduced ursodiol use, and improved growth parameters in NEC patients, with similar trends in SBA patients. No complications were observed.

Conclusions:

• Mucous fistula refeeding (MFR) is a safe and effective method to improve nutritional outcomes in infants with intestinal resection.
• MFR leads to decreased reliance on total parenteral nutrition (TPN) and earlier achievement of enteral autonomy.
• The findings support the use of MFR in select infants following intestinal resection for NEC or SBA.