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Efficacy and safety of mucous fistula refeeding in preterm infants: an exploratory randomized controlled trial
Eun Sun Lee1,2, Ee-Kyung Kim3,4, Seung Han Shin1,5
1Department of Pediatrics, Seoul National University Children's Hospital, 101, Daehak-Ro, Jongno-Gu, Seoul, 03080, South Korea.
Insights
Mucous fistula refeeding (MFR) improved growth and intestinal adaptation in preterm infants with enterostomies. While generally safe, further investigation into potential infectious complications is warranted.
Area of Science:
- Neonatalogy
- Pediatric Surgery
- Gastroenterology
Background:
- Preterm infants with enterostomies often face challenges with growth and intestinal adaptation.
- Mucous fistula refeeding (MFR) is a potential intervention to support these infants.
Purpose of the Study:
- To evaluate the safety and efficacy of MFR in promoting growth and intestinal adaptation in preterm infants with enterostomies.
- To compare outcomes between MFR and standard care in infants with varying stomal output.
Main Methods:
- An exploratory randomized controlled trial involving preterm infants (born before 35 weeks gestation) with enterostomies.
- Infants were assigned to high-output MFR, normal-output MFR, or control groups based on stomal output.
- Outcomes assessed included growth rate, serum citrulline levels, and bowel diameter.
Main Results:
- MFR was associated with a considerable increase in growth rate and significantly larger colon diameter.
- Serum citrulline levels did not show significant differences between the normal-output MFR and control groups.
- One case of bowel perforation and two cases of culture-proven sepsis were noted during MFR, with unclear association.
Conclusions:
- MFR demonstrates benefits for growth and intestinal adaptation in preterm infants with enterostomies.
- Implementation of MFR with a standardized protocol appears safe.
- Further research is needed to investigate infectious complications associated with MFR.
Background:
This study aimed to evaluate whether mucous fistula refeeding (MFR) is safe and beneficial for the growth and intestinal adaptation of preterm infants with enterostomies.
Methods:
This exploratory randomized controlled trial enrolled infants born before 35 weeks' gestation with enterostomy. If the stomal output was ≥ 40 mL/kg/day, infants were assigned to the high-output MFR group and received MFR. If the stoma output was < 40 mL/kg/day, infants were randomized to the normal-output MFR group or the control group. Growth, serum citrulline levels, and bowel diameter in loopograms were compared. The safety of MFR was evaluated.
Results:
Twenty infants were included. The growth rate increased considerably, and the colon diameter was significantly larger after MFR. However, the citrulline levels did not significantly differ between the normal-output MFR and the control group. One case of bowel perforation occurred during the manual reduction for stoma prolapse. Although the association with MFR was unclear, two cases of culture-proven sepsis during MFR were noted.
Conclusions:
MFR benefits the growth and intestinal adaptation of preterm infants with enterostomy and can be safely implemented with a standardized protocol. However, infectious complications need to be investigated further.
Trial Registration:
clinicaltrials.gov NCT02812095, retrospectively registered on June 6, 2016.
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