Case-matched Comparison of Outcomes Following Neonatal Mucous Fistula Refeeding: 13-year Institutional Review
Goeto Dantes1, Swathi Raikot2, Caroline Chivily3
1Department of Surgery, Emory University, Atlanta, GA, USA; Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA.
Background:
Refeeding ostomy effluent into the residual bowel via the mucus fistula (MFR) has been associated with decreased parenteral nutrition needs and decreased cholestasis. However, MFR is also associated with risks and the literature is not definitive. We performed a case matched comparison of neonates treated with and without MFR.
Methods:
All neonates who underwent enteral diversion between 2010 and 2023 were identified. Neonates who received MFR were propensity score matched with non-MFR neonates. Primary objectives included cholestasis and ability to achieve full feeds prior to enterostomy closure (EC). We also evaluated MFR complications (perforation, ostomy stricture, leak or prolapse).
Results:
262 neonates were case matched (131 MFR and 131 non-MFR). Age, height, and weight on admission were comparable. We found no difference in ability to achieve full feeds prior to EC. MFR neonates did have a lower incidence of cholestasis (p < 0.001). Complications occurred in 24 (18 %) of MFR neonates and abdominal reoperations prior to EC occurred more frequently in MFR (18 %) vs non-MFR (6.9 %) neonates, odds ratio 3.21 (1.44, 7.61).
Conclusion:
MFR is an important tool in the postoperative management of diverted neonates. However, when critically analyzed via statistical case matching, our study shows that the benefits may be more nuanced.
Level Of Evidence:
Level III.
Study Type:
Retrospective Chart Review.
Insights
Refeeding ostomy effluent into the residual bowel (MFR) reduced cholestasis in neonates but increased reoperation risks. This study suggests MFR benefits are nuanced, requiring careful consideration in postoperative care.
Area of Science:
- Neonatal surgery
- Pediatric gastroenterology
- Surgical outcomes
Background:
- Refeeding ostomy effluent into the residual bowel (MFR) is used in neonates with diverted bowels.
- MFR is linked to reduced parenteral nutrition and cholestasis but carries risks.
- Existing literature on MFR's efficacy and safety is not definitive.
Purpose of the Study:
- To compare outcomes of neonates treated with and without MFR.
- To evaluate the impact of MFR on cholestasis and achieving full feeds before enterostomy closure (EC).
- To assess MFR-related complications.
Main Methods:
- Retrospective chart review of neonates undergoing enteral diversion (2010-2023).
- Propensity score matching to compare MFR and non-MFR groups (131 neonates each).
- Analysis of cholestasis, ability to achieve full feeds, and MFR complications.
Main Results:
- No significant difference in achieving full feeds before EC between groups.
- MFR group showed a significantly lower incidence of cholestasis (p < 0.001).
- MFR was associated with higher rates of complications (18%) and reoperations before EC (18% vs. 6.9%).
Conclusions:
- MFR is a valuable tool for postoperative management in diverted neonates.
- Statistical case matching reveals that the benefits of MFR may be more complex than previously understood.
- The decision to use MFR should weigh reduced cholestasis against increased complication risks.
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