Mucous Fistula Refeeding in Newborns: Why, When, How, and Where? Insights from a Systematic Review

Area of Science:

• Neonatal surgery
• Pediatric gastroenterology
• Clinical nutrition

Background:

• Infants with high-output enterostomies often require prolonged parenteral nutrition (PN), leading to risks like infections and impaired growth.
• Mucous fistula refeeding (MFR) is a technique aimed at improving intestinal adaptation, weight gain, and distal bowel maturation in these infants.

Purpose of the Study:

• To systematically review and meta-analyze the effectiveness, safety, and technical aspects of mucous fistula refeeding (MFR) in infants.
• To compare outcomes between infants receiving MFR and those not receiving it.

Main Methods:

• A systematic review and meta-analysis following PRISMA guidelines, including studies without data or language restrictions.
• Data extracted from multiple databases (PubMed, EMBASE, CINAHL, Scopus, Web of Science, Cochrane Library, UpToDate).
• Risk of bias assessed using the Joanna Briggs Institute Critical Appraisal Checklist; meta-analysis used random- and fixed-effects models.

Main Results:

• Seventeen studies with 631 infants (482 MFR, 149 non-MFR) were included.
• MFR significantly improved weight gain (4.7 vs. 24.2 g/day) and reduced PN duration (60.3 vs. 95 days).
• MFR was associated with shorter hospital and NICU stays and a lower risk of cholestasis (OR 0.151).

Conclusions:

• Mucous fistula refeeding (MFR) demonstrates significant benefits for infants requiring parenteral nutrition, including improved weight gain and reduced feeding duration.
• Despite benefits, MFR practices are heterogeneous, highlighting the need for standardized protocols to optimize safety and efficacy in neonatal care.
• While MFR is associated with reduced cholestasis, complications like sepsis and intestinal perforation require careful monitoring.