Outcomes of refeeding through mucous fistula based on indications in neonatal surgery

Mucous fistula refeeding (MFR) preserves intestinal function in ostomized neonates by reinfusing proximal output into the distal limb. We aimed to define its indications, effectiveness and complications.

A retrospective review of neonates ostomized after neonatal surgery who received MFR for bowel stimulation/decompression and/or to reduce parenteral nutrition (PN) dependence and complications. Patients were categorized into four groups based on the underlying pathology: intestinal atresia, meconium ileus, intestinal ischemia and necrotizing enterocolitis (NEC).

Twenty-nine neonates received MFR. In neonates with intestinal atresia, parenteral nutrition (PN) requirements decreased from 86.6% to 59.5% (p 0.027), accompanied by a significant reduction in the bowel diameter discrepancy ratio, from 12.1:1 to 3.7:1 (p 0.017). In those with NEC, PN requirements decreased from 55% to 50% (p 0.719), although full distal stimulation was achieved. In cases of meconial pathology, PN requirements decreased from 45.5% to 35.5% (p 0.527), with 100% distal transit and lower rates of microcolon (p 0.021). In neonates with intestinal ischemia or focal intestinal perforation, PN requirements decreased from 60.5% to 5% (p < 0.035). The most frequent complications associated with MFR were reflux of intestinal contents (51.1%) and accidental tube displacement (30.3%).

Abdominal MFR promotes intestinal growth, reduces parenteral nutrition needs, and aids decompression and stimulation in meconium ileus and intestinal atresia. In NEC, commonly associated with larger resections and less distal remaining colon, no differences have been observed except for stimulating the rest of the colon and checking its permeability prior to reanastomosis.