Chyme reinfusion practices in the neonatal population
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In brief
In brief
This retrospective study examines chyme reinfusion therapy (CRT) in 49 neonates with stomas, finding that nearly half received CRT with significant improvements in weight gain. The practice involves refeeding proximal stoma output into the distal bowel to promote intestinal adaptation, though standardized protocols are needed to increase utilization in this underserved population.
- Chyme reinfusion therapy significantly improved weight gain in neonates (13.9 to 24.37 g/day, p=0.04) with intestinal stomas.
- CRT is underutilized: only 47% of eligible neonates received therapy despite proven nutritional benefits and safety profile.
- Common non-infectious complications (skin irritation 60%, prolapse 43%) were related to stoma presence, not CRT itself.
- Standardized CRT protocols with clear eligibility criteria are needed to increase adoption in neonatal intestinal failure.
- CRT mimics intestinal continuity by refeeding proximal output into distal limb, promoting bowel adaptation pre-reversal.
Written by the GCMD Library team from the article.
Abstract
Introduction
Chyme reinfusion therapy (CRT) is a safe and effective method to improve nutritional outcomes and promote intestinal adaptation in patients with stomas. This practice involves refeeding the proximal stoma output, down the distal limb, and mimics a state of intestinal continuity; thereby promoting growth and adaption of the distal bowel. Despite its promise, CRT in neonates is a relatively underutilised practice and can be of significant value in neonates with congenital bowel anomalies or necrotising enterocolitis. We aimed to identify the frequency, methodology and adverse effects associated with CRT in our neonatal population. We aimed to identify the frequency, methodology and adverse events associated with CRT in our neonatal population.
Methods
A ten-year retrospective cohort study was conducted using database searches at two major paediatric hospitals in New Zealand. All patients with suitable anatomy were identified, and data on CRT methodology and outcomes were recorded.
Results
Of the 49 eligible neonates, 23 (47%) underwent CRT. Indications for CRT included high stoma output, malnutrition with poor weight gain, and routine refeeding prior to stoma reversal. A nasogastric feeding tube was inserted into the distal limb and collected chyme was reinfused via manual bolus or automated syringe driver. The median (IQR) weight gain increased from 13.9 (3.50–22.89) to 24.37 (19.68–29.99) g/day during CRT (p = 0.04). 18 infections requiring medical intervention but unrelated to CRT occurred in 13 patients (56%). Amongst our cohort, there was a high rate of non-infectious events, including peri-stomal skin irritation (60%), stoma prolapse (43%) and stomal bleeding (26%).
Conclusion
CRT is an underutilised method of improving nutrition in neonates with intestinal failure. Premature neonates requiring double enterostomy formation are at high risk of infectious and non-infectious complications, but few of these are related to CRT. Standardised protocols providing clear eligibility criteria and detailed methodology for CRT are required to promote uniform utilisation of this practice.