Mucous fistula refeeding decreases parenteral nutrition exposure in postsurgical premature neonates

Infographic · Oct 2018 · 1 min read

In brief

Mucous fistula refeeding in premature neonates after bowel resection significantly reduces parenteral nutrition dependence, with patients reaching goal enteral feeds 15 days earlier and discontinuing PN 16 days sooner compared to standard ostomy management. This technique offers a safe strategy to minimize PN-associated hepatotoxicity in this vulnerable population.

Mucous fistula refeeding in premature neonates with enterostomies reduces time to goal enteral feeds by 15 days (28 vs 43 days, p=0.03)
Refeeding allows earlier discontinuation of parenteral nutrition (25 vs 41 days, p=0.04), potentially reducing PN-associated cholestasis risk
Post-anastomosis benefits are more pronounced: goal feeds achieved in 7.5 vs 20 days and PN stopped 17.5 days earlier with refeeding
Mucous fistula refeeding appears safe in this cohort with no increased complications, offering functional bowel continuity restoration
Prospective multicenter trials needed to validate refeeding benefits and identify optimal patient selection criteria across care settings

Written by the GCMD Library team from the infographic.

The infographic uses a teal background with a two-column layout. Each column contains a black icon of a bottle feeding into an intestine symbol, with the right column's icon crossed out. Below each icon are large text statistics showing days on TPN and patient counts. The header emphasizes the key finding in bold text.

Background/Purpose

Premature neonates can develop intraabdominal conditions requiring emergent bowel resection and enterostomy. Parenteral nutrition (PN) is often required, but results in cholestasis. Mucous fistula refeeding allows for functional restoration of continuity. We sought to determine the effect of refeeding on nutrition intake, PN dependence, and PN associated hepatotoxicity while evaluating the safety of this practice.

Methods

A retrospective review of neonates who underwent bowel resection and small bowel enterostomy with or without mucous fistula over 2 years was undertaken. Patients who underwent mucous fistula refeeding (RF) were compared to those who did not (OST). Primary outcomes included days from surgery to discontinuation of PN and goal enteral feeds, and total days on PN. Secondary outcomes were related to PN hepatotoxicity.

Results

Thirteen RF and eleven OST were identified. There were no significant differences among markers of critical illness (p > 0.20). In the interoperative period, RF patients reached goal enteral feeds earlier than OST patients (median 28 versus 43 days; p = 0.03) and were able to have PN discontinued earlier (median 25 versus 41 days; p = 0.04). Following anastomosis, the magnitude of effect was more pronounced, with RF patients reaching goal enteral feeds earlier than OST patients (median 7.5 versus 20 days; p ≤ 0.001) and having PN discontinued sooner (30.5 versus 48 days; p = 0.001).

Conclusions

RF neonates reached goal feeds and were able to be weaned from PN sooner than OST patients. A prospective multicenter trial of refeeding is needed to define the benefits and potential side effects of refeeding in a larger patient population in varied care environments.

The text in the image

Mucous Fistula Refeeding Decreases Parenteral Nutrition Exposure in Post-Surgical Premature Neonates. | Colin D. Gause, Madoka Hayashi, Courtney Haney, Daniel Rhee, Omar Karim, Brian W. Weir, Dylan Stewart, Jeffrey Lukish, Henry Lau, Fizan Abdullah, Estelle Gauda, Howard I. Pryor II | Journal of Pediatric Surgery | REFEEDING LEADS TO LESS DAYS ON TPN | Mucous Fistula Refeeding | No Refeeding | 25 days on TPN | (13 patients) | 41 days on TPN | (11 patients)

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