Mucous fistula refeeding decreases parenteral nutrition exposure in postsurgical premature neonates

Nutrition Management of Necrotizing Enterocolitis

“…The practice of refeeding of proximal stoma effluent through a distal mucous fistula uses the absorptive surface of the distal bowel for nutrient absorption, stimulates mucosal growth and intestinal adaptation, and prevents atrophy of the distal bowel . Infants who undergo mucous fistula refeeding have a shorter time from initiation of enteral feeds to attainment of goal feeds and PN discontinuation in the interoperative period …”

“…The safety of refeeding has posed concern for risk for perforation, GI bleed, sepsis, and mortality . Refeeding is thought to be safe and beneficial when administered in an ICU using a protocol that specifies the equipment and techniques used for mucous fistula cannulation and refeeding parameters . Gause et al described a refeeding protocol using a 6.0 Fr Foley catheter placed by a surgeon while monitoring for signs of vascular compromise.…”

“…Refeeding is thought to be safe and beneficial when administered in an ICU using a protocol that specifies the equipment and techniques used for mucous fistula cannulation and refeeding parameters . Gause et al described a refeeding protocol using a 6.0 Fr Foley catheter placed by a surgeon while monitoring for signs of vascular compromise. The authors’ protocol consisted of refeeding the succus entericus collected from the proximal enterostomy and instilling this into the mucous fistula via an electronic feeding pump at a rate of 1:1 .…”

“…Gause et al described a refeeding protocol using a 6.0 Fr Foley catheter placed by a surgeon while monitoring for signs of vascular compromise. The authors’ protocol consisted of refeeding the succus entericus collected from the proximal enterostomy and instilling this into the mucous fistula via an electronic feeding pump at a rate of 1:1 . The authors recommended replacement of the catheter in case of dislodgement in a patient who had been tolerating refeeding.…”

“…[36][37][38] Infants who undergo mucous fistula refeeding have a shorter time from initiation of enteral feeds to attainment of goal feeds and PN discontinuation in the interoperative period. 39 The practice of refeeding the output to the mucous fistula is thought to improve bowel adaptation and decrease time to full enteral feeds, but it does come with some risk. 40 The safety of refeeding has posed concern for risk for perforation, GI bleed, sepsis, and mortality.…”