Safety and efficacy of mucous fistula refeeding in low-birth-weight infants with enterostomies

Yabe, Kiyoaki; Kouchi, Katsunori; Takenouchi, Ayako; Matsuoka, Aki; Korai, Takahiro; Nakata, Chikako

doi:10.1007/s00383-019-04533-x

Cited by 13 publications

(12 citation statements)

References 19 publications

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“…Histopathological ndings of the distal ileum at the stoma closure showed that chronic in ammation and destruction of villous structures were more frequent in the control group than in the normal-output MFR group. Similar to our ndings, Yabe et al [9] reported that MFR helped increase intestinal mucosal thickness and maintain the villous structure of the distal ileum. Intestinal maturation and rehabilitation are reinforced by exposure to enteral nutrients and enterotrophic factors [17,18], which can be simulated by MFR.…”

Section: Discussionsupporting

confidence: 92%

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Efficacy and safety of mucous fistula refeeding in preterm infants: An exploratory randomized controlled trial

Lee

Kim

Shin

et al. 2022

Preprint

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Background: This study aimed to evaluate whether mucous fistula refeeding (MFR) is safe and beneficial for the growth and intestinal adaptation of preterm infants with enterostomies.Methods: This exploratory randomized controlled trial enrolled infants born before 35 weeks’ gestation with enterostomy. If the stomal output was ≥ 40 mL/kg/day, infants were assigned to the high-output MFR group and received MFR. If the stoma output was < 40 mL/kg/day, infants were randomized to the normal-output MFR group or the control group. Growth, serum citrulline levels, and bowel diameter in loopograms were compared. The safety of MFR was evaluated.Results: Twenty infants were included. The growth rate increased considerably, and the colon diameter was significantly larger after MFR. However, the citrulline levels did not significantly differ between the normal-output MFR and the control group. One case of bowel perforation occurred during the manual reduction for stoma prolapse. Although the association with MFR was unclear, two cases of culture-proven sepsis during MFR were noted.Conclusions: MFR benefits the growth and intestinal adaptation of preterm infants with enterostomy and can be safely implemented with a standardized protocol. However, infectious complications need to be investigated further.Trial registration: clinicaltrials.gov NCT02812095, retrospectively registered on June 6, 2016.

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Section: Discussionsupporting

confidence: 92%

“…It can prevent atrophy of the distal bowel and promote uid and nutrient absorption [6,7]. In previous retrospective studies, MFR was proven as a safe technique that helped in promoting infant growth and discontinuing PN [7][8][9][10]. However, no prospective studies have yet evaluated the e cacy and safety of MFR.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of mucous fistula refeeding in preterm infants: An exploratory randomized controlled trial

Lee

Kim

Shin

et al. 2022

Preprint

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“…Postoperatively, neonates who underwent MFR had lower chance of anastomotic leak (3 vs. 20%, p ¼ 0.029) and quicker progression to full feed after reversal in comparison to controls (median 7.5 vs. 20 days, p 0.001). 13,15 Histology and Microbiology…”

Section: Weight Gain Pn Dependence and Postoperative Coursementioning

confidence: 99%

“…Although the specific method of microbiological analysis was not mentioned, Yabe et al took stoma effluent for culture over the period of 0 to 3 hours. 15 There was no comment on stoma output, bag changes, etc., within this group alongside methodology. Haddock et al also commented on peritoneal cultures grown at initial lavage within the single mortality attributable to MFR and these may hint as to why perforations sustained during MFR are so sinister.…”

Section: Weight Gain Pn Dependence and Postoperative Coursementioning

confidence: 99%

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A Review on Safety and Outcomes of Mucous Fistula Refeeding in Neonates

2020

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Introduction The utility of mucous fistula refeeding (MFR) in neonates with short bowel syndrome is widely debated. Our purpose is to review MFR and outline methods, reported complications, and clinical outcomes (survival, weight gain, dependence on parenteral nutrition [PN], and time to enteral autonomy). Materials and Methods We performed a MEDLINE literature search and reference review from January 1980 to May 2020 for terms (“mucous fistula re-feeding” or “enteral re-feeding”) and neonates. We included studies that utilized conventional MFR in the neonatal period. Non-English language articles were excluded. Results We identified 11 relevant articles. Internationally, there was no consensus on methods of MFR. A total of 197 neonates underwent MFR. Within a single study, four neonates developed major complications; however, the procedure was well tolerated without major complications in 10 of the 11 studies. A mortality of nine patients during MFR highlights the burden of disease within the study population; however, of these, only one was directly attributable to MFR. Minor complications were seldom quantified. Three studies demonstrated a higher rate of weight gain and shorter PN support versus controls. Neonates who underwent MFR had lower chance of anastomotic leak and quicker progression to full feed after reversal versus controls. The influence of microorganisms in MFR was only investigated in one study. Conclusion Current evidence suggests benefits of MFR; however, an international consensus is yet to be reached on the optimal method. A large prospective study investigating the influence of MFR on the enteric system is required.

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