Mucous Fistula Refeeding Promotes Earlier Enteral Autonomy in Infants with Small Bowel Resection.

Abstract

OBJECTIVE\nInfants requiring intestinal resection due to necrotizing enterocolitis (NEC) or small bowel atresia (SBA) may benefit from mucous fistula refeeding (MFR) of enterostomy output to improve nutrition and bowel adaptation before reanastomosis. Previous series demonstrated improved outcomes with MFR but did not account for varied patient characteristics as potential sources of bias. We performed a cohort analysis using multivariable adjusted models to compare outcomes of patients with and without MFR.\n\n\nMETHODS\nRetrospective chart review was performed for patients with NEC or SBA and small bowel resection with enterostomy and mucous fistula. Demographic and outcome data was compared between MFR and non-MFR groups using adjusted multivariable analysis for potential confounding variables.\n\n\nRESULTS\nMFR was performed in 65 of 101 patients (64%), including 45 of 75 patients with NEC and 20 of 26 patients with SBA. Reasons for not receiving MFR included bowel stricture, technical limitation, or not otherwise specified. NEC patients receiving MFR had 14 fewer days to achieve full enteral feeds after intestinal reconnection, 22 fewer days of parenteral nutrition, lower peak direct bilirubin by 2.4\u200amg/dL, and 77% less odds of ursodiol use (all P\u200a<\u200a0.01). SBA patients had similar trends not reaching statistical significance. Growth parameters were improved in MFR groups. There were no complications or increased infections from MFR.\n\n\nCONCLUSION\nThis study suggests that MFR safely improves nutritional outcomes in infants with intestinal resection, related to decreased TPN dependence and earlier enteral autonomy.