title: Mucous fistula refeeding in premature neonates with enterostomies.
abstract: BACKGROUND
  Premature neonates with short bowel syndrome often have diverting enterostomies and distal mucous fistulae. The authors reviewed their experience in 12 premature neonates in whom proximal bowel contents were re-fed into the mucous fistula.
  
  
  METHODS
  We reviewed the records of 12 premature neonates who presented with acute abdomen and who underwent intestinal resection with formation of diverting enterostomy and mucous fistula between July 1999 and December 2002. All received parenteral nutrition. Refeeding of enterostomy contents into the distal mucous fistula was commenced after patency of the distal intestine was confirmed by radiologic examination. Demographic data, body weight and clinical outcomes were recorded.
  
  
  RESULTS
  Median gestational age was 31 weeks and mean birth weight was 1.59 kg. Diagnoses included necrotizing enterocolitis (n = 6), meconium ileus-like conditions (n = 2), ileal atresia (n = 2), malrotation with volvulus (n = 1) and focal intestinal perforation (n = 1). Refeeding was successfully established in all patients with no complications. The mean duration of refeeding was 63.5 days. All patients achieved good weight gain after refeeding (18.9 +/- 2.9 g/d) with a reduction of parenteral nutrition requirements. All enterostomies were subsequently closed. Four patients died of unrelated causes after reanastomosis and the remaining eight were discharged.
  
  
  CONCLUSIONS
  Mucous fistula refeeding is safe in premature neonates with enterostomies. It can prevent disuse atrophy in the distal loop and facilitate subsequent reanastomosis. Furthermore, the increased absorptive function provided by the small bowel incorporated in the mucous fistula can reduce the requirement for total parenteral nutrition.
authors.affiliation: Division of Paediatric Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China.
authors.forename: Kenneth K Y
authors.initials: KK
authors.lastname: Wong
authors.forename: Laurence C L
authors.initials: LC
authors.lastname: Lan
authors.forename: Steve C L
authors.initials: SC
authors.lastname: Lin
authors.forename: Audrey W S
authors.initials: AW
authors.lastname: Chan
authors.forename: Paul K H
authors.initials: PK
authors.lastname: Tam
mesh_terms: D004766:Enterostomy / Q000379:methods*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000601:surgery* / Q000628:therapy; D007412:Intestinal Fistula / Q000209:etiology / Q000628:therapy*; D008297:Male; D010288:Parenteral Nutrition; D012189:Retrospective Studies; D012778:Short Bowel Syndrome / Q000601:surgery* / Q000628:therapy; D016896:Treatment Outcome