Mucous fistula refeeding decreases parenteral nutrition exposure in postsurgical premature neonates.
OBJECTIVE
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 2years 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 43days; p=0.03) and were able to have PN discontinued earlier (median 25 versus 41days; 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 20days; p≤0.001) and having PN discontinued sooner (30.5 versus 48days; 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.
Department of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
Colin D
CD
Gause
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
Madoka
M
Hayashi
Department of Pediatric Nutrition, Johns Hopkins Hospital, Baltimore, MD, United States.
Courtney
C
Haney
Department of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
Daniel
D
Rhee
Department of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
Omar
O
Karim
Biostatistics, Epidemiology and Data Management Core, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
Brian W
BW
Weir
Department of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
Dylan
D
Stewart
Department of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
Jeffrey
J
Lukish
Department of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
Henry
H
Lau
Department of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
Fizan
F
Abdullah
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
Estelle
E
Gauda
Department of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States. Electronic address: hpryor1@jhmi.edu.
Howard I
HI
Pryor
D002779:Cholestasis / Q000209:etiology; D004750:Enteral Nutrition / Q000379:methods*; D004766:Enterostomy / Q000379:methods*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000601:surgery*; D007413:Intestinal Mucosa / Q000601:surgery*; D008297:Male; D017063:Outcome Assessment, Health Care; D010288:Parenteral Nutrition / Q000009:adverse effects / Q000706:statistics & numerical data*; D012189:Retrospective Studies
Associated liver disease; Mucous fistula; Parenteral nutrition; Refeeding; Short gut; TPN cholestasis