Beneficial effects of mucous fistula refeeding in necrotizing enterocolitis neonates with enterostomies.
BACKGROUND
Necrotizing enterocolitis in premature neonates often results in bowel resection and stoma formation. One way to promote bowel adaptation before stoma closure is to introduce proximal loop effluents into the mucous fistula. In this study, we reviewed our experience with distal loop refeeding with respect to control group.


METHODS
All patients with necrotizing enterocolitis between 2000 and 2014 necessitating initial diverting enterostomies and subsequent stoma closure in a tertiary referral center were included. Medical records were retrospectively reviewed. Demographic data, surgical procedures, and postoperative outcomes were analyzed.


RESULTS
92 patients were identified, with 77 patients receiving mucous fistula refeeding. The refeeding group showed less bowel ends size discrepancy (25 vs 53%, p=0.034) and less postoperative anastomotic leakage (3 vs 20%, p=0.029). Fewer refeeding group patients developed parenteral nutrition related cholestasis (42 vs 73%, p=0.045) and required shorter parenteral nutrition support (47 vs 135days, p=0.002). The mean peak bilirubin level was higher in the non-refeeding group (155 vs 275μmol/L, p<0.001). No major complication was associated with refeeding.


CONCLUSIONS
Mucous fistula refeeding is safe and can decrease risk of anastomotic complication and parental nutrition related cholestasis. It provides both diagnostic and therapeutic value preoperatively and its use should be advocated. Level III Treatment Study in a Case Control Manner.
Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
Eugene C T
EC
Lau
Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
Adrian C H
AC
Fung
Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong. Electronic address: kkywong@hku.hk.
Kenneth K Y
KK
Wong
Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
Paul K H
PK
Tam
D004750:Enteral Nutrition / Q000379:methods*; D020345:Enterocolitis, Necrotizing / Q000601:surgery*; D004766:Enterostomy / Q000379:methods*; D005260:Female; D005402:Fistula / Q000378:metabolism* / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007413:Intestinal Mucosa / Q000378:metabolism*; D007419:Intestinal Secretions / Q000378:metabolism*; D007422:Intestines / Q000601:surgery; D008297:Male; D009752:Nutritional Status; D012189:Retrospective Studies
Mucous fistula refeeding; Necrotizing enterocolitis; Neonate