No abstract

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.

Objective Our systematic review aims to compare recurrence rates and complications of biological versus synthetic patches for the repair of congenital diaphragmatic herniae. Methods Studies from January 1, 1980 to April 25, 2020, with patients under the age of 16 years and with a minimum 6-month follow-up, were included from MEDLINE, Embase, and Cochrane databases. Funnel plots for recurrence rates were constructed for biological and synthetic patches. Subgroup analysis was performed for recurrence rate at the 1-year time-point and data were gathered on individual adverse events from relevant studies. Results A total of 47 studies with 986 patients (226 biological, 760 synthetic) were included. Funnel plot analysis determined overall recurrence rates of 16.7% for synthetic and 30.3% for biological patches. Subgroup analysis of 493 and 146 patients with synthetic and biological patches, respectively, showed recurrence rates of 9.9 and 26%, respectively.The most commonly used patch types—PTFE (polytetrafluoroethylene) and SIS (small intestinal submucosa)—had 11.5 and 33.3% recurrence, respectively. Adhesive bowel obstruction rates ranged from 4 to 29% in studies that systematically reported it for synthetic, and 7 to 35% for biological patches. Gastroesophageal reflux rates ranged from 25 to 48% in studies that systematically reported it for synthetic, and 21 to 42% for biological patches. Pectus deformity rates were reported as high as 80% for synthetic patches. Conclusion Biological patches appear to have higher recurrence rates than synthetic patches, while skeletal deformities are associated more commonly with synthetic patches. Results of biological patches are mainly using SIS and this may overestimate complications of current superior biological patches.

No abstract

No abstract