A Review on Safety and Outcomes of Mucous Fistula Refeeding in Neonates

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.

Efficacy and safety of mucous fistula refeeding in preterm infants: An exploratory randomized controlled trial

“…On the contrary, Yabe et al cultured the stoma output 3 hours after its ejection and detected no pathogenic bacteria [9]. In a recent review, infection was not described as a MFR-related complication [27]. In our study, stoma contents were collected and recycled every 4 hours.…”

Efficacy and safety of mucous fistula refeeding in preterm infants: an exploratory randomized controlled trial

“…On the contrary, Yabe et al cultured the stoma output 3 h after its ejection and detected no pathogenic bacteria [ 9 ]. In a recent review, infection was not described as a MFR-related complication [ 27 ]. In our study, stoma contents were collected and recycled every 4 h. Two cases of sepsis occurred during MFR, but the relationship between MFR and sepsis could not be determined in this study.…”

Mucous fistula refeeding in neonates: a systematic review and meta-analysis

“…Two previous systematic reviews have been published about its use in neonates: Richardson et al 29 reviewed 5 studies and concluded clinical benefits such as weight gain and reduced use of parenteral nutrition, and the recent review by Ghattaura et al 30 (11 studies) also suggested significant clinical benefits such as better weight gain, shorter duration of parenteral nutrition, lower chance of anastomotic leak and quicker progression to full feeds after reversal. Neither of these studies, however, carried out a meta-analysis of the quantitatively reported outcomes in the literature, and the largest published study on the use of MFR in neonates was published in 202124 after the publication of both these systematic reviews.…”