15 A SYSTEMATIC REVIEW ON SAFETY AND OUTCOMES OF MUCOUS FISTULA RE-FEEDING IN NEONATES
Harmit Ghattaura1,2, Ingo Jester1
1Birmingham Children's Hospital, Birmingham, United Kingdom. 2The Royal Alexandra Children's Hospital, Brighton, United Kingdom

Abstract
Aims

The utility of mucous fistula re-feeding (MFR) in neonates with short bowel syndrome is widely debated. We reviewed MFR; varying methods, reported morbidity and clinical outcomes (survival, sepsis, weight gain, dependence on parenteral nutrition (PN) and time to enteral autonomy).

Methods

We performed a MEDLINE literature search and reference review for articles from January 1980 - December 2017 using terms (‘mucous fistula re-feeding’ OR ‘enteral re-feeding’) AND ‘neonate’. We included studies that utilised MFR in the neonatal period. Non-English language articles were excluded.

Results

Our search identified 9 relevant articles (n=156). Internationally there was no consensus on method of MFR. Utility of MFR according to diagnosis is demonstrated in Chart 1. 4 neonates developed major complications1 (1 bleeding, 3 perforation of mucous fistula) however the procedure was well tolerated without major complications in 8 of 9 studies. A mortality of 8 patients highlights the burden of disease within the study population however only one was directly attributable to MFR. 2 studies demonstrated a higher rate of weight gain and shorter PN support in comparison to non-MFR controls2,3. Neonates who underwent MFR had lower chance of anastomotic leak and quicker progression to full enteral feeds4. The influence of microorganisms in MFR on morbidity and sepsis was not investigated in any study.

Conclusion

- Evidence suggests benefits of MFR however international consensus is yet to be reached on method.

- The literature is sparse and further research is required; made difficult by the heterogeneity of the population.

- A prospective study investigating influence of changes in the enteric microbiome during MFR is required (in progress).



1.Haddock CA et al.J Pediatr Surg 2015;50:779-82. 2.Koike Y et al. J Pediatric Surg 2016;51:390-94. 3.Gause CD et al. J Pediatric Surg 2016;51:1759-765. 4.Lau E et al. J Pediatric Surg 2016;51:1914-16.

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