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.