Beneficial effects of mucous fistula refeeding in necrotizing enterocolitis neonats with enterostomies

Abstract

BACKGROUND/PURPOSE: Fulminant 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 and compare its effect with the control group. METHODS: All patients with necrotizing enterocolitis between 2000 and 2014 necessitating initial diverting enterostomies and subsequent stoma closure in a tertiary referral centre were included. Medical records were retrospectively reviewed. Demographic data, surgical procedures, and post-operative outcomes were analyzed. RESULTS: 92 patients were identified in the study period. 77 patients received mucous fistula refeeding. The refeeding group showed less size discrepancy between the bowel ends (25 vs 53%, p=0.034) and less post-operative anastomotic complications (2.6 vs 20.0%, p=0.029). Less refeeding group patients developed parenteral nutrition related cholestasis (42 vs 73%, p=0.045) and required shorter parenteral nutrition support (47 vs 135 days, p=0.001). The peak bilirubin level was comparable between the two groups. No major complication was associated with refeeding. CONCLUSIONS: Mucous fistula refeeding is safe, can decrease risk of anastomotic complication and parental nutrition related cholestasis. It provides both diagnostic and therapeutic value pre-operatively and its use should be advocated.