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

Part of Neonatal Surgery Essentials 7 items

Infographic · Jul 2023 · 1 min read

In brief

Systematic review of 16 studies (n=623) shows mucous fistula refeeding reduces parenteral nutrition duration by 37 days in neonates with ostomies, while also decreasing cholestasis rates and hospital stay. This technique maintains intestinal physiology by reintroducing proximal effluent into the distal limb after abdominal surgery.

Mucous fistula refeeding reduces parenteral nutrition duration by ~37 days in neonates with ostomies after abdominal surgery.
MFR maintains intestinal physiology by reintroducing proximal ostomy effluent into the distal mucous fistula.
Neonates receiving MFR show lower cholestasis rates, faster time to full enteral feeds, and shorter hospital stays.
Current evidence is low certainty (observational studies only); randomized trials needed to confirm benefits.
MFR is a practical strategy to optimize bowel function and reduce TPN dependence in neonates with temporary ostomies.

Written by the GCMD Library team from the infographic.

Three-panel infographic with red header and white background. Left panel shows newborn icon with anatomical markers and study metadata. Center panel displays anatomical illustration of intestinal mucous fistula with blue arrow indicating refeeding direction. Right panel presents clinical outcomes using icons for TPN bag, baby figure with cholestasis indicator, and sepsis symbol with relative risk values.

New infographic by Dr. Jose Campos and the Chilean society of pediatric surgery

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

Authors: Gonzalo Solís-García, Bonny Jasani

Full article: https://pubmed.ncbi.nlm.nih.gov/36858828/

Background and objective: Mucous fistula refeeding (MFR) aims to maximise bowel function when an ostomy is active after abdominal surgery, by introducing the proximal ostomy effluent into the distal mucous fistula to maintain intestinal physiology. The aim of the study was to assess the effectiveness and complications of MFR in neonates following abdominal surgery.

Design, setting and interventions: Systematic review and meta-analysis of randomised controlled trials and observational studies. PubMed, Embase, Cochrane and CINAHL were searched until June 2022 for studies including neonates with ostomy receiving MFR compared with neonates with ostomy without MFR.

Outcomes: The primary outcome was duration of parenteral nutrition. Secondary outcomes were time to full enteral feeds, rates of cholestasis, peak total serum bilirubin, sepsis, time to reanastomosis and length of hospital stay.

Results: A total of 16 observational studies were included (n=623). Compared with comparator group, neonates who received MFR had fewer days of parenteral nutrition (mean difference 37.17 days, 95% CI -63.91 to -10.4, n=244, 5 studies, GRADE: low). In addition, neonates who received MFR had lower rates of cholestasis, shorter time to reach full feeds and shorter hospital stay.

Conclusion: Low certainty of evidence suggests that MFR is associated with shorter duration of parenteral nutrition in neonates following abdominal surgery and stoma creation. Results of ongoing and future randomised trials may help to corroborate these findings.

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