Elliott Tessa, Walton J Mark
McMaster Pediatric Surgery Research Collaborative, McMaster University, Hamilton, Ontario, Canada.
McMaster Pediatric Surgery Research Collaborative, McMaster University, Hamilton, Ontario, Canada; Division of Pediatric Surgery, McMaster University, Hamilton, Ontario, Canada.
J Pediatr Surg. 2019 May;54(5):989-992. doi: 10.1016/j.jpedsurg.2019.01.050. Epub 2019 Feb 5.
Mucous fistula (MF) refeeding of proximal stoma effluent in neonates after small bowel resection can promote nutrient absorption and prevent atrophy of the unused distal bowel. This study aimed to assess the safety of this practice in neonates.
A retrospective chart review of all patients admitted to the neonatal intensive care unit (NICU) between 2009 and 2015 who underwent a laparotomy with creation of an enterostomy and mucous fistula was performed. Patients were included if they were refed proximal stoma effluent into the MF.
Thirty-one patients were identified that were refed. There were no major complications (perforation, stricture, death) related to refeeding. Patients were refed for an average of 41 days (± 22), with patients gaining an average of 25.7 g/day (± 10.1) while being refed. Total parental nutrition (TPN) was administered for an average of 55 days (± 31.4) between resection and reanastomosis, with only 7 (23%) developing cholestasis and 15 (48%) reaching full feeds in this time. Mean time to full feeds after reanastomosis was 36 days (± 58.6) with two patients having anastomotic leaks.
MF refeeding is a safe technique that has the potential to contribute to significant weight gain and a decreased dependence on total parenteral nutrition.
II.
小肠切除术后新生儿近端造口流出物经黏液瘘（MF）回输可促进营养吸收并防止未使用的远端肠管萎缩。本研究旨在评估该做法在新生儿中的安全性。
对2009年至2015年间入住新生儿重症监护病房（NICU）并接受剖腹术造口及黏液瘘手术的所有患者进行回顾性病历审查。若患者将近端造口流出物回输至MF，则纳入研究。
共确定31例接受回输的患者。未发生与回输相关的重大并发症（穿孔、狭窄、死亡）。患者回输平均41天（±22天），回输期间平均每日体重增加25.7克（±10.1克）。在切除与再次吻合之间，全肠外营养（TPN）平均使用55天（±31.4天），此期间仅7例（23%）发生胆汁淤积，15例（48%）实现完全经口喂养。再次吻合后达到完全经口喂养的平均时间为36天（±58.6天），有2例患者发生吻合口漏。
MF回输是一种安全的技术，有可能显著增加体重并减少对全肠外营养的依赖。
II级。
