Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Emory University - Children's Healthcare of Atlanta at Egleston.
Division of Pediatric Gastroenterology, Department of Pediatrics.
J Pediatr Gastroenterol Nutr. 2021 Nov 1;73(5):654-658. doi: 10.1097/MPG.0000000000003272.
Infants requiring intestinal resection because of necrotizing enterocolitis (NEC) or small bowel atresia (SBA) may benefit from mucous fistula refeeding (MFR) of enterostomy output to improve nutrition and bowel adaptation before reanastomosis. Previous series demonstrated improved outcomes with MFR but did not account for varied patient characteristics as potential sources of bias. We performed a cohort analysis using multivariable adjusted models to compare outcomes of patients with and without MFR.
Retrospective chart review was performed for patients with NEC or SBA and small bowel resection with enterostomy and MF. Demographic and outcome data was compared between MFR and non-MFR groups using adjusted multivariable analysis for potential confounding variables.
MFR was performed in 65 of 101 patients (64%), including 45 of 75 patients with NEC and 20 of 26 patients with SBA. Reasons for not receiving MFR included bowel stricture, technical limitation, or not otherwise specified. NEC patients receiving MFR had 14 fewer days to achieve full enteral feeds after intestinal reconnection, 22 fewer days of parenteral nutrition, lower peak direct bilirubin by 2.4 mg/dL, and 77% less odds of ursodiol use (all P < 0.01). SBA patients had similar trends not reaching statistical significance. Growth parameters were improved in MFR groups. There were no complications or increased infections from MFR.
This study suggests that MFR safely improves nutritional outcomes in infants with intestinal resection, related to decreased total parenteral nutrition (TPN) dependence and earlier enteral autonomy.
患有坏死性小肠结肠炎（NEC）或小肠闭锁（SBA）而需要进行肠道切除术的婴儿可能受益于肠造口输出物的黏膜瘘再喂养（MFR），以改善再吻合前的营养和肠道适应性。以前的系列研究表明 MFR 可改善结局，但并未考虑到潜在的偏倚来源，即患者特征的差异。我们使用多变量调整模型进行了队列分析，以比较接受和未接受 MFR 的患者的结局。
对 NEC 或 SBA 伴小肠切除术和肠造口术及 MF 的患者进行回顾性图表审查。使用调整后的多变量分析比较 MFR 组和非 MFR 组的人口统计学和结局数据，以控制潜在的混杂变量。
101 例患者中有 65 例（64%）接受了 MFR，其中 45 例 NEC 患者和 20 例 SBA 患者接受了 MFR。未接受 MFR 的原因包括肠狭窄、技术限制或其他原因。接受 MFR 的 NEC 患者在肠道重新连接后达到全肠内喂养的天数减少了 14 天，接受肠外营养的天数减少了 22 天，直接胆红素峰值降低了 2.4mg/dL，使用熊去氧胆酸的几率降低了 77%（均 P<0.01）。SBA 患者也有类似的趋势，但未达到统计学意义。MFR 组的生长参数得到改善。MFR 无并发症或感染增加。
本研究表明，MFR 安全地改善了肠道切除术婴儿的营养结局，与减少全肠外营养（TPN）的依赖和更早的肠内自主有关。
