Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.
Arch Dis Child Fetal Neonatal Ed. 2023 Sep;108(5):523-529. doi: 10.1136/archdischild-2022-324995. Epub 2023 Mar 1.
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.
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.
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.
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.
造口术后活动期，黏膜瘘再喂养（MFR）旨在通过将近端造口流出物引入远端黏膜瘘来维持肠道生理功能，从而最大程度地恢复肠道功能。本研究旨在评估 MFR 在腹部手术后的新生儿中的有效性和并发症。
设计、设置和干预措施：对随机对照试验和观察性研究进行系统评价和荟萃分析。检索 PubMed、Embase、Cochrane 和 CINAHL，直到 2022 年 6 月，以纳入接受 MFR 的造口新生儿与未接受 MFR 的造口新生儿的研究。
主要结局是肠外营养的持续时间。次要结局是全肠内喂养的时间、胆汁淤积的发生率、总血清胆红素峰值、败血症、再吻合时间和住院时间。
共纳入 16 项观察性研究（n=623）。与对照组相比，接受 MFR 的新生儿接受肠外营养的天数更少（平均差异 37.17 天，95%CI-63.91 至-10.4，n=244，5 项研究，GRADE：低）。此外，接受 MFR 的新生儿胆汁淤积发生率较低，达到全肠内喂养的时间较短，住院时间较短。
低确定性证据表明，MFR 与腹部手术后造口新生儿肠外营养持续时间较短相关。正在进行和未来的随机试验结果可能有助于证实这些发现。
