Department of Surgery, The University of Auckland, Auckland, New Zealand.
Department of Paediatric Surgery, Wellington Hospital, Wellington, New Zealand.
Pediatr Surg Int. 2024 Nov 27;41(1):7. doi: 10.1007/s00383-024-05904-9.
Chyme reinfusion therapy (CRT) is a safe and effective method to improve nutritional outcomes and promote intestinal adaptation in patients with stomas. This practice involves refeeding the proximal stoma output, down the distal limb, and mimics a state of intestinal continuity; thereby promoting growth and adaption of the distal bowel. Despite its promise, CRT in neonates is a relatively underutilised practice and can be of significant value in neonates with congenital bowel anomalies or necrotising enterocolitis. We aimed to identify the frequency, methodology and adverse effects associated with CRT in our neonatal population. We aimed to identify the frequency, methodology and adverse events associated with CRT in our neonatal population.
A ten-year retrospective cohort study was conducted using database searches at two major paediatric hospitals in New Zealand. All patients with suitable anatomy were identified, and data on CRT methodology and outcomes were recorded.
Of the 49 eligible neonates, 23 (47%) underwent CRT. Indications for CRT included high stoma output, malnutrition with poor weight gain, and routine refeeding prior to stoma reversal. A nasogastric feeding tube was inserted into the distal limb and collected chyme was reinfused via manual bolus or automated syringe driver. The median (IQR) weight gain increased from 13.9 (3.50-22.89) to 24.37 (19.68-29.99) g/day during CRT (p = 0.04). 18 infections requiring medical intervention but unrelated to CRT occurred in 13 patients (56%). Amongst our cohort, there was a high rate of non-infectious events, including peri-stomal skin irritation (60%), stoma prolapse (43%) and stomal bleeding (26%).
CRT is an underutilised method of improving nutrition in neonates with intestinal failure. Premature neonates requiring double enterostomy formation are at high risk of infectious and non-infectious complications, but few of these are related to CRT. Standardised protocols providing clear eligibility criteria and detailed methodology for CRT are required to promote uniform utilisation of this practice.
回输食糜疗法（Chyme reinfusion therapy，CRT）是一种安全有效的方法，可以改善肠造口患者的营养状况，促进肠道适应。该疗法涉及将近端肠造口输出物经远端肠管再回输，模拟肠连续性状态，从而促进远端肠管的生长和适应。尽管 CRT 有很大的前景，但在新生儿中，这种方法的应用相对较少，对于先天性肠道畸形或坏死性小肠结肠炎的新生儿可能具有重要价值。我们旨在确定 CRT 在我们的新生儿人群中的频率、方法和不良反应。
采用新西兰两家主要儿科医院的数据库检索进行了一项为期十年的回顾性队列研究。所有具有合适解剖结构的患者均被纳入研究，并记录 CRT 方法和结局的数据。
在 49 名符合条件的新生儿中，有 23 名（47%）接受了 CRT。CRT 的适应证包括肠造口输出量高、营养不良且体重增长不良，以及肠造口反转前常规喂养。将鼻胃管插入远端肠管，并通过手动推注或自动化注射器泵将收集的食糜再回输。在 CRT 期间，体重增加中位数（IQR）从 13.9（3.50-22.89）增加到 24.37（19.68-29.99）g/天（p=0.04）。在 13 名患者中，有 18 例需要医疗干预的感染，但与 CRT 无关（56%）。在我们的队列中，非感染性事件发生率较高，包括造口周围皮肤刺激（60%）、造口脱垂（43%）和造口出血（26%）。
CRT 是改善肠衰竭新生儿营养的一种未充分利用的方法。需要进行双肠造口形成的早产儿发生感染和非感染性并发症的风险较高，但这些并发症很少与 CRT 有关。需要制定标准化方案，提供 CRT 的明确纳入标准和详细方法，以促进该疗法的统一应用。
