Musleh Layla, Cozzi Ilaria, Di Napoli Anteo, Fusaro Fabio
Department of Public Health and Infectious Disease, Sapienza University of Rome, 00185 Rome, Italy.
Department of Pediatric Surgery, San Camillo-Forlanini Hospital, 00152 Rome, Italy.
Nutrients. 2025 Jul 30;17(15):2490. doi: 10.3390/nu17152490.
: Infants with high-output enterostomies often require prolonged parenteral nutrition (PN), increasing risks of infections, liver dysfunction, and impaired growth. Mucous fistula refeeding (MFR) is proposed to enhance intestinal adaptation, weight gain, and distal bowel maturation. This systematic review and meta-analysis assessed its effectiveness, safety, and technical aspects. : Following PRISMA guidelines, studies reporting MFR-related outcomes were included without data or language restrictions. Data sources included PubMed, EMBASE, CINAHL, Scopus, Web of Science, Cochrane Library, and UpToDate. Bias risk was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. Meta-analysis employed random- and fixed-effects models, with outcomes reported as odds ratios (ORs) and 95% confidence interval (CI). Primary outcomes assessed were weight gain, PN duration, and complications and statistical comparisons were made between MFR and non-MFR groups. : Seventeen studies involving 631 infants were included; 482 received MFR and 149 did not. MFR started at 31 postoperative days and lasted for 50 days on average, using varied reinfusion methods, catheter types, and fixation strategies. MFR significantly improved weight gain (4.7 vs. 24.2 g/day, < 0.05) and reduced PN duration (60.3 vs. 95 days, < 0.05). Hospital and NICU stays were also shorter (160 vs. 263 days, < 0.05; 122 vs. 200 days, < 0.05). Cholestasis risk was lower (OR 0.151, 95% CI 0.071-0.319, < 0.0001), while effects on bilirubin levels were inconsistent. Complications included sepsis (3.5%), intestinal perforation (0.83%), hemorrhage (0.62%), with one MFR-related death (0.22%). : Despite MFR benefits neonatal care, its practices remain heterogeneous. Standardized protocols are required to ensure MFR safety and efficacy.
高输出量肠造口术的婴儿通常需要长期肠外营养（PN），这会增加感染、肝功能障碍和生长发育受损的风险。提出黏液瘘管再喂养（MFR）以促进肠道适应、体重增加和远端肠成熟。本系统评价和荟萃分析评估了其有效性、安全性和技术方面。：遵循PRISMA指南，纳入报告MFR相关结果的研究，无数据或语言限制。数据来源包括PubMed、EMBASE、CINAHL、Scopus、Web of Science、Cochrane图书馆和UpToDate。使用乔安娜·布里格斯研究所批判性评价清单评估偏倚风险。荟萃分析采用随机和固定效应模型，结果以比值比（OR）和95%置信区间（CI）报告。评估的主要结果是体重增加、PN持续时间和并发症，并在MFR组和非MFR组之间进行统计学比较。：纳入了17项涉及631名婴儿的研究；482名接受MFR，149名未接受。MFR在术后31天开始，平均持续50天，采用多种再输注方法、导管类型和固定策略。MFR显著改善了体重增加（4.7对24.2克/天，<0.05）并缩短了PN持续时间（60.3对95天，<0.05）。住院和新生儿重症监护病房（NICU）住院时间也较短（160对263天，<0.05；122对200天，<0.05）。胆汁淤积风险较低（OR 0.151，95%CI 0.07-0.319，<0.0001），而对胆红素水平的影响不一致。并发症包括败血症（3.5%）、肠穿孔（0.83%）、出血（0.62%），有1例与MFR相关的死亡（0.22%）。：尽管MFR对新生儿护理有益，但其操作仍存在异质性。需要标准化方案以确保MFR的安全性和有效性。
