Case-matched Comparison of Outcomes Following Neonatal Mucous Fistula Refeeding: 13-year Institutional Review.

IF 2.4 2区医学 Q1 PEDIATRICS

Journal of pediatric surgery Pub Date : 2025-03-20 DOI:10.1016/j.jpedsurg.2025.162276

Goeto Dantes, Swathi Raikot, Caroline Chivily, Benjamin Herron, Lauriane Pinto, Zhulin He, Laura M Johnson, Megan Bouchard, Megan Durham, Gregory Sysyn, Anthony Piazza, Hanna Alemayehu

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引用次数: 0

Abstract

Background: Refeeding ostomy effluent into the residual bowel via the mucus fistula (MFR) has been associated with decreased parenteral nutrition needs and decreased cholestasis. However, MFR is also associated with risks and the literature is not definitive. We performed a case matched comparison of neonates treated with and without MFR.

Methods: All neonates who underwent enteral diversion between 2010 and 2023 were identified. Neonates who received MFR were propensity score matched with non-MFR neonates. Primary objectives included cholestasis and ability to achieve full feeds prior to enterostomy closure (EC). We also evaluated MFR complications (perforation, ostomy stricture, leak or prolapse).

Results: 262 neonates were case matched (131 MFR and 131 non-MFR). Age, height, and weight on admission were comparable. We found no difference in ability to achieve full feeds prior to EC. MFR neonates did have a lower incidence of cholestasis (p < 0.001). Complications occurred in 24 (18 %) of MFR neonates and abdominal reoperations prior to EC occurred more frequently in MFR (18 %) vs non-MFR (6.9 %) neonates, odds ratio 3.21 (1.44, 7.61).

Conclusion: MFR is an important tool in the postoperative management of diverted neonates. However, when critically analyzed via statistical case matching, our study shows that the benefits may be more nuanced.

Level of evidence: Level III.

Study type: Retrospective Chart Review.

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新生儿粘膜瘘再喂养的病例对照比较：13年机构回顾。

背景：通过黏液瘘管（MFR）将造口出水重新喂入残肠与减少肠外营养需求和减少胆汁淤积有关。然而，MFR也与风险有关，而且文献并不确定。我们对接受和未接受MFR治疗的新生儿进行了病例匹配比较。方法：选取2010-2023年间所有接受肠内转流的新生儿。接受MFR的新生儿倾向评分与未接受MFR的新生儿相匹配。主要目的包括在肠造口关闭（EC）之前实现胆汁淤积和充分喂养的能力。我们还评估了MFR并发症（穿孔、造口狭窄、渗漏或脱垂）。结果：262例新生儿病例匹配（MFR 131例，非MFR 131例）。入院时年龄、身高和体重具有可比性。我们发现在EC之前实现全饲料的能力没有差异。结论：MFR是分流新生儿术后处理的重要工具。然而，当通过统计案例匹配进行批判性分析时，我们的研究表明，这些好处可能更加微妙。证据等级：三级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of pediatric surgery 医学-外科

CiteScore

1.10

自引率

12.50%

发文量

569

审稿时长

38 days

期刊介绍： The journal presents original contributions as well as a complete international abstracts section and other special departments to provide the most current source of information and references in pediatric surgery. The journal is based on the need to improve the surgical care of infants and children, not only through advances in physiology, pathology and surgical techniques, but also by attention to the unique emotional and physical needs of the young patient.