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
{"title":"新生儿粘膜瘘再喂养的病例对照比较：13年机构回顾。","authors":"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","doi":"10.1016/j.jpedsurg.2025.162276","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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).</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p><p><strong>Level of evidence: </strong>Level III.</p><p><strong>Study type: </strong>Retrospective Chart Review.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162276"},"PeriodicalIF":2.4000,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Case-matched Comparison of Outcomes Following Neonatal Mucous Fistula Refeeding: 13-year Institutional Review.\",\"authors\":\"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\",\"doi\":\"10.1016/j.jpedsurg.2025.162276\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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).</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p><p><strong>Level of evidence: </strong>Level III.</p><p><strong>Study type: </strong>Retrospective Chart Review.</p>\",\"PeriodicalId\":16733,\"journal\":{\"name\":\"Journal of pediatric surgery\",\"volume\":\" \",\"pages\":\"162276\"},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2025-03-20\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of pediatric surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.jpedsurg.2025.162276\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"PEDIATRICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of pediatric surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jpedsurg.2025.162276","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PEDIATRICS","Score":null,"Total":0}
Case-matched Comparison of Outcomes Following Neonatal Mucous Fistula Refeeding: 13-year Institutional Review.
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.
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.
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