Mucous fistula refeeding decreases parenteral nutrition exposure in postsurgical premature neonates

Colin D. Gause, Madoka Hayashi, Courtney Haney, Daniel Rhee, Omar Karim, Brian Weir, Fray Dylan Stewart, Jeffrey Lukish, Henry Lau, Fizan Abdullah, Estelle B Gauda, Howard I. Pryor

Research output: Contribution to journalArticle

Abstract

Background/Purpose Premature neonates can develop intraabdominal conditions requiring emergent bowel resection and enterostomy. Parenteral nutrition (PN) is often required, but results in cholestasis. Mucous fistula refeeding allows for functional restoration of continuity. We sought to determine the effect of refeeding on nutrition intake, PN dependence, and PN associated hepatotoxicity while evaluating the safety of this practice. Methods A retrospective review of neonates who underwent bowel resection and small bowel enterostomy with or without mucous fistula over 2 years was undertaken. Patients who underwent mucous fistula refeeding (RF) were compared to those who did not (OST). Primary outcomes included days from surgery to discontinuation of PN and goal enteral feeds, and total days on PN. Secondary outcomes were related to PN hepatotoxicity. Results Thirteen RF and eleven OST were identified. There were no significant differences among markers of critical illness (p > 0.20). In the interoperative period, RF patients reached goal enteral feeds earlier than OST patients (median 28 versus 43 days; p = 0.03) and were able to have PN discontinued earlier (median 25 versus 41 days; p = 0.04). Following anastomosis, the magnitude of effect was more pronounced, with RF patients reaching goal enteral feeds earlier than OST patients (median 7.5 versus 20 days; p ≤ 0.001) and having PN discontinued sooner (30.5 versus 48 days; p = 0.001). Conclusions RF neonates reached goal feeds and were able to be weaned from PN sooner than OST patients. A prospective multicenter trial of refeeding is needed to define the benefits and potential side effects of refeeding in a larger patient population in varied care environments.

Original languageEnglish (US)
Pages (from-to)1759-1765
Number of pages7
JournalJournal of Pediatric Surgery
Volume51
Issue number11
DOIs
StatePublished - Nov 1 2016

Fingerprint

Parenteral Nutrition
Fistula
Newborn Infant
Enterostomy
Small Intestine
Cholestasis
Ambulatory Surgical Procedures
Critical Illness
Multicenter Studies
Safety

Keywords

  • Associated liver disease
  • Mucous fistula
  • Parenteral nutrition
  • Refeeding
  • Short gut
  • TPN cholestasis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

Cite this

Mucous fistula refeeding decreases parenteral nutrition exposure in postsurgical premature neonates. / Gause, Colin D.; Hayashi, Madoka; Haney, Courtney; Rhee, Daniel; Karim, Omar; Weir, Brian; Stewart, Fray Dylan; Lukish, Jeffrey; Lau, Henry; Abdullah, Fizan; Gauda, Estelle B; Pryor, Howard I.

In: Journal of Pediatric Surgery, Vol. 51, No. 11, 01.11.2016, p. 1759-1765.

Research output: Contribution to journalArticle

Gause, Colin D. ; Hayashi, Madoka ; Haney, Courtney ; Rhee, Daniel ; Karim, Omar ; Weir, Brian ; Stewart, Fray Dylan ; Lukish, Jeffrey ; Lau, Henry ; Abdullah, Fizan ; Gauda, Estelle B ; Pryor, Howard I. / Mucous fistula refeeding decreases parenteral nutrition exposure in postsurgical premature neonates. In: Journal of Pediatric Surgery. 2016 ; Vol. 51, No. 11. pp. 1759-1765.
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abstract = "Background/Purpose Premature neonates can develop intraabdominal conditions requiring emergent bowel resection and enterostomy. Parenteral nutrition (PN) is often required, but results in cholestasis. Mucous fistula refeeding allows for functional restoration of continuity. We sought to determine the effect of refeeding on nutrition intake, PN dependence, and PN associated hepatotoxicity while evaluating the safety of this practice. Methods A retrospective review of neonates who underwent bowel resection and small bowel enterostomy with or without mucous fistula over 2 years was undertaken. Patients who underwent mucous fistula refeeding (RF) were compared to those who did not (OST). Primary outcomes included days from surgery to discontinuation of PN and goal enteral feeds, and total days on PN. Secondary outcomes were related to PN hepatotoxicity. Results Thirteen RF and eleven OST were identified. There were no significant differences among markers of critical illness (p > 0.20). In the interoperative period, RF patients reached goal enteral feeds earlier than OST patients (median 28 versus 43 days; p = 0.03) and were able to have PN discontinued earlier (median 25 versus 41 days; p = 0.04). Following anastomosis, the magnitude of effect was more pronounced, with RF patients reaching goal enteral feeds earlier than OST patients (median 7.5 versus 20 days; p ≤ 0.001) and having PN discontinued sooner (30.5 versus 48 days; p = 0.001). Conclusions RF neonates reached goal feeds and were able to be weaned from PN sooner than OST patients. A prospective multicenter trial of refeeding is needed to define the benefits and potential side effects of refeeding in a larger patient population in varied care environments.",
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AU - Gause, Colin D.

AU - Hayashi, Madoka

AU - Haney, Courtney

AU - Rhee, Daniel

AU - Karim, Omar

AU - Weir, Brian

AU - Stewart, Fray Dylan

AU - Lukish, Jeffrey

AU - Lau, Henry

AU - Abdullah, Fizan

AU - Gauda, Estelle B

AU - Pryor, Howard I.

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N2 - Background/Purpose Premature neonates can develop intraabdominal conditions requiring emergent bowel resection and enterostomy. Parenteral nutrition (PN) is often required, but results in cholestasis. Mucous fistula refeeding allows for functional restoration of continuity. We sought to determine the effect of refeeding on nutrition intake, PN dependence, and PN associated hepatotoxicity while evaluating the safety of this practice. Methods A retrospective review of neonates who underwent bowel resection and small bowel enterostomy with or without mucous fistula over 2 years was undertaken. Patients who underwent mucous fistula refeeding (RF) were compared to those who did not (OST). Primary outcomes included days from surgery to discontinuation of PN and goal enteral feeds, and total days on PN. Secondary outcomes were related to PN hepatotoxicity. Results Thirteen RF and eleven OST were identified. There were no significant differences among markers of critical illness (p > 0.20). In the interoperative period, RF patients reached goal enteral feeds earlier than OST patients (median 28 versus 43 days; p = 0.03) and were able to have PN discontinued earlier (median 25 versus 41 days; p = 0.04). Following anastomosis, the magnitude of effect was more pronounced, with RF patients reaching goal enteral feeds earlier than OST patients (median 7.5 versus 20 days; p ≤ 0.001) and having PN discontinued sooner (30.5 versus 48 days; p = 0.001). Conclusions RF neonates reached goal feeds and were able to be weaned from PN sooner than OST patients. A prospective multicenter trial of refeeding is needed to define the benefits and potential side effects of refeeding in a larger patient population in varied care environments.

AB - Background/Purpose Premature neonates can develop intraabdominal conditions requiring emergent bowel resection and enterostomy. Parenteral nutrition (PN) is often required, but results in cholestasis. Mucous fistula refeeding allows for functional restoration of continuity. We sought to determine the effect of refeeding on nutrition intake, PN dependence, and PN associated hepatotoxicity while evaluating the safety of this practice. Methods A retrospective review of neonates who underwent bowel resection and small bowel enterostomy with or without mucous fistula over 2 years was undertaken. Patients who underwent mucous fistula refeeding (RF) were compared to those who did not (OST). Primary outcomes included days from surgery to discontinuation of PN and goal enteral feeds, and total days on PN. Secondary outcomes were related to PN hepatotoxicity. Results Thirteen RF and eleven OST were identified. There were no significant differences among markers of critical illness (p > 0.20). In the interoperative period, RF patients reached goal enteral feeds earlier than OST patients (median 28 versus 43 days; p = 0.03) and were able to have PN discontinued earlier (median 25 versus 41 days; p = 0.04). Following anastomosis, the magnitude of effect was more pronounced, with RF patients reaching goal enteral feeds earlier than OST patients (median 7.5 versus 20 days; p ≤ 0.001) and having PN discontinued sooner (30.5 versus 48 days; p = 0.001). Conclusions RF neonates reached goal feeds and were able to be weaned from PN sooner than OST patients. A prospective multicenter trial of refeeding is needed to define the benefits and potential side effects of refeeding in a larger patient population in varied care environments.

KW - Associated liver disease

KW - Mucous fistula

KW - Parenteral nutrition

KW - Refeeding

KW - Short gut

KW - TPN cholestasis

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