Our Summary

This research paper looks at the potential benefits of a treatment called mucous fistula refeeding (MFR) for infants who have had part of their intestine removed due to conditions called necrotizing enterocolitis (NEC) or small bowel atresia (SBA). The aim of MFR is to help improve the baby’s nutrition and help their intestines adapt before they are reconnected.

In the past, studies showed that MFR improved outcomes for these infants, but they did not take into account the different characteristics of the babies involved which could have influenced the results. This study took these variables into account to give a more accurate comparison of outcomes for babies with and without MFR.

The researchers found that of the 101 patients they looked at, 65 had MFR. The reasons the others did not have MFR included issues with the intestine or technical limitations. For babies with NEC who received MFR, it took 14 fewer days to start feeding them normally after their intestines were reconnected, they needed 22 fewer days of nutrition given through an IV, and they had a 77% lower chance of needing a specific medication.

For babies with SBA, the results were similar, but not statistically significant. However, these babies did show improved growth rates. Importantly, there were no complications or increased risk of infection from MFR.

In summary, this study suggests that MFR can safely improve nutritional outcomes for babies who have had part of their intestine removed, by reducing the need for IV nutrition and helping them start normal feeding earlier.

FAQs

  1. What is the purpose of mucous fistula refeeding (MFR) in infants requiring intestinal resection?
  2. How does MFR affect nutritional outcomes in infants with intestinal resection?
  3. Were there any complications or increased infections from MFR as noted in the study?

Doctor’s Tip

A helpful tip a doctor might tell a patient about bowel resection is to consider mucous fistula refeeding (MFR) of enterostomy output to improve nutrition and bowel adaptation before reanastomosis. This can lead to improved outcomes such as decreased total parenteral nutrition (TPN) dependence and earlier enteral autonomy. It is important to discuss the potential benefits of MFR with your healthcare provider to see if it is a suitable option for you.

Suitable For

Patients who may benefit from bowel resection and mucous fistula refeeding (MFR) include infants with necrotizing enterocolitis (NEC) or small bowel atresia (SBA) who require intestinal resection with enterostomy. In this study, MFR was associated with improved outcomes such as reduced days to achieve full enteral feeds, decreased dependence on parenteral nutrition, lower peak direct bilirubin levels, and decreased need for ursodiol use. Growth parameters were also improved in patients who received MFR. Overall, MFR was found to be a safe and effective strategy to improve nutritional outcomes in infants undergoing bowel resection for NEC or SBA.

Timeline

Before bowel resection:

  1. Infants diagnosed with necrotizing enterocolitis (NEC) or small bowel atresia (SBA) may require intestinal resection.
  2. Patients may undergo small bowel resection with enterostomy.
  3. Mucous fistula refeeding (MFR) may be considered as a method to improve nutrition and bowel adaptation before reanastomosis.
  4. Patients may be evaluated for suitability for MFR based on factors such as bowel stricture or technical limitations.

After bowel resection:

  1. MFR is performed in a subset of patients, with the majority receiving the intervention.
  2. Patients who received MFR had improved outcomes, including fewer days to achieve full enteral feeds after intestinal reconnection, reduced days on parenteral nutrition, lower peak direct bilirubin levels, and decreased odds of ursodiol use.
  3. Growth parameters were improved in patients who underwent MFR.
  4. There were no complications or increased infections associated with MFR.
  5. The study suggests that MFR safely improves nutritional outcomes in infants with intestinal resection, leading to decreased total parenteral nutrition (TPN) dependence and earlier enteral autonomy.

What to Ask Your Doctor

  1. What is the purpose of a bowel resection in my case?
  2. Why do some patients benefit from mucous fistula refeeding (MFR) before reanastomosis?
  3. What are the potential risks and benefits of MFR in my situation?
  4. How will MFR impact my recovery time and overall outcomes?
  5. Are there any specific criteria that make me a good candidate for MFR?
  6. What alternatives to MFR are available for me?
  7. How will MFR affect my nutritional status and bowel adaptation?
  8. Will MFR require any additional monitoring or care during my recovery?
  9. Are there any potential complications associated with MFR that I should be aware of?
  10. Can you provide me with more information on the outcomes of patients who have undergone MFR compared to those who have not?

Reference

Authors: Woods SD, McElhanon BO, Durham MM, Figueroa J, Piazza AJ. Journal: J Pediatr Gastroenterol Nutr. 2021 Nov 1;73(5):654-658. doi: 10.1097/MPG.0000000000003272. PMID: 34347677