PC1108: Feasibility, Safety, and Short-term Outcomes of Mucous Fistula Refeeding in Infants with Intestinal Failure and Stoma

Background: Infants with intestinal failure (IF) requiring stoma and mucous fistula creation are faced with unique nutritional challenges in the period prior to reanastomosis (RA). Enteral nutrition (EN) advancement reduces the risk of complications associated with parenteral nutrition (PN), such as blood stream infections and cholestasis, though this must be balanced with feed tolerance and optimal growth. It is unclear if mucous fistula refeeding (MFR) prior to RA is safe and beneficial in this population.

Methods: Infants with IF requiring stoma creation and RA admitted to Texas Children's Hospital between January 2014 and December 2020 were studied. The practice of MFR was adopted at Texas Children’s Hospital in 2018. Infants in No-MFR group (2014-2018) were compared to those who received MFR (2018-2020). Patient demographics, surgical characteristics, PN use, EN advancement, growth, and complications were compared.

Results: Of 68 patients included, 52 (76.5%) were in the No-MFR group and 16 (23.5%) were in the MFR group. Patient characteristics were similar except for the occurrence of NEC in the No-MFR group (Table1). Outcomes of patients in the MFR and No-MFR groups are compared in Table 2. In the MFR group, 8/16 (50%) infants achieved enteral autonomy (EA) prior to RA compared to 14/52 (27%) in the No-MFR group (p=0.126). Due to poor growth, PN was restarted in 5/8 (63%) infants in the MFR group who had achieved EA prior to RA. Median maximum feed volume prior to RA was 90 ml/kg/d in No-MFR group vs. 110 ml/kg/d in MFR group (p=0.331). Peak conjugated bilirubin (CB) trended lower in MFR group, but did not reach significance (4.5 vs. 2.4 mg/dL; p=0.107). PN days after RA, anthropometrics at RA and discharge, and length of hospitalization were not different between groups.

Conclusion: In this small retrospective study of infants with IF and stoma, MFR demonstrated to be feasible and safe. Infants with MFR achieved similar short-term outcomes including growth at discharge compared to infants who did not receive MFR. The MFR group had higher EA and enteral feed volumes and lower CB levels of clinical significance prior to RA. Though likely due to smaller sample size, this did not meet statistical significance. Achieving enteral autonomy prior to RA with MFR is possible but challenging due to difficulties in achieving optimal growth without PN support. MFR in infants with IF and stoma is safe with tangible benefits and warrants further study.