Mucous fistula refeeding in neonates with short bowel syndrome

Background/Purpose: Neonates with enterostomies commonly suffer from a func tional short bowel syndrome (SBS) and have a greater risk of electrolyte an d fluid loss with poor weight gain. The authors describe their experience w ith refeeding stoma effluent into the mucous fistula in neonates. Methods: A 5-year (1993 to 1997) chart review of neonates with stoma efflue nt refeeding was undertaken. Demographics, medical history, surgical proced ures, timing, and duration of refeedings were reviewed. Enteral and total p arenteral nutritional (TPN) requirements, electrolyte, and acid-base distur bances were recorded. Results: Six neonates (gestational ages of 27 to 38 weeks, birth weights of 533 to 3400 g) were identified with nutritional or electrolyte complicatio ns before the commencement of refeeding. Enterostomy indications included n ecrotizing enterocolitis(n = 2), intestinal atresia type 3b (n = 1), compli cations from ruptured omphalocoele (n = 1), congenital adhesive band obstru ction (n = 1), and midgut volvulus after congenital diaphragmatic hernia re pair (n = 1). Weight gain during refeeding ranged from 5 to 25 g/kg/d with duration of refeeding lasting 16 to 169 days (two neonates were refed at ho me) until reanastomoses were done 6 to 44 weeks after the original surgery. There were no complications, and TPN requirements were diminished or elimi nated. Conclusion: This technique represents a simple and safe method, which lesse ns the need for TPN and electrolyte supplementation in neonates with entero stomies and SBS before reanastomosis. J Pediatr Surg 34:1100-1103. Copyrigh t (C) 1999 by W.B. Saunders Company.