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Mucous fistula refeeding in neonates: a systematic review and meta-analysis
  1. Gonzalo Solís-García1,2,3,4,
  2. Bonny Jasani1,4
  1. 1 Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
  2. 2 Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
  3. 3 Neonatology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  4. 4 Pediatrics, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Gonzalo Solís-García, Neonatology, The Hospital for Sick Children. University of Toronto., Toronto, M5G1X8, Ontario, Canada; gonzalo.solis{at}; Dr Bonny Jasani, Neonatology, The Hospital for Sick Children, Toronto, M5G1X8, Ontario, Canada; bonny.jasani{at}


Background and objective Mucous fistula refeeding (MFR) aims to maximise bowel function when an ostomy is active after abdominal surgery, by introducing the proximal ostomy effluent into the distal mucous fistula to maintain intestinal physiology. The aim of the study was to assess the effectiveness and complications of MFR in neonates following abdominal surgery.

Design, setting and interventions Systematic review and meta-analysis of randomised controlled trials and observational studies. PubMed, Embase, Cochrane and CINAHL were searched until June 2022 for studies including neonates with ostomy receiving MFR compared with neonates with ostomy without MFR.

Outcomes The primary outcome was duration of parenteral nutrition. Secondary outcomes were time to full enteral feeds, rates of cholestasis, peak total serum bilirubin, sepsis, time to reanastomosis and length of hospital stay.

Results A total of 16 observational studies were included (n=623). Compared with comparator group, neonates who received MFR had fewer days of parenteral nutrition (mean difference 37.17 days, 95% CI −63.91 to −10.4, n=244, 5 studies, GRADE: low). In addition, neonates who received MFR had lower rates of cholestasis, shorter time to reach full feeds and shorter hospital stay.

Conclusion Low certainty of evidence suggests that MFR is associated with shorter duration of parenteral nutrition in neonates following abdominal surgery and stoma creation. Results of ongoing and future randomised trials may help to corroborate these findings.

  • neonatology
  • intensive care units, neonatal

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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  • Contributors GS-G designed the protocol for the study, collected the data, analysed the data and wrote the initial draft of the manuscript. BJ developed the original research idea, designed the protocol for the study, collected the data and critically review and contributed significantly to the manuscript. Both authors are guarantors and accept full responsibility for the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.